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At least 145 records · Page 8Linked to original sources
PubMed1979

Herpes zoster of the larynx--how common?

Herpes zoster of the larynx is considered to be rare, but on reviewing the literature it is noted that some authors considered it to be more common than already acclaimed. Herpes may prove to be a common cause of cord palsies presently labelled as idiopathic and serological tests for herpes should be asked for. Of note is the fact that the cord palsy of a herpetic lesion can be short-lived and that earache is a common symptom. In this paper four cases of herpes laryngis are presented. It is advised that the larynx should be examined in all cases of herpes zoster of the head and neck.

Adult↗
PubMed1987

Malignant external otitis.

During the years 1972-1985, 50 patients with malignant external otitis (MEO) were seen in our department. All our patients complained of severe earache; they presented initially with an apparently simple external otitis, but failed to improve when the usual measures were adopted. They all presented with granulation tissue in the external ear canal, and five of our patients had multiple cranial nerve involvement. MEO is in effect a severe external otitis which, if untreated, proceeds towards an osteomyelitis of the skull base. MEO is more prevalent in the summer, when external otitis is rampant. In some years, a relatively large number of these patients appear; in others there are none. The reason for this is unknown. In Israel, the disease is more prevalent in Jews than in Arabs. Diabetes was present in 68 per cent of our patients-severe diabetes in 42 per cent, mild diabetes in 26 per cent but 32 per cent of our patients were diabetes-free. The only otological past history in our patients was of a recent traumatic insult to the external ear canal; this was the case in about 8 per cent of them. Today, the treatment of choice of this important disease is local debridement supplemented by appropriate antibiotic treatment for 6-8 weeks. This should include some semi-synthetic penicillin to which pseudomonas aeruginosa is sensitive, combined with an appropriate aminoglycoside. During the earlier years of our encounter with MEO, two of our 10 patients died of it; later on, when we learned better how to treat it, the mortality rate decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Basal cell carcinoma of the middle ear--a natural history.

The natural course of basal cell carcinoma of the middle ear is described. This tumour is extremely rarely found in the middle ear and only two cases have been reported to date. The appearance of the tumour was heralded by earache and deafness, followed years later by wide local destruction of the temporal and parietal bones, base of skull, facial palsy and multiple distant metastases. The patient refused both surgical and irradiation therapy and died 10 years after the initial diagnosis.

Adult↗
PubMed1993

Extracranial and intracranial complications of suppurative otitis media. Report of 102 cases.

During the eight-year period, 1983-1990, 102 cases of intracranial (IC) and extracranial (EC) complications from 17 144 suppurative otitis media were reviewed. The prevalence of each complication was 0.24 and 0.45 per cent respectively. Facial paralysis, subperiosteal abscess and labyrinthitis were the common complications among the EC group, while meningitis and brain abscess were common in the IC group. Twenty five per cent of the EC group and 44 per cent of the IC group had more than two complications. The reliable warning signs and symptoms for IC complications were fever, headache, earache, vestibular symptoms, meningeal signs and impairment of consciousness. Proteus spp., Pseudomonas aeuruginosa and Staphylococcus spp. were the commonest organisms isolated from both groups. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both patient groups. Mortality rate in the IC group was 18.6 per cent. Morbidity rate in each group was 14.3 per cent (EC) and 27.9 per cent (IC) respectively. Epidemiological presentations, clinical features and the result of treatment are discussed.

Acute Disease↗
PubMed1994

Non-explosive blast injury of the ear.

Non-explosive blast injury of the ear refers to the otological trauma caused by a blow to the ear that seals the external auditory meatus. It results in a sudden increase of air pressure within the ear canal that strikes the tympanic membrane. The present study portrays the various aspects of middle and inner ear damage in 91 patients resulting from an assault we entitled a 'non-explosive blast injury' to the ear. Sixty cases were caused by a slap or a fist, 13 patients suffered sport accidents, mostly in ball games, and 18 patients were injured during swimming and water sports activities. The common symptoms were hearing loss, earache, tinnitus, vertigo and otorrhoea. All 91 patients presented with acute perforations of their eardrums. The mean conductive hearing loss was 11.2 dB. A high tone sensorineural hearing loss was detected in only 20 per cent of the patients. A spontaneous closure of the perforation with a conservative management approach was observed in 94.8 per cent of the patients. Healing of the perforation was always associated with closure of the air-bone gap, while the results of the sensorineural hearing loss recovery were less favourable.

Adolescent↗
PubMed2002

Ear involvement in acute promyelocytic leukemia at relapse: a disease-associated 'sanctuary'?

Extramedullary (EM) involvement occurs infrequently in acute promyelocytic leukemia (APL) and usually involves skin and CNS. We describe seven patients (four observed at a single institution) who relapsed in various sites of the auditory apparatus, including the external canal and middle ear (temporal bone). Front-line treatment included ATRA and chemotherapy (six patients) or chemotherapy alone (one patient). Three patients had concomitant hematologic relapse, two had molecular relapse and two were in hematologic and molecular remission when ear localization was documented. Local symptoms that stimulated further diagnostic studies included ear bleeding/discharge in the first patient, but were mild in the others (hypoacusia, five patients; earache, two patients). Ear involvement by leukemia was documented by histological and/or molecular studies after local surgery in five cases, and by CT scan or NMR in the remaining patients. We suggest that the ear might represent a specific sanctuary for disease involvement in APL.

Adolescent↗
PubMed1996

Local anaesthesia in middle ear surgery: survey of patients and surgeons.

The use of local anaesthesia for middle ear surgery is long established and has many advantages. However, it is only performed by a small number of UK otolaryngologists (20%). This lack of enthusiasm is due to concerns that patients may not tolerate the discomfort during the operation. Therefore, a survey was conducted on patients who had middle ear operations: stapedotomy, myringoplasty, ossiculoplasty and mastoidectomy. The intense sensation of noise during the operation (29.6% of patients) and anxiety (24%) were the most common discomforts, followed by dizziness (14.8%), backache (13.9%), claustrophobia (9.3%) and earache (1.9%). In spite of these discomforts, 89% of patients still preferred local anaesthesia to general anaesthesia for a similar procedure. The author suggests that good patient selection, pre-operative explanation and the use of appropriate sedation are the important factors for local anaesthesia ear procedures to be acceptable to patients.

Anesthesia, Local↗
PubMed2004

Clinical, double-blind, placebo-controlled study investigating the combination of acetylsalicylic acid and pseudoephedrine for the symptomatic treatment of nasal congestion associated with common cold.

It was the aim of this clinical study to demonstrate the efficacy of 1000 mg acetylsalicylic acid (ASA, CAS 50-78-2) in combination with 60 mg pseudoephedrine (PSE, CAS 90-82-4), compared with placebo, in the symptomatic treatment of nasal congestion associated with the common cold. A further aim was to demonstrate the efficacy of 500 mg ASA + 30 mg PSE and of 1000 mg paracetamol (CAS 103-90-2) + 60 mg PSE (active control) in the symptomatic treatment of nasal congestion. The study was designed as a randomized, two-center, double-blind, double-dummy, placebo-controlled, parallel-group, single-dose efficacy and safety trial over 6 h and was carried out in the USA. In total, at two centers, 643 patients who had a history and diagnosis of acute upper respiratory tract infection (URTI), were included; they showed symptoms such as nasal congestion, scratchy/sore throat, headache, generalized muscle ache, earache, runny nose, fever, sneezing etc. The investigational drugs ASA and PSE were both provided as granules in sachets and the granules were dissolved in water before administration; the combined preparation of paracetamol + PSE was administered as commercially available tablets encapsulated for blinding. For all preparations, matching placebos were provided. The primary efficacy variable was the area under the curve for differences from baseline on a nasal congestion scale in the first 2 h after treatment. To be eligible for the study, otherwise healthy volunteers were to present with nasal stuffiness of recent onset that reached a score of at least 6 on the 11-point scale for nasal congestion (0 = not stuffy, 10 = very stuffy). The primary analysis of the primary efficacy variable was calculated by analysis of variance including treatment group, severity (moderate/severe) and center as main strata. The analysis was performed using the intent-to-treat population. All active treatments proved to be statistically significantly superior to placebo with regard to the primary efficacy variable. Significant superiority of active treatment compared with placebo could also be demonstrated for an interval of up to 6 h after intake of the drug and for the relief of nasal congestion. The lower dose did not reveal significant different results compared with placebo for relief of nasal congestion in patients with a severe nasal congestion score at baseline. As well in patients with moderate nasal congestion score (NCS) at start of the study the difference from baseline in the NCS compared with placebo was not statistically significant. Thus a trend towards better efficacy in the higher dose could be assumed. No difference was found between 1000 mg ASA + 60 mg PSE and the active control. There were no differences between the two centers. The treatment proved to be safe and well tolerated, without relevant differences between the four treatment groups. Main adverse events were found to be related to the upper respiratory tract infection or were of gastrointestinal nature. In conclusion, the combination of ASA with PSE can be considered as an effective and safe remedial for the symptomatic treatment of the nasal congestion during URTI.

Acetaminophen↗
PubMed2000

[Oscar Wilde. Medical observations on the 100th anniversary of his death 30 November 2000].

BACKGROUND AND BIOGRAPHICAL ANNOTATIONS: Oscar Wilde, the brilliant poet, essayist and playwright, son of the famous oculist and aurist William Wilde in Dublin, died on November 30th 1900 at the age of 46 of an otogenic cerebral abscess. By way of introduction the biographical stations are briefly outlined. In 1895 Wilde at the summit of his career was found guilty of homosexual intercourse and sentenced to two years of imprisonment and forced labour. THE CASE HISTORY: As a sequence of the circumstances in the prison and diarrhoea Wilde lost 30 lbs weight during the first months and became very weak. Although one Sunday early in October 1895 he felt very sick and begged to be allowed to stay in bed the doctor of the prison taking him for a malingerer forced him to get up and attend the service in the chapel. There he collapsed and suffered a fracture of the skull involving the right ear, and a concussion with temporary unconsciousness. Previously there had been a mild deafness of this ear, probably a bland type of chronic otitis media. After the accident there was bleeding from the ear and suppuration which lasted for many months often associated with heavy pain. After the discharge from prison in 1897 for a while the complaints were slight and Wilde travelled around France and Italy accompanied by friends. Finally he settled down in a hotel in Paris. In September 1900 heavy earache recurred and Wilde was confined to bed. Several doctors were taking care of him. At October 10th 1900 a Parisian surgeon performed an operation on Wilde's right ear, probably of the kind that had been suggested by his father William Wilde: Wilde's incision. The lethal outcome could not be averted. DISCUSSION: The case history is reported in detail based on the extant documents, analysed and put in relation to the medical knowledge and therapeutical means available around 1900. A successful treatment would not have been possible at that time, even under more favourable circumstances.

Brain Abscess↗
PubMed2004

[Herpes zoster oticus: symptom constellation and serological diagnosis].

BACKGROUND: Herpes zoster oticus is a rare illness with cutaneous symptoms (eruptions) and a colored picture of brain nerve failures. The clinical symptoms, the symptom constellation, diagnostics and therapy, however, have been examined till now only in few studies. PATIENTS AND METHODS: In this study 91 cases of a zoster oticus were looked at in retrospect from the complete archives of the university ENT clinic Jena/Germany in the period from 1932 to 2001. Inclusion criterion was the occurrence eruptions in the ear region. The demographic data, subjective and objective symptoms, the symptom constellations, diagnostic methods and the therapy were arranged. RESULTS: Women (68.1 %) were concerned more frequently than men (31.9 %). The average illness age was 51.2 days. The prodromal stage lasted for 2.2 days in the average. Earache (50.2 %) and headache (11.0 %) were the most frequent first symptoms. No prodroma appeared in 27.5 % of the cases. The facial nerve (86.8 %) was most frequently affected, the vestibular nerve in 76.9 % and the cochlear nerve in 36.3 %. Other brain nerve damages were extremly rare. The therapy success was identical with regard to the brain nerve regeneration at all times. A positive antibody titer for VZV-IgM and/or IgA or an IgG is a sign for an acute infektion. VZV-IgA antibody titers appeared more constantly, frequent and early than an IgM. CONCLUSIONS: Women have a greater risk of falling ill at a zoster oticus than men. Although more than 72 hours is behind the beginning of the symptoms in this study, treatment with virostatic drugs should always be carried out in zoster oticus. Different therapy methods do not have any influence to the success therapy of the therapy. The facial nerve showed the best cure trend. A postzosteric pain develops approximately the half of the cases at the zoster oticus. The serological diagnostic is not necessary in clinically clear cases.

Adolescent↗
PubMed1997

[Chlamydia pneumoniae infection in a family].

UNLABELLED: HISTORY AND SYMPTOMS: For 11 weeks a 38-year-old woman had suffered from a respiratory infection with peribronchitis, nocturnal coughing fits and earache. INVESTIGATIONS, TREATMENT AND COURSE: The Chlamydia-CFR titre was raised. Subsequent throat swabs of her husband and two daughters grew Chlamydia pneumoniae (C.p.), but not in her case; 5 days earlier she had been started on roxithromycin. 3 weeks before the patient fell ill her two daughters had a flu-like illness with cough and subfebrile temperature and her husband also had flu-like symptoms, which regressed after few days. Antibiotic treatment with roxithromycin improved the symptoms in the mother and older daughter, but the younger daughter was not given treatment because she had no symptoms at the time the microorganism had been isolated. She developed joint symptoms, like those of reactive arthritis, 12 weeks after the mother's illness had begun, and conjunctivitis 5 weeks later. CONCLUSIONS: It is likely that the daughters had the C.p. infection first and then infected their parents. While the father's and older daughter's illness quickly regressed, the mother became quite ill. Her serology was positive for a primary infection in adulthood, but in the daughters the serology was negative and, despite demonstration of the organism, the diagnosis of acute C.p. infection could not be made.

Adolescent↗
PubMed1991

[Unilateral sacroiliitis in multiorgan tuberculosis].

A tight but painless soft-tissue swelling in the left parasternal region, with chronic cough and lumbo-ischial pain becoming progressively more severe over several months, occurred in a 27-year-old man. The chest X-ray film was normal, radiography of the iliosacral joints revealed right-sided sacroiliitis. In the further course of the illness night sweat, nightly fever up to 38 degrees C and weight loss of 7 kg in two months, as well as severe treatment-resistant earache developed. When hospitalized, another chest X-ray film showed disseminated small nodular foci pointing to tuberculosis. Sputum and irrigation fluid from the right middle-ear contained Mycobacterium tuberculosis. Biopsy material from the parasternal tumour and middle-ear mucosa contained caseous granulomas, confirming the diagnosis of tuberculous sacroiliitis as part of multi-organ tuberculosis. Tuberculostatic treatment--400 mg isoniazid, 600 mg rifampicin, and 1,500 mg pyrazinamide daily (the latter discontinued after 8 weeks)--normalized the appearance in the chest X-ray film. The patient returned to his home in Holland and, four years later, reported that he was free of any symptoms, even during sport activity.

Adult↗
PubMed2000

Controlled multicenter study on chronic suppurative otitis media treated with topical applications of ciprofloxacin 0.2% solution in single-dose containers or combination of polymyxin B, neomycin, and hydrocortisone suspension.

Otic drops of either ciprofloxacin 0.2% solution (CIP) or a combination of polymyxin B, neomycin, and hydrocortisone suspension (PNH) were administered for 6 to 12 days to patients (14-71 years old) with chronic suppurative otitis media in a randomized, nonblinded, multicenter clinical trial. Two hundred thirty-two enrolled patients were analyzed for efficacy on a "per protocol" basis. The most frequently identified causal agents were Staphylococcus aureus (28% of the patients), Pseudomonas aeruginosa (19%), and Staphylococcus sp (9%). Clinical success was observed in 91% and 87% of the CIP-and PNH-treated patients, respectively. At 1-month follow-up, 4% of CIP and 6% of PNH patients showed a relapse of otorrhea. Bacteriologic eradication was seen in 89% and 85% of patients in the CIP and PNH groups, respectively. At 1-month follow-up, reinfection or recurrence of infection appeared in 3 patients in the PNH group and in 1 patient in the CIP group. Both treatments were well tolerated. The most frequently reported adverse events were pruritus, stinging, and earache. Audiometric tests did not show changes attributable to study drugs in any but 1 patient in the PNH group. This clinical trial shows that topical 0.2% ciprofloxacin solution in single-dose containers is effective and well tolerated in patients with chronic suppurative otitis media.

Administration, Topical↗
PubMed1999

Acute otitis media and age at onset among children in Greenland.

This survey examines the age at onset of acute otitis media (AOM) in 591 unselected Greenlandic children aged 3, 4, 5 and 8 years from the two largest towns in Greenland. The attendance rate was 86%. Parental information about episodes of AOM was cross-checked in medical records, which were available for 95% of the children. AOM was defined as episodes with earache, otorrhoea or previous treatment for AOM, with written otoscopic evidence of AOM resulting in treatment with weak analgetics or antibiotics. Recurrent AOM (rAOM) was defined as > or = 5 AOM episodes since birth. In total, 66% of the children had experienced AOM at least once. Of all children, 40% had AOM during the first year of life. Median age of the first episode was 10 months (range: 1-84 months), and there was no sex difference. Children between 7 and 12 months of age were at highest risk of AOM. Children with rAOM had their first AOM episode at a significantly younger age than children with < 5 AOM episodes (median: 7 months, range: 2-48 months). In addition, 83% of children with rAOM had their first AOM episode before 12 months of age compared with 53% of children with < 5 episodes (p < 0.0001). The relative risk of rAOM was eight times greater if the first episode of AOM occurred before six months of age compared to more than 24 months of age. Thirty-five percent of children with rAOM had chronic otitis media as well, compared to only 4% of children with < 5 AOM episodes. We conclude that early onset of AOM (before one year of age) occurs frequently in Greenlandic children compared to others, and a high proportion of these children develop rAOM.

Acute Disease↗
PubMed1975

External otitis among swimmers and nonswimmers.

Studies were undertaken between the summers of 1970 and 1974 to determine the effects of swimming on the incidence of external otitis and on the isolation of Pseudomonas aeruginosa from infected outer ears. The frequency of "earaches" reported by swimmers during a telephone survey conducted during the summer of 1971 was 2.4 times the frequency reported by nonswimmers. Furthermore, the risk of a swimmer acquiring external otitis, determined from reports of outer-ear infections received from physicians during the same period, was approximately five times as great as the risk to nonswimmers. Swimming also increased the risk of P aeruginosa involvement in otitis externa, and reported infections among swimmers tended to be more severe than infections among nonswimmers.

Environmental Exposure↗
PubMed2006

Prehospital diagnostic and therapeutic management of otogenic Streptococcus pneumoniae meningitis.

Prehospital diagnostics and therapeutic management, as well as clinical and laboratory data from 57 consecutive cases with otogenic pneumococcal meningitis (OPM) in Denmark during a 2-y period (1999-2000) were studied by review of discharge and medical records including a questionnaire sent to the general practitioners responsible for the individual patient. 12 cases were <2 y of age, whereas the remaining 45 cases were >21 y of age. Fever (in 98%) and altered consciousness (in 98%), respectively, were significantly more frequent prehospital symptoms (median duration of symptoms: 2 d (1-4)) than earache (in 71%, p < 0.0001), tympanic perforation (in 38%, p < 0.0001), and back rigidity (in 25%, p < 0.0001) in OPM. Some 82% visited a physician before admission, and an otogenic focus was diagnosed in 57%, a myringotomy was performed in 12%, and antibiotic therapy was initiated in 29% of these cases. Prehospital antibiotic therapy was more likely to be initiated in patients where the physician found an otogenic focus compared to patients where an otogenic was not found (46% vs 6%, respectively, p = 0.01). However, <10% of cases with OPM were treated for otitis media with adequate dosing of antibiotics for more than 1 d based on pharmacodynamic estimates. The clinical course was more severe in adults than in children (e.g. need for assisted ventilation (61% vs 0%, respectively, p < 0.01), development of sequelae (75% vs 8%, respectively, p < 0.01) together with higher CSF WBC and CSF protein levels (3738 vs 1361 cells/microl and 3.8 vs 1.6 g/l, respectively, p < 0.01), whereas corticosteroids were more frequently given to children than to adults (55% vs 3%, p < 0.001). Prehospital antibiotic therapy was not significantly associated with a more favourable outcome of OPM (50% vs 60%, respectively, p = 0.73). In conclusion, our results suggest that an otogenic focus is as frequent in adults as in children with pneumococcal meningitis and that an otogenic examination should be performed on patients presenting with fever and altered consciousness. Moreover, OPM seems predominantly to occur in patients receiving no or inadequate antibiotic therapy for otitis media.

Acute Disease↗
PubMed1999

Effects of indoor environmental factors on risk for acute otitis media in a subtropical area.

The objective of this study was to examine the relationship between indoor environmental factors and acute otitis media in a subtropical area. A case-control study was performed using participants from a prevalence survey that included 219 school children with acute otitis media and 219 age- and gender-matched controls. The study was confined to 4164 primary school children aged 6-12 yr attending 8 primary schools in Kaohsiung rural municipalities who participated in a prevalence study of the health effects of an indoor environment. An acute otitis media case was defined as a child with acute symptoms (presenting with earache, fever, irritability, and/or discharge from the ear) diagnosed by a physician in the previous year. Controls selected from the same school did not have chronic or acute respiratory illness or an ear-related illness during the same period. Information regarding the home environment was obtained using a structured written questionnaire, completed by the parents of the children. Of the many indoor environmental factors included in this study, only living in a home with indications of dampness (mold, flooding, home dampness) showed an association with acute otitis media. It was concluded that dampness in the home is a new public health issue in subtropical areas.

Acute Disease↗