Carbamazepine intoxication following the use of erythromycin in children.
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Adolescent↗
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Results for “Otitis Externa”
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Pseudomonas infections in children with human immunodeficiency virus infection.
Thirteen bacteremias and 25 nonbacteremic infections caused by Pseudomonas spp. occurred in 22 of 236 children with human immunodeficiency virus infection with a rate of infection of 0.098 (bacteremia, 0.030) per patient year. Four patients were neutropenic (less than 500/microliters). Central venous catheter (CVC)-related infections were most frequent (n = 20) followed by otitis externa (n = 6) and pneumonia (n = 5). Pseudomonas aeruginosa was the most common isolate and caused both CVC-related and CVC-unrelated infections, whereas other Pseudomonas spp. and Xanthomonas maltophilia were almost exclusively associated with CVC-related infections. The children who received appropriate therapy had a favorable outcome. In 7 CVC-related infections (35%) the catheter was removed. Pseudomonas spp. are of increasing importance in human immunodeficiency virus-infected children causing significant morbidity and increased hospitalization. These infections may be life-threatening if appropriate therapy is not vigorously initiated.
Adolescent↗
The use of topical ofloxacin for otic diseases in infants and children. Summary and conclusions.
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Acute Disease↗
Illness and injuries at summer camp.
Children at summer camp are at risk of injury and illness. The American Academy of Pediatrics and the American Camping Association have specific guidelines for the medical care of children in summer residential camps. This report describes the types of illnesses and injuries seen in 730 children attending camp for 2 weeks, use of the infirmary, and difference in the onset of infectious diseases compared with injuries during the camp session. During the month studied, there were 921 infirmary visits. The most common diagnoses were injuries and infectious disease. Girls and boys were equally likely to be seen in the infirmary and had the same distribution of diagnoses. Infectious disease (gastroenteritis) had a later mean day of onset during the camp session than did injuries and was increasing in frequency at the end of each session. Potential common camp medical problems (sunburn, otitis externa) were prevented by simple medical preventive care.
Adolescent↗
Hearing aids worn with tympanic membrane perforation: complications and solutions.
Hearing aids are sometimes recommended in ears with tympanic membrane perforation. Presented are six illustrative cases that represent various degrees of perforation, ear-mold styles, and wearing habits. The degrees of perforation represented include total, 50%, 20%, myringotomy tube, and modified mastoid cavity (canal up). Patients wearing earmolds with total perforation experience nearly constant irritation, infection, itching, or drainage. Rare periods of success are achieved in such cases by strict adherence to hygiene and ventilation guidelines. Lesser degrees of perforation usually experience significantly fewer problems if such guidelines are followed. Ear ventilation is found to be the primary success factor, whether achieved by periods of non-use or earmold venting. Since the potential for serious complications always exists, such fittings require patient education and regular otologic follow-up.
Aged↗
The efficacy of Burow's solution as an ear preparation for the treatment of chronic ear infections.
OBJECTIVE: To determine the efficacy of Burow's solution as an otologic preparation for the treatment of chronic ear infection. STUDY DESIGN: Two studies were included: 1) a prospective clinical study and 2) a laboratory study on antibacterial and antifungal effects. SETTING: A private otology practice and a laboratory study. PATIENTS: Fifty-eight patients with refractory otorrhea. INTERVENTION: Diagnosis by otoscopy, audiometry, and bacteriology. METHODS: Burow's solution was mixed in solutions with four organisms: methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, Candida albicans, and Aspergillus. Soon after Burow's solution was mixed in the solutions with organisms, and 5, 10, and 20 minutes thereafter, the mixtures were cultured on agars. The numbers of the bacterial or fungal colonies were counted to evaluate the effect of Burow's solution. MAIN OUTCOME MEASURES: Changes in the clinical findings of the ears, the symptom of otorrhea, and side effects were assessed. RESULTS: Thirty-five (70%) of the 50 ears assessed were "cured" and 10 (20%) ears assessed were "improved." No significant side effect was observed. Regarding the laboratory study, the four organisms disappeared within 20 minutes after Burow's solution was mixed. CONCLUSION: Burow's solution was considered to be an effective otologic preparation.
Acetates↗
Medical illnesses and injuries encountered during surfing.
Surfing is an exciting sport enjoyed in many coastal communities around the globe. Participants are prone to various conditions ranging from acute injuries to conditions borne from chronic environmental exposure. Lacerations, contusions, sprains, and fractures are the common types of acute traumatic injury. Injury from the rider's own surfboard is the prevailing mechanism of injury. Interaction with marine animals may lead to injury through envenomation. Although jellyfish stings are common, no definitive treatment strategy has been proven most effective in dealing with such stings. Exposure to jellyfish and other nematocyst-containing larvae can cause a reaction known as seabather's eruption. Stingrays and coral reefs present further hazards to the surfboard rider. Infection of wounds is often seen and should be treated with fluoroquinolones or third-generation cephalosporins to cover Vibrio species, along with Staphylococcus and Streptococcus species. Otologic sequelae of surfing include auditory exostoses, ruptured tympanic membrane, and otitis externa.
Athletic Injuries↗
Long-term assessment after implantation of the Vibrant Soundbridge device.
OBJECTIVE: To present long-term results with a semi-implantable middle ear implant, the Vibrant Soundbridge (VSB), and analyze pre- and post-operative results of audiologic tests. STUDY DESIGN: Retrospective chart review with additional patient interview and audiologic testing. SETTING: One tertiary referral center. SUBJECTS: Twenty patients who met the selection criteria of the manufacturer were evaluated at least two years after implantation. INTERVENTIONS: Monaural Implantation of the VSB in 20 patients, in two of these 20 patients implantation of the second ear in a second stage. RESULTS: Assessment of benefit and satisfaction using the standardized International Outcome Inventory for Hearing Aids, the Glasgow Benefit Inventory, and Visual Analogue Scales in all patients. Fifteen patients agreed to undergo audiologic testing at follow-up including pure-tone- and speech audiometry in silence and noise. The majority of patients (13/20) reported to be satisfied or very satisfied with the VSB. Aided speech perception was comparable between the VSB and the hearing aid preoperatively. When compared to the preoperative audiograms, residual hearing from 0.5-4 kHz was significantly worse in the operated ear with 8 dB (Wilcoxon signed rank test p < 0.001) but only 2.6 dB in the non-operated ear (Wilcoxon signed rank test, p > 0.05). Major surgical complications did not occur. Permanent alteration in taste occurred in three patients and revision surgery was necessary in another three patients. CONCLUSION: Satisfaction with the VSB was not superior to conventional hearing aids in subjective and in audiometric terms. Because of its impact on residual hearing and the requirement of implantation middle ear surgery, implantation of the VSB should be limited to patients with relevant side effects of hearing aids, e.g., severe chronic otitis externa.
Adult↗
Otorrhea--a fresh look at an old symptom.
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Anti-Infective Agents↗
Value of different methods for the characterisation of Aspergillus terreus strains.
To evaluate different methods for strain differentiation, 10 isolates of Aspergillus terreus from Germany and two epidemiologically unrelated strains were investigated. The sources of the isolates were patients with cystic fibrosis (4), immunosuppression (2), otitis externa (2), sinusitis (1) and endocarditis (1). Environmental isolates were obtained from a contaminated cell culture and from soil. The isolates did not differ in their macroscopic and microscopic morphology, in their protein patterns analysed by SDS-PAGE and in their susceptibility to amphotericin B and itraconazole. The RFLP analysis of total genomic DNA digested by EcoRI resulted in patterns that were too faint for interpretation. However, after hybridisation of the digested DNA with a short DNA probe of repetitive sequence, six different patterns were found. Based on the patterns of the randomly amplified polymorphic DNA (RAPD) with three primers, nine different genotypes were discriminate. RAPD patterns discriminated the epidemiologically unrelated reference strains (endocarditis isolate from Thailand, soil isolate from the USA) and the isolates from Germany. It is concluded that, in contrast to the phenotypic methods, the analysis of RAPD patterns is useful for strain differentiation of A. terreus.
Amphotericin B↗
Description of Enterococcus canis sp. nov. from dogs and reclassification of Enterococcus porcinus Teixeira et al. 2001 as a junior synonym of Enterococcus villorum Vancanneyt et al 2001.
Strains from anal swabs and chronic otitis externa in dogs were shown to be phylogenetically related to the Enterococcus faecium species group. They shared a number of phenotypic characteristics with these species, but they could be easily differentiated by biochemical reactions. In addition, the canine strains were unusual in their nearly complete failure to grow on sodium azide-containing enterococci-selective media and in their Voges-Proskauer reactions (usually negative). By using 16S rRNA sequencing and DNA-DNA hybridization of representative strains, as well as tDNA interspacer gene PCR and SDS-PAGE of whole-cell proteins, the group of canine strains was shown to constitute a novel enterococcal species. The name Enterococcus canis sp. nov. is proposed for this species, with LMG 12316T (= CCUG 46666T) as the type strain. Concurrently, the taxonomic situation and nomenclatural position of Enterococcus porcinus were investigated. As no phenotypic or genotypic differences were found between this species and Enterococcus villorum, the name E. porcinus is considered to be a junior synonym of E. villorum.
Animals↗
Hearing aid prescribing: is the specialist opinion necessary?
A restructuring of the service for provision of hearing aids has been proposed by the Royal National Institute for the Deaf. This is based on the assumption that very few patients referred for hearing aids have significant ear disease and it is not necessary for them to see an ENT specialist. The case notes of 200 consecutive patients referred to the Hearing Aid clinic were reviewed. In only half of these would a hearing aid have been prescribed without a specialist opinion. The remainder either did not need a hearing aid or required further investigation and surgical or medical treatment. In addition there was significant evidence of lack of expertise amongst General Practitioners in recognizing ear disorders. It is imperative that any patient requiring a hearing aid be seen by someone experienced in otology rather than be dealt with by the General Practitioner alone.
Academies and Institutes↗
A prospective study of the clinical findings, treatment and histopathology of 44 cases of pyotraumatic dermatitis.
Pyotraumatic dermatitis (hot spot) is a common clinical syndrome in dogs but there are few prospective scientific studies related to it. The aim of this study was to investigate correlations among clinical pyotraumatic dermatitis, histopathology of the lesions and possible predisposing causes. The relationship of these with breed, age, sex and location of lesion was assessed statistically. A clinical diagnosis of acute pyotraumatic dermatitis was made in 44 privately owned dogs. Males exceeded females (P = 0.0348) and lesions were more common in dogs aged 4 years or less (P < 0.0001). Lesions were most often seen on the cheek, neck and lateral thigh with a significant correlation between breed and site of lesion (P < 0.0001). In 31 cases a possible underlying cause was found or suspected. In contrast to previous studies, no otitis externa was recorded and the study was conducted in an area without endemic fleas. Fourteen breeds were represented of which Rottweiler, German shepherd dog and golden retriever were most common. There was no significant seasonal incidence and no correlation among site of lesion and cause, time of year, age or sex. Histopathologically, the dogs could be separated into four patterns by the presence or absence of eosinophils and/or folliculitis. Eosinophils have not previously been recorded in pyotraumatic dermatitis but were seen in 29 cases. Acute folliculitis was seen in 20 cases. However, no correlation was seen among age, sex, breed, underlying cause or site of lesion and histopathology. Twenty-seven cases were cultured for bacteria of which 25 grew Staphylococcus intermedius and two were negative.
Animals↗
Bilateral ear canal neoplasia in three dogs.
Bilateral ear canal infections are common in dogs. Ear canal neoplasia is usually associated with unilateral problems, and is uncommon in dogs. To the best of the author's knowledge, bilateral aural neoplasia has not been reported in dogs, and only four case reports were found in the human literature. This report presents three dogs that had bilateral tumours in their ear canals. They were presented with bilateral otitis externa. All three dogs exhibited tissue proliferation of both ear canals that did not respond to glucocorticoids. Treatment consisted of total ear canal ablation, and tissues were submitted for histopathological evaluation. Case # 1 (a 10-year-old, male cocker spaniel) was diagnosed as ceruminious gland carcinoma. Cases # 2 and 3 were diagnosed as squamous cell carcinoma. Case # 1 was diagnosed 4 years earlier as having keratinization disorder, which was causing its chronic ear problems. Case # 2 (a 5-year-old, female French bulldog) was diagnosed 4 years earlier as having atopic dermatitis, which did not respond to hyposensitization, and only partially responded to glucocorticoids therapy. Case # 3 (a 9-year-old, male German shepherd) was diagnosed by the referring veterinarian as having unilateral ear canal proliferation 2 months prior to presentation. However, otoscopic examination showed bilateral proliferation that obstructed both canals. In summary, bilateral ear canal neoplasia should be considered in cases of nonresponsive, proliferative aural pathology.
Animals↗
A clinical and microbiological study of external otitis.
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Bacteria↗
In vitro activity of climbazole, clotrimazole and silver-sulphadiazine against isolates of Malassezia pachydermatis.
Malassezia pachydermatis is a yeast-like, mainly zoophilic fungus, also known as Malassezia canis. It can be isolated in 20-50% from normal ear cerumen specimen from dogs or cats and has an even higher prevalence in non-suppurative otitis externa in animal species such as these. The genus Malassezia contains the two species M. furfur, a mainly anthropophilic fungus which physiologically occurs on human skin, and M. pachydermatis. We performed Minimal Inhibitory Concentration (MIC)-testings of 40 clinical isolates of M. pachydermatis against climbazole (CLIM), clotrimazole (CLOT) and silver-sulphadiazine (SILV). While CLOT and CLIM are broad-spectrum antimycotics of the azole-type, SILV is a sulphonamide compound with antibacterial and antimycotic properties used topically in veterinary medicine. For CLIM, the range of MICs was between < 0.06 and 1 micrograms/ml with an empirical median mean of 0.06 microgram/ml; for CLOT the range was between < 0.06 and 32 micrograms/ml (mean = 4 micrograms/ml), respectively. The MICs for SILV ranged between 0.25 and > 64 micrograms/ml (mean = 16 micrograms/ml) against all tested strains. In conclusion, the two azole-antimycotics CLIM and CLOT showed good in vitro activity against M. pachydermatis. The activity of CLIM was even higher than that of CLOT, which might be due to the better water solubility of CLIM. The activity of SILV was significantly lower.
Animals↗
Dissemination of the gene encoding exfoliative toxin of Staphylococcus intermedius among strains isolated from dogs during routine microbiological diagnostics.
Phenotypic properties and species-specific PCR tests based on the nuc gene of Staphylococcus intermedius and S. aureus, and a conserved region of 16S rDNA were used to identify 45 S. intermedius and four S. aureus isolated from samples of dogs during routine diagnostics. Four S. pseudintermedius strains used for control purposes reacted positively with the S. intermedius nuc PCR showing the close relationship between both species. Investigating the 45 S. intermedius and four S. pseudintermedius strains for the prevalence of the exfoliative toxin SIET encoding gene yielded the presence of the gene for 21 of the S. intermedius and two of the S. pseudintermedius strains. Partial sequencing of the toxin gene of a single S. intermedius strain and comparing this sequence with that obtained from GenBank revealed an almost complete identity. The presence of the exfoliative toxin gene could mainly be found among S. intermedius isolated from skin and wound infections and from otitis externa possibly indicating a role of this toxin for the clinical symptoms.
Animals↗
Total ear canal ablation combined with lateral bulla osteotomy for end-stage otitis in dogs. Results in thirty dogs.
Thirty dogs with end-stage otitis were treated by either unilateral or bilateral total ear canal ablation and lateral bulla osteotomy. Otitis was considered end stage when the horizontal ear canal was collapsed, stenotic, or occluded in conjunction with chronic infection of the external and middle ear. The dogs were evaluated clinically and radiographically for 4 to 63 months. The frequency of scratching, head shaking, aural drainage, and para-aural fistulation was significantly decreased. Abnormal ear carriage and head tilt were not changed. The results in 23 dogs were graded as excellent or improved. One dog died of intraoperative hemorrhage. Complications during the period from suture removal to follow-up included para-aural fistulation (3 dogs), facial nerve paralysis (5 dogs), and head tilt (3 dogs).
Animals↗