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PubMed2002

Prevalence of ectoparasites in a population of feral cats from north central Florida during the summer.

Ectoparasites are a common and important cause of skin disorders in cats. Ectoparasites are capable of disease transmission and can cause life-threatening anemia in young or debilitated animals. The objective of this study was to determine the potential feline ectoparasites in domestic cats by using a cohort of feral cats from north central Florida that have not received veterinary care and have no known exposure to insecticide application. A total of 200 feral cats were randomly selected for this study. Four monthly sessions were scheduled for feral cat ectoparasite examination and sample collection. Five minutes flea combing revealed that 185/200 (92.5%) of the cats were infested with fleas. The cat flea, Ctenocephalides felis was the most common flea infesting 92.5% feral cats (mean = 13.6; standard deviation +/- 16.4 fleas per cat). Pulex simulans was identified on 9/200 (4.5%) (mean = 1 +/- 0.50 fleas per cat). Echidnophaga gallinacea was found on 11/200 (5.5%) of cats (mean = 14.8 +/- 9.63 fleas per cat). There was a significant difference (P = 0.0005) in the average number of C. felis counted per cat between months. Mean counts in June (18.3 +/- 2.4) and July (16.6 +/- 2.1) were significantly (P < 0.01) higher than in August (8.4 +/- 2.5) and September (7.7 +/- 2.0). Only 15/200 cats had skin disease. Flea infestation may potentially be the underlying cause in 10/15. Otoscopic examination of both ears revealed mite movement and black ceruminous exudate typically indicative of the presence of Otodectes cynotis in 45/200 (22.5%) cats. Examination of a swab specimen from both ear canals of all cats revealed O. cynotis in 74/200 (37%) cats. Of 74 cats positive on ear swab, 8 (10.8%) showed a normal ear canal appearance (no or mild ceruminous exudate) in both ears upon otoscopic examination. A total of nine ticks were recovered from five cats. The number and species of ticks recovered were: one adult female Rhipicephalus sanguineus; one adult female Amblyomma americanum; one adult male A. americanum; five adult female Dermacentor variabilis; and one adult female Ixodes scapularis. All superficial skin scrapes were negative. Hair clippings from the abdomen of all cats revealed 2/200 (1%) of the cats were infested with Felicola subrostratus.

Animals↗
PubMed1985

Long term follow-up of secretory otitis media in children: the effects of adenotonsillectomy with insertion of a ventilation tube.

The long term effects of adenotonsillectomy and ventilation tube were studied in 78 children with serous otitis media. Duration of postoperative follow-up range from 2 to 8 years, with an average of 4.5 years. Repeated preoperative and postoperative pure tone audiometry as well as otoscopic examinations under a microscope were undertaken routinely for the assessment of the progress or improvement of the disorder. Three months after the operation, an average improvement of the hearing thresholds was 16.3 dB. However, it was 20.3 dB in the final examination. Under the otoscopic examinations, 35% of the ears were noted to have various kinds of pathological changes. Tympanic atelectasis of Grade I and II (Sadé) was noted in 17% of all the ears. Retraction pocket of the pars flaccida was found in 2%, permanent perforation in 4% and cholesteatoma in 2% of these ears.

Adenoidectomy↗
PubMed1988

Medical management of active chronic otitis media: a controlled study.

About 2 per cent of adults have active chronic otitis media, the majority being managed by medical means. Previous controlled studies have been unable to show benefit from any medication, including systemic or topical antibiotics, but the effect of the addition of topical steroids to the latter has never been evaluated. One hundred and sixty three adults with active chronic otitis media were randomly allocated to receive either antibiotic/steroid ear drops or placebo therapy over a 4-6 week period. Fifty-two per cent of ears receiving active therapy, as opposed to 30 per cent on placebo therapy (p less than 0.05), became otoscopically inactive if compliance to medication was greater than 70 per cent. However, when there was an open mastoid cavity, active therapy was no more successful than placebo. Though gentamicin was the antibiotic used, there was no evidence of ototoxic inner ear damage. Surprisingly, correlation between clinical activity and patient report of a discharge was poor. Forty per cent of both treatment groups considered that their ear had become dry following therapy and these were not the same patients whose ears had become otoscopically inactive.

Administration, Oral↗
PubMed1995

Clinical photographs as teaching aids: how reliable are they?

A study to investigate the value and reliability of clinical photographs as teaching aids was undertaken. Twenty colour photographs were taken using the StarMed video-otoscopic system. The pictures, which were a mixture of normal and abnormal ears, were shown to 21 experienced otolaryngologists from the UK and Canada. These clinicians were asked to identify the abnormality if any. The median score for correctly identified pictures was 15 (range 12-18). This score was identical for both the UK and Canadian subgroups. Although the abnormalities were consistently well recognized with an average correct identification rate of 90 per cent (range 67-100 per cent), the 'normals' were recognized significantly less well at only 41 per cent (range 5-71 per cent) (chi-squared = 110.6; 1 df; p < 0.001). This result is probably due to failure of the camera to capture the huge variation and subtleties in the range of normal, and the clinicians' natural inclination to identify pathology, when in doubt. We would conclude that as long as this failing is recognized, clinical photographs, and specifically those from the video-otoscope, represent a useful and reliable teaching tool.

Audiovisual Aids↗
PubMed2004

Effect of accurate diagnostic criteria on incidence of acute otitis media in otitis-prone children.

Over 70% of children currently suffer from acute otitis media (AOM) before their second birthday, and incidence is increasing rapidly. Recent studies have raised concern about inadequate use of diagnostic equipment and insufficient training in diagnoses. We recruited 309 children with a history of recurrent otitis media who were followed for 6 months during 1 infectious season. A study physician examined and treated any child whose parents suspected AOM. Pneumatic otoscope and tympanometry were used. Number of AOM diagnoses during the study was compared with AOM diagnoses during the preceding 6-month period. AOM diagnoses decreased 56%, and nearly 80% of children had fewer episodes of AOM discovered than during the preceding 6 months. AOM is frequently over-diagnosed. Use of proper diagnostic criteria, the pneumatic otoscope, and tympanometry can help correct diagnosis, and thereby reduce incidence of AOM.

Acute Disease↗
PubMed1991

Otitis media in adult trauma patients: incidence and clinical significance.

To determine the incidence and clinical significance of otitis media in traumatized adults requiring intubation, 67 adult trauma patients admitted to a level-I trauma center over a 6-month period who required three or more days of intubation were examined otoscopically for the presence of otitis media. Eleven of these intubated brain-injured patients had otitis and upon examination all were found to have purulent paranasal sinusitis as well. In conclusion, all intubated patients with severe head injuries should be evaluated otoscopically for the presence of otitis and those patients with otitis should be examined for the presence of sinusitis.

Acute Disease↗
PubMed1982

Pneumatic otoscopy in infants and children.

The pneumatic otoscope is indispensable in evaluating pressure within the middle ear of infants and children by measuring the tympanic membrane mobility. If the eardrum moves normally in response to positive and negative pressure, then a significant ear effusion, suppurative or nonsuppurative, is highly unlikely. Tympanic membrane color, luster, translucence, and light reflex should therefore be correlated with mobility before any decisions regarding therapy are made. In addition, the pneumatic otoscope with a veterinary otic speculum appears to be a simple and safe way to evaluate the vagina and rectum of infants and young children.

Child↗
PubMed2006

Dehiscent high jugular bulb: a pitfall in middle ear surgery.

OBJECTIVE: The aim of this study was to present our experience on facing the dehiscent high jugular bulb (HJB) during middle ear surgery in the past 2 decades. STUDY DESIGN: Retrospective review. SETTING: Secondary referral hospital. PATIENTS: From January 1982 to June 2002, consecutive 1,657 patients underwent surgical intervention for middle ear cleft diseases, a total of 1,857 operations. Of them, 10 ears (0.5%) in nine patients were proven to have dehiscent HJB during operation for adhesive otitis media in four ears and for chronic otitis media with cholesteatoma in six ears. MAIN OUTCOME MEASURES: Each patient underwent otoscopic examination, radiographic examination, and audiometry before and 6 months after operation. RESULTS: Otoscopic examination revealed atrophic changes in the pars tensa with adhering to the promontory in two ears, attic retraction in one ear, and both findings in seven ears. All lesions were located beneath the basal turn of the cochlea and the round window niche at anteroinferior and/or posteroinferior quadrants. Active bleeding was encountered in two ears (20%) while elevating the tympanomeatal flap, which was treated by pressure compression associated with gelfoam sheet, then covered with an autologous cartilage to protect the dehiscent bulb. For the remaining eight ears, the bulbs were reinforced with fascia, perichondrium, or autologous cartilage. All 10 ears were allowed completion of the planned surgery without complications. CONCLUSION: HJB is not a contraindication for middle ear surgery. Awareness of this pitfall may lessen the operation risk.

Adult↗
PubMed1976

Acoustic impedance measurement in the otological assessment of multiply handicapped children.

This survey investigated the use of acoustic impedance measurement on a population of multiply handicapped children and correlated the results with otoscopy. Thirty-one children were tested with an impedance meter studying tympanometry, tympanic membrane compliance, and acoustic reflex. Otoscopic examination was also scheduled for each child. The results show that 42% of children tested had some kind of middle-ear problem, mostly unrecognized at the time of this survey. There was 100% agreement between impedance and otoscopic findings. Apparently impedance audiometry can be useful for identifying middle-ear disorders in children who cannot be tested by traditional audiometric methods.

Acoustic Impedance Tests↗
PubMed1993

A model to refine the selection of children with otitis media with effusion for adenoidectomy.

The selection of children with otitis media with effusion for adenoidectomy has been criticized on a number of grounds. In spite of the widespread popularity of the procedure there are few objective guidelines to help the otolaryngologist make a decision which is therefore usually subjective. We present a scientifically derived model using a Generalized Linear Interactive Modelling (GLIM) technique from a population of 122 children who underwent either adenoidectomy or no pharyngeal surgery. The outcome parameter studied was otoscopic clearance in an unoperated ear 1 year after treatment. This was related principally to the operation type (P < 0.001) and to the age at which the operation was performed (P < 0.005). Using a probability of clearance threshold of 50% the model was tested on a prospective population of 166 children and outcome was correctly predicted in over 72%. This model enables the surgeon to determine the probability of clearance of effusion following adenoidectomy in an individual child. At a probability threshold of 50% adenoidectomy would be offered to children with bilateral otitis media with effusion aged between 4.33 and 8.00 years. Over the age of 8 years the probability of clearance occurring spontaneously increases beyond 50%. By careful selection of the probability of clearance thresholds it was possible to produce otoscopic resolution in over 80% of those selected to undergo adenoidectomy. The model also enables the otolaryngologist to determine the proportion of children with established disease that require adenoidectomy at his own chosen probability thresholds which will ensure that a more effective resource allocation is achieved.

Adenoidectomy↗
PubMed1996

Examining the ear: clinical teaching.

Although otolaryngology represents up to 20% of the workload of general practitioners, the time allocated in the undergraduate medical curriculum to clinical teaching of ENT disorders is disproportionately small. Many GPs have indicated a desire for further training in ENT, particularly in small groups. This study was carried out on a group of 27 GPs who wished to revise their diagnostic skills in otoscopy by attending a 2-hour teaching session on basic examination of the ear and the recognition and management of common otological conditions. The GPs skill in otoscopy before and after the course was assessed subjectively by means of a self-administered questionnaire and scored objectively by ENT surgeons. Aspects of otoscopy chosen for assessment were technique of examination of the external ear, choosing correct speculum size, techniques of holding the otoscope and pinna, tympanic membrane description and diagnostic ability. An improvement between the objective pre- and post-workshop scores was found for assessment of the external ear, choice of speculum size, description of the tympanic membrane and diagnostic ability. No significant differences in the pre- and post-workshop scores was found for the techniques of holding the otoscope or holding the pinna. The majority of the GPs found the workshop beneficial. Postgraduate teaching of specialist diagnostic skills such as otoscopy to GPs is useful. An improvement in such skills should enable the GPs to manage ENT problems more confidently and refer patients appropriately to the ENT outpatients.

Clinical Competence↗
PubMed2007

Use of selamectin for the treatment of psoroptic and sarcoptic mite infestation in rabbits.

Selamectin, a novel avermectin compound, was evaluated for its efficacy against naturally occurring infestations of Psoroptes cuniculi and Sarcoptes scabiei. A total of 42 New Zealand rabbits with psoroptic mange and 37 Angora rabbits with sarcoptic mange were used in the present study. On day 0, infested rabbits were treated topically with either selamectin at minimum dose of 6 mg kg(-1) (6-18 mg kg(-1) for New Zealand rabbits, n = 31 and 10-12 mg kg(-1) for Angora rabbits, n = 23) or vehicle only (control groups, n = 11 for New Zealand rabbits, n = 14 for Angora rabbits). The efficacy of selamectin was assessed both clinically and parasitologically by the presence or absence of viable mites. Rabbits were scraped for sarcoptic mites on days 7, 14, 28, 42 and 56 and had otoscopeic and/or microscopic examination for the detection of Psoroptes mites on days 7, 14, 42 and 56. Fisher's exact test was used to assess differences between the vehicle and selamectin treatment in the number of rabbits without mites (cure rates) on each assessment date. It was found that significantly fewer selamectin-treated rabbits had mites detected on skin scrapings (for S. scabiei) or otoscopeic and/or microscopic examination (for P. cuniculi) (P < 0.01) than the vehicle group. Results of the present study suggest that selamectin is effective against naturally infestations of P. cuniculi and S. scabiei in rabbits.

Administration, Cutaneous↗
PubMed1982

Acute otalgia in children - findings and diagnosis.

One hundred and seventy-one children up to 15 years of age and with acute otalgia were examined to find out whether otalgia or any other symptoms were so closely related to acute otitis media (AOM) as to make otoscopic examination unnecessary. AOM was diagnosed in 46%, simplex otitis in 15%, serous otitis media (SOM) in 17%, and normal eardrums in 22%. Children with AOM had fever and spontaneous perforation of the eardrums in 78% and 30% of the cases, respectively. Of the children who had not AOM (54%), the otalgia could in most cases be classified as referred pain due to, for instance, discomfort when swallowing, nasal obstruction or throat pain. Other reasons were general irritability due to fever, teething or moderate hearing loss. The difficulties in diagnosing AOM simply on the basis of symptoms were demonstrated in the investigation. Symptoms such as otalgia, otorrhea, fever or upper respiratory tract infection (URI), possibly except for the combination of otorrhea and fever, can occur without AOM. A correct otoscopic examination and evaluation of the eardrums is necessary in children with otalgia, other symptoms of URI or in doubtful cases of acute illness. Physicians without possibilities to evaluate the eardrums properly should thus refer the patient to an otologist without delay.

Acute Disease↗
PubMed2006

Total serum IgE and IgE antibodies specific to house dust mite found in two aged-matched cohorts of children with and without otitis media with effusion.

OBJECTIVES: To determine whether otitis media with effusion (OME) is associated with elevated serum immunoglobulin E (IgE) and IgE specific for house dust mite. DESIGN: Forty-seven children who had evidence of bilateral OME, both otoscopically and on tympanometry, on two separate occasions, 3 months apart were admitted for ventilation tubes. Forty-eight children admitted for minor eye surgery who had otoscopically normal ears and no history of middle ear problems were used as controls. Bloods samples were taken under anaesthesia. Total IgE and IgE radioallergosorbent test (RAST) to house dust mite was measured by the Pharmacia Unicap 100 system. The results from the two groups were compared. SETTING: Birmingham Children's Hospital. PARTICIPANTS: Children between the ages of 3 and 10. Children with Down's syndrome, cleft lip and palate, ciliary abnormalities, known immunodeficiencies and cardiac abnormalities were excluded. MAIN OUTCOME MEASURES: Total IgE and RAST to house dust mite. A RAST of >0.35 was taken to be positive. RESULTS: There was no statistical difference between the control and study groups for the total IgE. Six children from both study and control groups had a raised house dust mite RAST. There was no difference in the levels between either group. CONCLUSIONS: Our findings indicate that there is no direct relationship between OME and biochemical evidence of allergy, specifically to house dust mite.

Allergens↗
PubMed1977

Deafness after bacterial meningitis.

Seventeen children with previous bacterial meningitis and 17 sib controls were examined clinically and otoscopically. They were also tested with air-conduction and bone-conduction audiometry and evaluated by tympanometry. There were no major neurological abnormalities and few otoscopical signs of ear disease. 21% of the ears showed abnormalities on air-conduction audiometry but all were normal on bone-conduction audiometry. 30% had abnormal middle-ear pressures (more negative than 100 mm water) on tympanometry and 7% had abnormal compliance of the drum. There were no significant differences on any test between the postmeningitis children and the sib controls. Population studies have confirmed that minor hearing loss due to middle-ear dysfunction is common in children, but is probably temporary in most of them. We have found no excess of middle-ear dysfunction and no sensorineural deafness in these postmeningitis children, but other workers have shown that nerve deafness may occur in association with clinical neurological damage. However, much of the deafness attributed to bacterial meningitis in other studies may well reflect population variability.

Child↗
PubMed1993

Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets).

OBJECTIVE: To measure the time to spontaneous resolution of severe chronic otitis media with effusion (glue ear) in children and study the effects of adenoidectomy, adenotonsillectomy, and ventilation tubes (grommets). DESIGN: Randomised controlled study over 12 years. SETTING: Paediatric otorhinolaryngology clinics and in-patient unit. SUBJECTS: 228 children aged 2-9 years with pronounced hearing loss from glue ear and persistent bilateral middle ear effusions confirmed on three occasions over three months. INTERVENTIONS: Children were randomly allocated to adenotonsillectomy, adenoidectomy, or neither procedure. In all groups a Shepard type ventilation tube was inserted in one randomly chosen ear. Follow up was annually for five years and then less often for up to seven years four months. For analysis the two operated groups were combined. MAIN OUTCOME MEASURES: Otoscopic clearance of fluid, change in tympanogram, and improvement in mean audiometric hearing threshold. RESULTS: Survival analysis showed appreciable otoscopic and tympanometric resolution of fluid with ventilation tubes alone and adenoidectomy alone compared with no surgery. Further improvement was seen after combination of both treatments. Mean audiometric hearing thresholds improved with fluid resolution. Resolution was delayed in younger children and in those whose parents smoked, irrespective of treatment. Whereas a single insertion of a Shepard tube resolved the glue for a mean (SD) period of 9.5 (5.2) months, the effect of adenoidectomy was sustained throughout follow up. CONCLUSIONS: Treatment of glue ear considerably shortened the time to fluid resolution, combined adenoidectomy and tube insertion being better than either procedure alone. Resolution was longer in younger children and those whose parent(s) smoked, irrespective of treatment.

Adenoidectomy↗
PubMedDate not supplied

Otoscopy and photography: a new method.

A new hand-held otoscope photographic system, convenient and suitable for clinical application, is introduced. This instrument allows clear otoscopic examination in stenotic or tortuous ear canals, and photographs the subject in one procedure. The instrument consists of a rod-lens optical system, a fiberoptic light source, a camera, and exchangeable speculum and a strobe light. Color photographs of tympanic membranes and middle ear pathology are presented.

Ear Canal↗
PubMed1992

Is undergraduate otoscopy teaching adequate?--An audit of clinical teaching.

Otoscopy is an important skill for the general practitioner, yet skill in the technique is rarely assessed formally at undergraduate level. This study aimed to assess the effect of teaching on the acquisition of otoscopic skill. Thirty-five medical students were assessed prospectively during their ENT attachments. Seventeen students were randomized to the standard course and 18 attended an additional seminar on otoscopy. Students' confidence was assessed for various aspects of otoscopy using a visual analogue scale, and clinical skill was assessed in examining four patients. Assessments took place at the beginning and end of the course. Students gained in their confidence and skill for all parameters, although the clinical ability to distinguish normal from abnormal tympanic membranes changed little from baseline levels. Extra teaching produced better gains in confidence (P less than 0.05) and skill (P less than 0.01) in identifying specific features of the tympanic membrane and eliminated errors of the 'false negative' variety. A minimal investment in teaching effort produces appreciable gains in students' otoscopic skills. This has implication for the planning of undergraduate ENT courses and vocational training for general practice.

Clinical Competence↗