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PubMed1999

Otorrhoea: a management protocol for a tropical doctor.

Ear discharge is a common symptom encountered in clinical practice in the tropics. The aim of this paper is to highlight the practical management of otorrhoea from a general practitioner's perspective with special reference to the tropics and developing countries.

Algorithms↗
PubMed1981

Cefadroxil monohydrate versus erythromycin in paediatric patients.

Cefadroxil monohydrate, an oral cephalosporin with a long half-life, was compared to erythromycin estolate for efficacy in treating upper respiratory tract infections in children. The study was carried out on forty patients, twenty receiving cefadroxil and twenty receiving erythromycin. Each drug was dosed at 50 mg/kg/day and was given every 12 hours in two equally divided doses. The complete cure rate was 95% for the cefadroxil group and 80% for the erythromycin group. Two patients originally in the erythromycin test group showed no improvement either bacteriologically or clinically after 3 days of treatment. It was found that these patients harboured S. aureus which had become resistant to erythromycin during the course of therapy. Both patients were shifted to cefadroxil treatment and achieved complete cures. Two patients in the erythromycin group and one in the cefadroxil group were diagnosed as having scarlet fever. All three responded clinically, yet cultures from the two treated with erythromycin showed persistence of bacteria while the one treated with cefadroxil proved to be cured both clinically and bacteriologically.

Cefadroxil↗
PubMed2005

Evidence for ototopical glucocorticoid-induced decrease in hypothalamic-pituitary-adrenal axis response and liver function.

To clarify whether ototopical glucocorticoid treatment is associated with impaired hypothalamic-pituitary-adrenal axis (HPA) activity and altered hepatic metabolism, one commercially available dexamethasone-containing ointment was tested. At present, very little is known about the effects of ototopical glucocorticoid treatment on HPA and liver function. Ten beagle dogs received two daily therapeutic doses of dexamethasone (0.6 mg/ear) in the outer auditory canal for 21 d in a single-blind, placebo-controlled study. Resting cortisol concentrations were assessed before, during, and after treatment using an RIA system. Adrenal function and HPA feedback sensitivity were measured by a standard dose (250 microg) ACTH stimulation test. Serum biochemical and hematological parameters were measured, whether ototopical glucocorticoids affect hepatic function was studied, and blood cell counts were made. Ototopical dexamethasone treatment induced a marked suppression (to about 100%) of resting plasma cortisol concentrations below the placebo effect (P < 0.0001) within the first 11 d, and these remained reduced during the entire treatment period up to d 19. As well, an ACTH stimulation test found a markedly reduced rise in plasma cortisol concentrations (P = 0.0004). Concomitantly, significant increases in serum activities of alkaline phosphatase, gamma-glutamyl transferase, alanine transaminase, and aspartate transaminase were detected. Moreover, we found a significant reduction in differential leukocyte counts of eosinophils and lymphocytes, whereas neutrophils increased. Although cortisol levels and hematological parameters returned to baseline 7 d after treatment cessation, liver enzyme activities remained elevated. In conclusion, these findings suggest that after ototopical application, dexamethasone is sufficiently absorbed from the auditory canal to suppress HPA function as well as to alter metabolic and hemopoietic profiles. Thus, in long-term treatment of otitis externa or media, the systemic adverse suppression of HPA has to be considered in relation to stress exposure, whereas changes in serum enzyme activities may not be interpreted as hepathopathy.

Administration, Topical↗
PubMed2001

Severe audiovestibular loss following ear syringing for wax removal.

Syringing of the ear is one of the commonest procedures performed for cleaning cerumen from the external auditory canal. Common complications following syringing are pain, external auditory canal trauma and otitis externa. Hearing and vestibular loss are often mentioned as a complication in descriptions of this technique, but we have not been able to find a reported case of such an occurrence. We report one such a case.

Aged↗
PubMed2003

Microbial contamination of non-disposable instruments in otolaryngology out-patients.

Nosocomial infections are an important cause of morbidity and contaminated equipment may contribute to this. There has been little work concerning contamination of non-disposable equipment in Otolaryngology. This study investigates the efficacy of the cleaning regimen for non-disposable instruments in an Otolaryngology out-patients clinic. Instruments were swabbed before each clinic, when they had been autoclaved, then after use on patients, when they had been washed with detergent and chlorhexidine. Swabs of 86 instruments were cultured using standardized microbiological techniques. Fifteen instruments (17 per cent) were contaminated, most with coagulase negative staphylococci. Two specimens of Micrococcus luteus were cultured and one each of Pseudomonas aeruginosa, Acinetobacter lwoffii and Aureobacterium spp. Micrococcus luteus and coagulase negative staphylococci may represent skin contaminants, but Aureobacterium spp. and Acinetobacter lwoffii can be sources of nosocomial infection. Pseudomonas aeruginosa is a potentially serious pathogen and is implicated in the aetiology of otitis externa. These findings question the efficacy of the current cleaning techniques.

Cross Infection↗
PubMed2004

Clinical evaluation of the electronic nose in the diagnosis of ear, nose and throat infection: a preliminary study.

The term electronic nose describes an electronic system that is able to mimic the human sense of smell. Electronic noses have been developed over the last 10 or more years to perform a variety of identification tasks in various industries. More recently electronic noses have attracted new interest in their application in the field of medical diagnosis. The aim of this study is to explore the use of an electronic nose to identify and classify pathogens associated with ear, nose and throat (ENT) infections. In this study 90 bacterial swab samples were collected from 90 patients with ENT infections. Some of these samples were analysed immediately with a commercial electronic nose (Cyranose C320). Similar numbers of swabs were also taken from the same site of infection and were sent for microbiology culture and sensitivity. The electronic nose diagnosis was compared with the microbiology diagnosis and it was found that the electronic nose diagnosis was correct in 88.2 per cent of the cases, which is an encouraging result.

Bacterial Infections↗
PubMed2004

Sweet's syndrome affecting the external auditory canal and tympanic membrane.

We report a patient who developed left ear pain, dry cough, and fever. The external auditory canal was tender, swollen, erythematous and full of debris. Later the patient developed widespread tender and red skin nodules and pustules that subsequently coalesced to form plaques. Identical lesions developed also in the external auditory canal and the tympanic membrane of the affected ear. Skin biopsy showed dermal neutrophilia, compatible with the diagnosis of Sweet's syndrome. Rapid improvement was achieved with prednisone after the failure of antibiotics.

Adult↗
PubMed2006

Clinical and microbiological profiles of ear infections in Osogbo, Nigeria.

Despite the fact that discharging ears (DE) are one of the most common presentations to ear, nose and throat (ENT) clinics in the tropics, few reports have documented the aetiologic agents involved. The pathogenesis is therefore not fully understood and treatment remains controversial. We present in this report the microbiological characteristics of DE over a 3-year-period at the ENT clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Southwest Nigeria.

Acute Disease↗
PubMed1977

Pseudomonas mastoiditis.

Opportunistic infections of the external auditory canal or the middle ear due to Pseudomonas aeruginosa occurring in patients with low resistance to infection have a 35 percent mortality rate. Once the process extends into the pneumatized temporal bone, eradication becomes more difficult and the mortality rate increases to 72 percent because of the high incidence of involvement of cranial nerves, adjacent intracranial vessels, and meningitis. Treatment is directed towards the underlying condition, administration of systemic carbenicillin and gentamicin, topical colistin therapy, and judicious surgical debridement. Pseudomonas vaccine may be of help. Fifteen cases are presented. Nine follow the pattern of malignant external otitis and six began as a primary acute otitis media.

Adult↗
PubMed2002

Pathological and clinical aspects of the diseases caused by Malassezia species.

From veterinary point of view Malassezia pachydermatis has the greatest significance. It has been standing in the focus of interest since the early 1990s, mostly because of the frequency of otitis externa and dermatitis caused by this yeast in dogs. This is the only lipid-independent species in the genus Malassezia. It can be found in very large proportion on the skin of healthy animals, but can be isolated in much greater number from diseased dogs. It often causes illness together with other pathogens (e.g. Staphylococcus intermedius). Some breeds are predisposed. In addition to the treatment of the accidental concurrent diseases, therapy consists of systemic and/or topical antimicrobial treatment. Ketoconazole is used most frequently. Malassezia pachydermatis plays also a role in the skin disorders of other carnivores. It has little zoonotic potential, it can be dangerous to immunocompromised humans. The other Malassezia species have little veterinary importance, although M. sympodialis and M. globosa were isolated from asymptomatic animals (mostly cats) and from mixed infections.

Animals↗