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PubMed1987

Quantitation of pneumatic otoscopy.

Pneumatic otoscopy has long been espoused as an easily and rapidly used, inexpensive method for routine evaluation of the tympanic membrane and middle ear. This widely used technique, however, has not been explored in a quantitative manner. Therefore, we measured the differential pressure and frequency of the pressure pulse used by a group of experienced otoscopists during routine pneumatic otoscopic examination. We found the pressure pulse varied from 170 to 520 mm H2O and the frequency varied from 2.2 to 4.9 pulses per second. We used a pneumatic pump to deliver a controlled pressure pulse--at a frequency of 4.0/sec--to the pneumatic otoscope. This device was used to measure the minimum pressure pulse necessary for the experienced otoscopist to merely detect tympanic membrane movement in normal ears. The threshold for visible movement ranged from 10 to 15 mm H2O. Thus, even the most gentle otoscopist used a pressure pulse an order of magnitude higher than the threshold for detection of visible movement in normal ears. The gap between the pressure pulse at threshold for visual detection of movement and that which is routinely used offers the possibility of increased sensitivity and specificity for this commonly used diagnostic tool. Preliminary data are presented from this study in which the pressure pulses required for visual detection of tympanic membrane movement in diseased ears were determined.

Ear Diseases↗
PubMed2005

Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey.

BACKGROUND: Middle ear disease (otitis media) is common and frequently severe in Australian Aboriginal children. There have not been any recent large-scale surveys using clear definitions and a standardised middle ear assessment. The aim of the study was to determine the prevalence of middle ear disease (otitis media) in a high-risk population of young Aboriginal children from remote communities in Northern and Central Australia. METHODS: 709 Aboriginal children aged 6-30 months living in 29 communities from 4 health regions participated in the study between May and November 2001. Otitis media (OM) and perforation of the tympanic membrane (TM) were diagnosed by tympanometry, pneumatic otoscopy, and video-otoscopy. We used otoscopic criteria (bulging TM or recent perforation) to diagnose acute otitis media. RESULTS: 914 children were eligible to participate in the study and 709 were assessed (78%). Otitis media affected nearly all children (91%, 95%CI 88, 94). Overall prevalence estimates adjusted for clustering by community were: 10% (95%CI 8, 12) for unilateral otitis media with effusion (OME); 31% (95%CI 27, 34) for bilateral OME; 26% (95%CI 23, 30) for acute otitis media without perforation (AOM/woP); 7% (95%CI 4, 9) for AOM with perforation (AOM/wiP); 2% (95%CI 1, 3) for dry perforation; and 15% (95%CI 11, 19) for chronic suppurative otitis media (CSOM). The perforation prevalence ranged from 0-60% between communities and from 19-33% between regions. Perforations of the tympanic membrane affected 40% of children in their first 18 months of life. These were not always persistent. CONCLUSION: Overall, 1 in every 2 children examined had otoscopic signs consistent with suppurative ear disease and 1 in 4 children had a perforated tympanic membrane. Some of the children with intact tympanic membranes had experienced a perforation that healed before the survey. In this high-risk population, high rates of tympanic perforation were associated with high rates of bulging of the tympanic membrane.

Australia↗
PubMed1983

Reliability and validity of industrial audiometry: implications for hearing conservation program design.

Hearing conservation in industry relies heavily on monitoring audiometry to detect early noise-induced hearing loss in workers who are exposed to potentially damaging noise, with or without hearing protectors. The "real-world" reliability and validity of these measurements, as well as otoscopic observations in industry, have not been extensively investigated. In addition, there is considerable controversy over the selection of a definition of "significant threshold shift" in industrial audiometry. These and related issues were considered in a series of three studies utilizing data from an active hearing conservation program. Test-retest variability in industry is much higher than has been reported for clinical settings; this variability is reduced by pure-tone averaging. Workers referred for otologic evaluation were found to have hearing levels which were, on the average, about 5 dB better than indicated by plant audiometry, even without excluding 4% of referred workers who had unilateral deafness and showed "shadow curves" on the plant audiograms. Otoscopic data obtained by the plant audiometrists were uncorrelated with the results of otoscopy by consultant otologists. Techniques borrowed from decision theory and signal detection theory were used to evaluate possible criteria for significant threshold shift. Criteria based on pure-tone averaging were superior to those based on a certain amount of threshold shift for any frequency tested. It is proposed that a significant threshold shift be defined as a 10 dB or greater change for the worse for either the 0.5, 1, 2 kHz pure-tone average or the 3, 4, 6 kHz pure-tone average, in either ear, and that such shifts be validated by prompt retesting. Even with this criterion, a substantial number of shifts (most shifts, in some situations) will be either spurious or attributable to disorders other than noise-induced hearing loss, such as presbycusis. Otologic referral in cases of large or repeated shifts may prevent unjustified administrative actions, to the advantage of both workers and management. A practical consequence of the use of monitoring audiometry may be a de facto lowering of the permissible exposure level to 85 dBA TWA.

Adult↗
PubMed2002

Diagnostic accuracy, tympanocentesis training performance, and antibiotic selection by pediatric residents in management of otitis media.

OBJECTIVE: To assess the accuracy of pediatric residents in recognizing the physical examination findings of acute otitis media (AOM) and otitis media with effusion (OME), technical competence to perform tympanocentesis, and knowledge of guideline-recommended antibiotic management of AOM. METHODS: A total of 383 pediatric residents from various programs in the United States viewed 9 different video-recorded pneumatic otoscopic examinations of tympanic membranes during a continuing medical education course. The ability to differentiate AOM, OME, and normal was ascertained. A mannequin of a child was used to assess technical proficiency of performing tympanocentesis on artificial tympanic membranes. A series of questions was posed regarding appropriate, pathogen-directed, second-line antibiotic selection for AOM. RESULTS: The average +/- standard deviation correct diagnosis on the otoscopic video examination was 41% +/- 16% (range: 19%-70%; median: 38%) by pediatric residents, tympanocentesis was optimally performed by 89%, and appropriate antibiotic therapy for drug-resistant Streptococcus pneumoniae was selected by 78% and appropriate therapy for beta-lactamase-producing Haemophilus influenzae was selected by 74%. CONCLUSIONS: According to this video-based examination, pediatric residents misdiagnose OME frequently. Pediatric residents have the skills to be trained to perform tympanocentesis. Approximately 75% of pediatric residents have knowledge of the appropriate antibiotics to select for treatment of resistant AOM pathogens. Interactive instruction with simulation technology may enhance skills and lead to improved diagnostic accuracy and treatment paradigms.

Anti-Bacterial Agents↗
PubMed2003

How helpful is pneumatic otoscopy in improving diagnostic accuracy?

BACKGROUND: Pneumatic otoscopy is believed to be helpful in optimally assessing the presence or absence of middle ear effusion (MEE). Although expert clinicians teach the importance of this diagnostic skill to trainees, evidence exists that many pediatric providers do not typically perform pneumatic otoscopy. OBJECTIVE: To determine if the otoscopic accuracy within a group of clinicians improves with the pneumatic assessment when compared with the static assessment using videotaped otoendoscopic examinations (VOEs). METHODS: Residents and faculty from 2 pediatric training programs served as subjects. All viewed a set of 50 video otoscopic examinations of tympanic membranes (TMs) from a validated VOE developed previously for training purposes. The video displays each TM in a static presentation and then in a pneumatic (mobile) presentation, followed by a final static presentation. Each subject first viewed the initial static presentation of each TM and responded "yes/no" to the presence of MEE, and then viewed the pneumatic presentation of the same TM and again responded "yes/no" to the presence of MEE. We compared the accuracy of assessment for both the static and the pneumatic tests. RESULTS: Thirty-four pediatric residents and 6 clinical faculty participated. Accuracy (percent of total test items correct) on the pneumatic test was uniformly greater than accuracy on the static test. The mean absolute improvement in the accuracy from the static test (61%) to the pneumatic test (76%) was 15% (95% confidence interval [CI] = 12%-18%). The mean relative improvement in accuracy from the static test to the pneumatic test was 26% (95% CI = 19%-32%). Higher accuracy on the VOE was associated with greater absolute (r = 0.57) and greater relative (r = 0.47) improvement. The mean relative improvement in sensitivity and specificity from static viewing to pneumatic viewing was 24% (95% CI = 15%-33%) and 42% (95% CI = 27%-58%), respectively. CONCLUSIONS: Using a video otoendoscopic test, we found that accurate identification of both the presence and the absence of MEE improved after pneumatic assessment of TM mobility. Providers who were more accurate at otoscopy, defined by higher video total test scores, benefited more from the pneumatic component than providers with lower scores.

Acoustic Impedance Tests↗
PubMed2005

Audiological profile in older children and adolescents with unrepaired cleft palate.

OBJECTIVE: To study the audiological profile in the cleft population comprising older children and adolescents with unrepaired cleft palate and to arrive at a consensus regarding management of otitis media with effusion in this unique group. SETTING: Tertiary care institute in Chandigarh, Punjab, India. DESIGN: Prospective study based on all patients older than 7 years with unrepaired cleft palate, attending the plastic surgery outpatient department, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India, from January 2001 to December 2002. Patients with submucous cleft were excluded from the study. General characteristics, otoscopic findings, pure tone audiometry, and impedence audiometry of all patients were recorded. RESULTS: Patients' ages ranged from 8 to 18 years, with a mean of 10.5 years. Regarding otological complaints, 86.7% were asymptomatic. Otoscopic findings revealed mild retraction as the most common finding in 50% of the ears. Type B curve was the most common tympanometric finding. The highest and lowest hearing thresholds recorded were 45 db and 15 db, respectively, with a mean of 27.11 db. CONCLUSION: The audiological profile of this unique group, which neither had undergone palatoplasty nor had received treatment for the ear condition, demonstrates a mild to moderate hearing impairment. This definitely requires treatment, but owing to the lack of a prospective control group, it is difficult to conclude whether these patients are benefited by conservative treatment alone or by an early aggressive surgical treatment for otitis media with effusion (OME).

Acoustic Impedance Tests↗
PubMed2005

Audiological status of Chinese patients with cleft lip/palate.

OBJECTIVE: To review the audiological and otoscopic status of Chinese children and young adults seen at a cleft lip and palate clinic in Hong Kong and compare with previous studies of Western clinical populations. DESIGN: The hearing health status of the patients was analyzed on the basis of the results of their otoscopic, pure tone audiometric, and tympanometric examinations. The patients' sex, age, race, and type of cleft pathology were examined for their potential relationship to hearing health status. PARTICIPANTS: The records of 180 predominantly Chinese patients attending the Cleft Lip and Palate Centre, Prince Philip Dental Hospital/University of Hong Kong from July 1977 to December 1999 were reviewed. RESULTS AND CONCLUSION: The results indicated 13.4% of patient ears failed the audiometric screening and 23.7% of patient ears yielded abnormal tympanometric results. Patients' sex, age, and type of cleft pathology were found not to be related to hearing screening results. The prevalence of hearing disorder was in contrast with Western studies that show a much higher rate of audiological problems in children and young adults with cleft lip/palate. Racial factors were considered to be possible reasons for this disparity. Other factors, such as timely medical and surgical intervention, including early cleft palate repair and the insertion of ventilation tubes in cases of middle ear effusion, do not convincingly account for the study findings.

Acoustic Impedance Tests↗
PubMed2003

Efficacy and safety of topical administration of selamectin for treatment of ear mite infestation in rabbits.

OBJECTIVE: To evaluate the efficacy and safety of topical administration of selamectin in rabbits naturally infested with Psoroptes cuniculi. DESIGN: Randomized controlled trial. ANIMALS: 48 mixed-breed domestic rabbits with active P. cuniculi mite populations and clinical ear lesions. PROCEDURES: Rabbits were randomly allocated to 1 of 6 treatment groups. On day 0, rabbits in groups 1 and 2 were given vehicle, rabbits in groups 3 and 4 were given selamectin at a dose of 6 mg/kg (2.7 mg/lb), and rabbits in groups 5 and 6 were given selamectin at a dose of 18 mg/kg (8.2 mg/lb). On day 28, rabbits in groups 2, 4, and 6 were given a second dose of vehicle or selamectin. Otoscopic examinations were performed and ear lesion size was measured weekly for 8 weeks. Quantitative viable mite counts were performed on day 56. RESULTS: On days 7 through 56, lesion sizes for all selamectin-treated groups were significantly lower than sizes for control groups; there were no significant differences in lesion sizes among selamectin-treated groups. All rabbits in the 2 control groups had viable adult P. cuniculi mites for the duration of the study, as determined by otoscopic examination, whereas all rabbits in the 4 selamectin-treated groups were free from P. cuniculi mites on days 7 through 56. No adverse reactions associated with selamectin treatment were observed. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that topical application of selamectin at a dose of 6 or 18 mg/kg can completely eliminate mites from rabbits naturally infested with P. cuniculi.

Administration, Topical↗
PubMed1993

Middle ear barotrauma associated with hyperbaric oxygenation treatment.

We investigated the signs and symptoms of middle ear barotrauma in 67 patients with hyperbaric oxygenation treatment as well as the influence of predisposing factors. Ear damage was classified into 5 grades on the basis of objective findings at otoscopic examination. The incidence of middle ear barotrauma assessed by objective criteria was 68.7%, and showed little variation with age or primary disease. On the other hand, the incidence assessed by subjective symptoms was lower than the objectively-based incidence in aged patients, those with severe neurological diseases, and those who had difficulties speaking. Patients with a trauma grade of 2 or more complained of severe symptoms and were appropriate candidates for treatment. It is considered that otoscopic examination should be performed in patients who undergo hyperbaric oxygenation treatment and that prior management of nasal and paranasal diseases is beneficial in the prevention and treatment of middle ear barotrauma.

Adult↗
PubMed1995

Oxygen diving-induced middle ear under-aeration.

Middle ear negative pressure and effusions have been described after oxygen diving. The prevalence, dynamics and pathophysiology of this phenomenon are not clear, and were hence investigated in the present study. Thirty-four oxygen divers with normal otoscopic and tympanometric evaluation participated in the study. The subjects' symptoms were documented, and pneumatic otoscopy and tympanometry were repeated immediately after the completion of a 3 h, 15 feet oxygen dive, and 7 h later on awakening from the night's sleep. Most divers had positive otoscopic findings the morning after the dive, all of which cleared within 4 h of rising. A significant decrease was observed in average middle ear compliance (p = 0.0463, one way ANOVA), and an increase was found in the number of ears with tympanic compliance less than 0.3 ml (p = 0.0001, Kruskal-Wallis non-parametric ANOVA). In addition, 14.7% of the ears had type C, and 27.9% type B tympanograms the morning after the dive (p = 0.0001 chi2). The generalized nature of oxygen-induced middle ear under-aeration, combined with the dynamics of the symptoms and signs observed, make middle ear barotrauma, tympanic cavity oxygen absorption, and middle ear epithelial oxygen toxicity all unlikely explanations. The observed phenomenon and its dynamics might stem from a reversible derangement in a middle ear chemoreceptor reflex arch, which has recently been suggested as regulating middle ear aeration.

Acoustic Impedance Tests↗
PubMed1984

Otoscopy and tympanometry in screening for middle ear disorders in children.

In this study tympanometry and otoscopy were conducted in 893 children in Kuwait. Otoscopic examination revealed pathologic findings in 41.7%, while 30.6% had type B or C tympanograms. Based on referral criteria commonly used in tympanometry 31% of the children should be referred for further evaluation. Using the combined otoscopic and tympanometric evaluation of the ears the referral rate could be reduced to 18%.

Acoustic Impedance Tests↗
PubMed1993

Evaluation of acoustic reflectometry in detecting otitis media in children.

Accurate detection of middle-ear effusion in children is not only useful but also necessary for diagnosis, management and follow-up of otitis media. A relatively new device, the Acoustic Otoscope (model 101, ENT Medical Devices) has been introduced for detecting middle-ear fluid in children. We tested 158 ears and the diagnosis was confirmed by acoustic admittance, acoustic reflex and pneumatic otoscopy. We propose 4.5 as a better breakpoint (the number on the vertical scale of the instrument which is the lower limit indicating middle-ear effusion) than 4.0 which is proposed by the manufacturer. In our results the 4.5 breakpoint maximizes both positive and negative predictive values (83 and 82% respectively) with satisfactory sensitivity and specificity (86 and 79% respectively) in detection of otitis media. Our clinical experience with this instrument, during the past 2 years, has led us to conclude that it is simple, non-invasive and objective. Unlike tympanometry, it requires no hermetic seal and is effective even if the child is crying. However, it is not sensitive enough when there are bubbles or negative pressure in the middle ear. When the user is aware of the flexibility of the instrument's breakpoints (in our opinion this is an advantage of the device) for different uses and different populations, the reflectometer often reduces the need for tympanometry and confirms the otoscopic examination.

Acoustic Impedance Tests↗
PubMed1998

[Two cases of dermatophytosis of the external auditory meatus].

We report two cases of dermatophytosis of the external auditory meatus. Case 1: A 44-year-old man suffered from severe itching in the right external auditory meatus for a year, and had also had tinea unguium for several years. He visited our outpatient clinic because of scaly erythema which had developed on the auricle. Otoscopic examination revealed yellow-brown dry cerumen and redness from the cartilaginous to the bony portion of the external auditory meatus. Case 2: A 14-year-old boy, the son of Case 1, suffered from severe itching in the left external auditory meatus. He scratched the auditory meatus with an earpick which his father had used. Otoscopic examination revealed a similar lesion as in the father's case, although he had no history of dermatophytosis elsewhere on his body, including the auricle. Direct examination using a KOH method of the cerumen from both cases demonstrated numerous fungal elements. Fungal culture identified Trichophyton rubrum. Both cases were successfully treated with oral itraconazole. We suggest that infection from father to son was transferred by the earpick.

Adolescent↗
PubMedDate not supplied

Acute Otitis media, malaria and pyrexia in the under five age group.

BACKGROUND: Acute Otitis media is one of the most common childhood infections. It is responsible for every third visit to a pediatrician in a developed world. However, in Nigeria there is scanty knowledge about the incidence of Acute Otitis Media (AOM). OBJECTIVE: This study aimed at determining the incidence of AOM among under five year old children presenting with pyrexia, and to compare the incidence of AOM as a cause of pyrexia with the incidence of malaria in pyrexic children. DESIGN: It is a cohort study of 200 children of between the ages of 2 weeks and five years with a rectal temperature of 38 degrees C and above, seen over a period of 3 months. SETTING: The study was conducted at the Obafemi Awolowo University Teaching Hospital (OAUTHC) Comprehensive Health Centre, Eleiyele, and the children emergency room of the OAUTHC, Ile-Ife. PATIENTS AND METHODS: A questionnaire to collect information on the demographic data was administered to each mother/guardian of the patient. Otoscopic examination using a battery-operated hand held otoscope and magnifying lenses were done in addition to general systemic physical examination. Thin and thick blood smears were made for malaria parasite. The dried slides were examined under the microscope using the X 100 objective. Sixteen of the patients' slides were lost after processing. RESULTS: Out of the 200 patients that were studied, 58 (29%) had AOM. The highest incidence was recorded in the age group 12-24 months while the least age of occurrence was found to be the age group 4-5 years. Malaria parasitemia was found in 81 (43.5%) while 21 (25.9%) of those with parasitemia also had AOM. But 76 (36%) of the study population had neither AOM nor malaria parasitemia. CONCLUSION: Acute Otitis media was found in 29% of under five years old presenting with pyrexia. It was found to be highest in the first and second year of life, and was found to be least in the 5th year of life. Malaria was found in 81 (43.5%) of the children, and 21 (10.5%) of the children had malaria with a co-existing AOM.

Acute Disease↗
PubMed1998

Magnetic Resonance Angiography in Pulsatile Tinnitus: The Role of Anatomical Variations.

Pulsatile tinnitus (PT) is a perception of a rhythmical sound that is synchronous with the heartbeats. Despite being seen rarely in daily practice, frequently it is associated with identifiable causes, thus warranting special attention in regard to the etiological diagnosis. PT results from blood flow turbulence, which in turn results from changes in flow velocity or in the vessel lumen. One of the most important causes of PT is the paraganglioma, a vascular tumor that appears as a reddish retrotympanic mass. However, a normal tympanic membrane mandates differentiating among other diagnoses, such as arteriovenous malformations or fistulas, intracranial or extracranial aneurysms, a high or dehiscent jugular bulb, and persistent stapedial artery. Owing to the progress of radiological evaluation, magnetic resonance angiography (MRA) has proven to be excellent for evaluating vascular diseases. From January 1995 to June 1997, the authors prospectively studied 16 patients with PT and normal otoscopic examination. The study comprised 1 male and 15 female patients (ages 25-71 years; mean age, 42.5 years). All were subjected to MRA evaluation, which revealed the etiological diagnosis in 13 cases (81.25%), including 2 aneurysms and 1 case of intracranial hypertension. Of the 13 patients 9(69.23%) presented with at least one variation of vascular anatomy of the skull, showing a close correlation, in most cases, with the side on which PT occurred. Our results confirm that MRA is an excellent primary screening modality for patients with PT and normal otoscopic findings. The authors point out the importance of making etiological diagnoses in such cases, suggesting that variations of the vascular anatomy of the skull are a possible etiology.

Journal Article↗
PubMed2000

Anesthesia of six-week-old New Zealand White rabbits for thoracotomy.

Many methods of administering surgical anesthesia to rabbits have been described. We are studying the effects of anterior thoracic spinal procedures on the growth of young rabbit spines. We introduce a method for intubation using direct laryngoscopy without the need for specially manufactured or costly equipment and for administration of anesthesia applicable to six-week-old New Zealand White (NZW) rabbits. Induction of anesthesia was initiated with 5% isoflurane in a sealed plastic anesthesia box. No premedication was given. We performed direct laryngoscopy by using an otoscope. Under direct visualization, a 5-French polypropylene catheter was passed through the speculum of the otoscope and advanced through the vocal cords. The endotracheal tube without the adapter then was advanced over this guide. A vigorous cough reflex was noted as the tube passed through the vocal cords. We have found this cough reflex to be a very reliable indicator of correct placement. Throughout the surgical procedure, anesthesia was maintained with isoflurane delivered from a standard small-animal anesthetic machine using pediatric breathing hoses, y-piece, and ventilator. Recovery after surgery was rapid.

Anesthesia, Spinal↗
PubMedDate not supplied

[The efficacy of combining antibiotic treatment with topical intranasal steroid administration in the treatment of chronic otitis media with effusion].

OBJECTIVES: We evaluated the efficacy of antibiotic treatment with or without topical administration of intranasal budesonide in chronic otitis media with effusion (OME). PATIENTS AND METHODS: The study included 62 patients (age range 2 to 12 years) with chronic OME. The patients were randomly assigned to three groups, namely, antibiotic treatment (20 patients, ampicillin/sulbactam, 25 mg/kg/daily), antibiotic treatment combined with intranasal budesonide (20 patients, 200 mg/daily), and no treatment (22 patients). All patients and families were questioned regarding the presence of allergy, frequent upper respiratory tract infections, passive smoking, low birth weight, and pre-school nursery attendance. Otoscopic examination findings and the results of tympanograms obtained at the time of diagnosis, and at the end of four and eight weeks of treatment were evaluated. RESULTS: At the end of eight weeks, significant improvement in tympanograms and otoscopic findings was obtained in both groups when compared with the control group (p<0.05). Resolution rates were 24% (9/37 ears), 39% (14/36), and 5% (2/40) with antibiotic, budesonide, and no treatment groups, respectively. Although budesonide treatment was associated with a higher rate of resolution of effusion compared to that of antibiotic alone, this did not reach significance (p>0.05). CONCLUSION: Further studies with larger patient series are required to better evaluate the efficacy of antibiotic treatment and topical intranasal steroid administration in chronic OME.

Acoustic Impedance Tests↗
PubMed2003

[Microbiology of the external auditory canal in patients with asteatosis and itching].

OBJECTIVES: We examined the microbiology of the external auditory canal in patients with asteatosis and itching and evaluated the efficacy of topical 2% alcohol and boric acid solution in patients with normal flora. PATIENTS AND METHODS: Bacteriological and mycological cultures were obtained from 76 ears of 45 patients (36 females, 9 males; mean age 41.8 years; range 17 to 66 years) presenting with normal otoscopic findings and no history of ear diseases. Treatment protocols were planned according to the culture results. Patients with normal flora were administered topical 2% alcohol and boric acid solution to relieve itching. RESULTS: Cultures yielded normal flora in 65 ears (85.5%), bacterial pathogenic flora in 10 ears (13.1%), and mycosis in one ear (1.3%). Complaints of itching decreased significantly following treatment with alcohol and boric acid solution in patients with normal flora (p<0.05). No correlation was detected between age and the severity of itching (p>0.05). CONCLUSION: Despite normal otoscopic findings, external auditory canal cultures may show pathogenic colonization in patients with asteatosis. Topical administration of alcohol and boric acid solution seems to relieve itching in patients with normal flora.

Administration, Cutaneous↗