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PubMed1977

Otitis externa due to Pseudomonas in swimming pool bathers.

An outbreak of otitis externa was observed to affect one third of 230 swimmers using a new swimming pool within three weeks of its opening. Pseudomonas aeruginosa was grown from the water and from all of the nine swabs taken from the infected ears of the swimmers. During the same period only six other cases of otitis externa were seen in the local general practice serving 4,000 patients. The disinfection procedures were found to be defective and after they were corrected the outbreak subsided.

Adolescent↗
PubMed1997

Treatment of chronic otitis externa by KTP/532 laser.

The traditional meatoplasty operations performed for chronic otitis externa, which has entered the 'fibrotic' phase, are often unsatisfactory because the results in terms of canal patency, hearing gain and patient satisfaction are variable. Although the use of laser in chronic ear surgery is well recognized, it has not been previously reported as a meatoplasty technique. Ten KTP laser meatoplasty operations were performed on eight patients with chronic otitis externa. This pilot study shows the technique to be effective, fast and with a high patient satisfaction rate in the short-term (mean follow-up period 9.3 months). The average increase in hearing thresholds was 24 dB HL. Significant patient benefit was obtained in at least six out of eight patients using the Belfast rule of thumb. The technique has many advantages over the traditional meatoplasty operations but the long-term results require evaluation.

Adult↗
PubMed1991

Microbial aetiology of otitis externa.

Microbiological samples were collected from the ears of patients with otitis externa for a period of 1 year. Altogether, 226 evaluable samples from 104 males and 122 females were received. The age range of the patients was similar to that of the Norwegian population. A wide variety of bacteria and fungi was isolated. The commonest isolates, excluding normal flora, were Staphylococcus aureus (34.1%), Pseudomonas aeruginosa (22.1%) and Streptococcus pyogenes (8.8%); 9.3% samples contained fungi. Of all samples, 15% showed a mixture of Gram-positive and Gram-negative, potentially pathogenic, bacteria. Infection due to Gram-negative organisms alone was commoner in males, while the lack of any obvious microbial aetiology was more frequent in females. Isolation of S. aureus together with S. pyogenes was common but that of S. aureus together with S. pyogenes was common but that of S. aureus together with P. aeruginosa was unusual. In treated patients, the finding of streptococci and S. aureus was rare whereas that of P. aeruginosa or absence of growth was common. Otitis externa involving Gram-positive bacteria seems to be more prevalent in our area than in that of other reported studies.

Adolescent↗
PubMed2006

Systematic review of topical antimicrobial therapy for acute otitis externa.

OBJECTIVE: To determine the efficacy of topical antimicrobials for acute otitis externa. STUDY DESIGN: Systematic review and random effects meta-analysis of randomized, controlled trials with parallel groups permitting one or more of the following comparisons: antimicrobial vs placebo, antiseptic vs antimicrobial, quinolone antibiotic vs nonquinolone antibiotic, steroid-antimicrobial vs antimicrobial, or antimicrobial-steroid vs steroid. RESULTS: Twenty trials met inclusion criteria and 18 had data suitable for pooling. Topical antimicrobials increased absolute clinical cure rates over placebo by 46% (95% confidence interval [CI], 29% to 63%) and bacteriologic cure rates by 61% (95% CI, 46% to 76%). No significant differences were noted in clinical cure rates for other comparisons, except that steroid alone increased cure rates by 20% compared with steroid plus antibiotic (95% CI, 3% to 38%). Quinolone drops increased bacteriologic cure rates by 8% compared with nonquinolone antibiotics (95% CI, 1% to 16%), but had statistically equivalent rates of clinical cure and adverse events. CONCLUSION: Topical antimicrobial is highly effective for acute otitis externa with clinical cure rates of 65% to 80% within 10 days of therapy. Minor differences were noted in comparative efficacy, but broad confidence limits containing small effect sizes make these of questionable clinical significance. SIGNIFICANCE: Summary estimates from the 13 meta-analyses can be used to facilitate evidence-based management recommendations and clinical practice guideline development.

Acute Disease↗
PubMedDate not supplied

Comparison of microbial isolates and susceptibility patterns from the external ear canal of dogs with otitis externa.

Otic exudate was obtained from 33 dogs with otitis externa for cytopathology and culture. Two samples were taken from the same location in the external ear canal, for a total of 100 samples. Thirty-six (36%) samples isolated only a single organism, of which 21 (21%) were Malassezia spp. Two organisms were present in 23 (23%) of the samples. Cultures of the two samples agreed in 40 (80%) of the 50 pairs. Cytopathology agreed with culture results only 68% of the time. Cytopathology and culture may not be as definitive as previously assumed because of apparent variability of the microbial population within the external canal.

Animals↗
PubMed1998

Susceptibility of bacterial isolates from chronic canine otitis externa to twenty antibiotics.

In this paper we present the results of studies on the susceptibility to antibiotics of bacteria isolated from chronic canine otitis externa. We tested 46 bacterial strains (S. aureus, coagulase-negative staphylococci, Corynebacterium spp., and gram-negative bacilli) with 20 different antibiotics. We observed increased resistance to antibiotics of bacteria isolated from canine otitis externa as compared to the resistance reported earlier. This may be due to the indiscriminate use of some antibiotics in the last years and indicates the importance of sensitivity testing for the effective treatment of chronic otitis externa, especially that caused by gram-negative bacilli. The clinician may initiate empiric treatment with antibiotics before obtaining the sensitivity test results; the best results may be expected from a topical application of Bacitracin or Chloramphenicol, and from a systemic therapy with Cephalosporines. Therapeutical scheme for treating various bacterial groups are presented in the paper.

Animals↗
PubMed1959

Otitis externa.

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Humans↗
PubMedDate not supplied

[Otitis externa].

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Humans↗
PubMed1988

Otitis externa. A disease of multifactorial etiology.

Dogs and cats with long-standing otitis externa pose a difficult diagnostic challenge for the veterinarian, because chronically affected ears usually have the same appearance regardless of the underlying cause(s). In patients with chronic otitis externa, the disease is often caused by different combinations of primary, predisposing, and perpetuating factors. The unique therapeutic needs of each patient may be determined by careful interpretation of historical and physical findings, which should be supported by ancillary diagnostic tests.

Animals↗
PubMed2005

Effects of beta-thujaplicin on anti-Malassezia pachydermatis remedy for canine otitis externa.

The antifungal activity of beta-thujaplicin was evaluated against 51 Malassezia pachydermatis strains isolated from canine ear canals with or without otitis externa. For comparison, sensitivity tests were performed on M. pachydermatis isolates for nystatin, ketoconazole, and terbinafine HCl, all clinically available antifungal agents. The minimal inhibition concentrations over 50% of the tested isolates (MIC50) were 3.13 microg/ml for beta-thujaplicin and nystatin, 0.016 microg/ml for ketoconazole, and 1.56 microg/ml for terbinafine HCl. The antifungal effect for M. pachydermatis of beta-thujaplicin compared favorably with commercial antifungal agents. None of the 51 M. pachydermatis isolates showed resistance against any of the tested antibiotics investigated in this study. Ten representative isolates of M. pachydermatis were subcultured for 30 generations at concentrations close to the MIC levels of beta-thujaplicin, nystatin, ketoconazole, and terbinafine HCl, and examined to determine whether they had acquired resistance to each drug. As a result, M. pachydermatis was found to achieve resistance more easily for ketoconazole and terbinafine HCl than for beta-thujaplicin or nystatin. The MIC50 of beta-thujaplicin did not change during the course of subculture, and it is thought that the potential development of a resistant strain is low, even with continuous infusion for otitis externa therapy. beta-Thujaplicin is an inexpensive and safe treatment with anti-inflammatory and deodorant effects that can be recommended as an effective remedy for canine otitis externa.

Animals↗
PubMed2005

Malignant (invasive) otitis externa involving the temporomandibular joint.

Malignant (invasive) otitis externa (MOE) is an infection involving the external auditory meatus (EAM), most often found in elderly diabetics, which carries a high morbidity and mortality. In advanced cases it may give rise to osteomyelitis and cranial neuropathies. This is a case ofMOE, which invaded the posterior wall of the right temporomandibular joint (TMJ), resulting in severe trismus and pain. Subsequently, this required treatment by replacement of the glenoid fossa with a Silastic prosthesis.

Arthroplasty, Replacement↗
PubMed1978

Malignant otitis externa.

A case is described of malignant otitis externa which was cured by a regime of general and local treatment, including the use of the antibiotic Tobramycin and timely mastoid surgery. The origins, progression, diagnosis and treatment of the disease are discussed with reference to some of the increasingly numerous reports in the literature. Reports disclose an increasing incidence and also an improved prognosis. The former is probably related to the survival of more elderly diabetics and the latter to a better understanding of the disease process and to early medical and, if necessary, surgical treatment. An important feature regarding treatment has been the advent of powerful specific antibiotics including Tobramycin.

Diabetes Complications↗
PubMed2006

Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa.

For fifteen years oral ciprofloxacin has been the standard treatment for malignant otitis externa, a sometimes fatal osteomyelitis of the skull base usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is developing. Over a 16-month period, we saw five cases where malignant otitis externa progressed, with the development of cranial nerve palsies in four cases, despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became necessary. One case was managed largely as an out-patient, but four patients spent many weeks in hospital. Only two cases had diabetes and this was monitored and controlled. Pseudomonas aeruginosa was isolated in four of the five cases, but antibiotic sensitivity to ciprofloxacin was not determined. In one case a later isolate was tested and found to be ciprofloxacin resistant. Progress was monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis and assessing response to treatment we considered serial magnetic resonance imaging or computed tomography more useful than isotope bone scan. There must be a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no longer be assumed. Bacterial isolates must be tested for sensitivity to antibiotics including ciprofloxacin, and further biopsy and culture are essential if treatment fails.

Aged↗
PubMedDate not supplied

Treatment of chronic otitis externa with Trichophyton, Oidiomycetes, Epidermophyton antigen.

Chronic otitis externa may be a sensitivity (dermatophytid) reaction from a distant pathogenic superficial fungal infection, eg, tinea pedis and monilial vaginitis, which are often difficult to eradicate. Skin testing is done with a combined antigenic extract of TOE (Trichophyton; Oidiomycetes, ie, Monilia or Candida albicans; and Epidermophyton). The serial dilution titration method of skin testing is done, and the end point of reaction is determined. Treatment is begun on a weekly basis, with subcutaneous administration of 0.3 cc of a TOE extract two dilutions weaker than the end point. Symptomatic improvement is usually noted within two to four weeks, with objective improvement within eight weeks. After a variable maintenance period, the injections are spaced at less frequent intervals.

Antigens, Fungal↗
PubMed2006

Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis.

Malignant otitis externa (MOE) is a severe infection of external auditory canal and skull base. A 17-year-old diabetic girl was admitted with diabetic ketoacidosis. Cellulitis of her right ear occurred on the second day of hospitalization and a black necrotic scar in the same region appeared on the next day. The lesion rapidly invaded to right side of neck and surrounding tissue of the patient. Therefore, antimycotic therapy was started. Unfortunately the patient died on seventh day of hospitalization because of probably extensive fungal invasion. Physicians should suspect MOE connected to mucormycosis especially in patients with cutaneous lesions of ear unresponsive to antibiotic therapy.

Absidia↗
PubMed2002

[Chronic stenosed otitis externa: a report of 14 cases].

OBJECTIVE: To evaluate the clinical features of chronic stenosed otitis externa (CSOE) and its treatment. METHODS: Fourteen patients with CSOE from 1992 to 2000 were analyzed retrospectively. RESULTS: In etiologic study, otitis externa and eczema were found in nine cases, chronic suppurative otitis media in three, acetic acid burn in one, and no apparent precipitating causes in one. Ten cases were cured through single operation, 3 experienced 2 operations and one had had 3 operations. The restenosis of external auditory canal occurred in four ears. CONCLUSIONS: CSOE is a rare disease. Surgical treatment is the main effective method for CSOE. The important items for treatment are: removing all stenotic fibrous tissue, widening bony canal, covering all bare bone with skin, preventing wound infection and close postoperative follow-up.

Adolescent↗
PubMed2000

Non-pseudomonal malignant otitis externa and jugular foramen syndrome secondary to cyclosporin-induced hypertrichosis in a diabetic renal transplant patient.

We present the case of a 58-year-old diabetic renal transplant patient who developed a left jugular foramen syndrome, secondary to an ipsilateral staphylococcal malignant (necrotizing) otitis externa. This followed a protracted episode of uncomplicated otitis externa with no evidence of bone involvement on computed tomography (CT) scanning. Cyclosporin-induced hypertrichosis (excess hair growth) in his external auditory canal contributed greatly to the initial difficulty in managing his otitis externa. Following an initial successful treatment with prolonged intravenous antibiotics the patient relapsed with a secondary infection in the same anatomical site due to Candida parapsilosis. Despite further intensive treatment including antimicrobials, a subtotal petrosectomy and hyperbaric oxygen therapy he eventually succumbed to his disease.

Candidiasis↗