Otitis Externa Research Articles

Temporal Bone Myeloid Sarcoma Presenting as Necrotizing Otitis Externa: A Case Report and Literature Review.

Myeloid sarcoma (MS) is a proliferation of immature myeloid cells that occurs extramedullary, often accompanying acute myeloid leukemia (AML). It typically presents in areas such as lymph nodes, skin, and the head and neck regions. The emergence of MS within the temporal bone is rare, and it can manifest through nonspecific symptoms. In this paper, we reported a case of A 47-year-old female presented with right-sided otalgia, otorrhea, tinnitus, reduced hearing, and ear fullness, and developed facial asymmetry. She was initially diagnosed with necrotizing otitis externa and was treated accordingly. Further investigations were conducted, leading to the diagnosis of MS. She began treatment with induction chemotherapy followed by consolidation therapy. And we reviewed the literature and included 14 MS cases with the same anatomical localization, discussing the primary presentation, immunohistochemistry, and treatment approaches of these patients. In conclusion, temporal bone MS should be considered in patients with a history of AML presenting with nonspecific symptoms. Diagnostic modalities for MS include computed tomography and magnetic resonance imaging scans. Systemic chemotherapy remains the preferred treatment approach. The complexity and diversity of temporal bone MS presentations necessitate further comprehensive research to enhance understanding and improve management strategies for this rare condition.

Changes functional prediction of ear canal flora in chronic bacterial otitis externa

ObjectiveTo investigate ear canal microflora’s structure, composition and function in patients with chronic bacterial otitis externa.MethodsA case-control study design method was used to collect the ear canal secretions from 14 patients with chronic bacterial external otitis (CB group) and 14 healthy controls (H group) treated in the Department of Otolaryngology and Head and Neck Surgery in the First Affiliated Hospital of Hainan Medical University. 16S rRNA high-throughput sequencing technology was used to sequence the ear canal microflora’s V3 ~ V4 region gene amplification products in the participating population. The α diversity of ear canal microflora in 2 groups was analyzed. Based on the weighted Unifrac distance, principal coordinate analysis was performed to compare the β diversity of ear tract microflora between the two groups. The differences in ear microflora at phylum and genus levels were analyzed. PICRUSt2 function prediction and BugBase phenotype prediction were also performed.Resultsα diversity analysis showed that the diversity and richness of auricular microflora in the CB group were significantly lower than those in the H group. β diversity analysis showed that there were some differences between the two groups. At the phylum level, the relative abundance of Bdellovibrionota, Campylobacterota, and WPS-2 in the microbiota of patients in the CB group was significantly lower than that in the H group, and the differences were statistically significant. At the genus level, the relative abundance of Pseudomonas, Acinetobacter, Pelomonas, Sphingomonas, Bradyrhizobium, Brevundimonas, Enhydrobacter, Actinomyces, Paracoccus and Chryseobacterium in the ear canal of Group H is significantly higher than that of Group CB. Functional prediction of PICRUSt2 suggests that amino acid biosynthesis and bacterial microbiota may be related. In BugBase phenotypic prediction, the contribution of aerobic phenotype in group CB was significantly lower than that in group H.ConclusionThe diversity and abundance of the ear canal flora of patients with chronic bacterial otitis externa were significantly lower than those of the healthy population, and their bacterial colony structure was significantly altered. Dysbiosis of the ear canal flora may be an important cause of chronic bacterial otitis externa.

Deciding treatment end point in necrotizing otitis externa: validation of a standardized clinical response assessment strategy with positron emission tomography findings.

Primary: To explore criteria for treatment endpoint in NOE. Secondary: To study correlation of inflammatory markers, Erythrocyte sedimentation Rate (ESR) and C-reactive protein (CRP) with disease status. Prospective cohort study conducted in a tertiary care hospital over two years (2021-2023) consisted 28 patients with NOE. Treatment culmination point was decided based on symptoms control and correlated with PET-scan findings. Clinical response was analysed with respect to the serum inflammatory markers and PET Scan findings. There was fair degree of agreement between clinical resolution and resolution of findings on PET scan (kappa coefficient - 0.76 [95% CI; 0.40,1.00]). Inflammatory markers showed statistically significant decline with clinical resolution but failed to return to normal. Decision to terminate treatment of NOE can be reliably made on clinical grounds in patients remaining asymptomatic for three weeks. Resolution of inflammation on PET scan is in congruity with the clinical remission .

Antimicrobial and antibiofilm effect of promethazine on bacterial isolates from canine otitis externa: an in vitro study

Otitis externa is an inflammatory disease of the external ear canal of complex and multifactorial etiology associated with recurrent bacterial infection. This study aimed to assess the antimicrobial and antibiofilm activity of promethazine against bacterial isolates from dogs with otitis externa, as well as the effect of this compound on the dynamics of biofilm formation over 120 h. Planktonic bacterial susceptibility to promethazine was evaluated to determine the minimum inhibitory concentrations (MIC). The minimum biofilm eradication concentration (MBEC) was also determined by broth microdilution. To evaluate the effect on biofilm growth, promethazine was tested at three concentrations MIC, MIC/2 and MIC/8, with daily readings at 48, 72, 96 and 120 h. The MICs of promethazine ranged from 48.83 to 781.25 μg mL−1. Promethazine significantly (P < 0.05) reduced mature biofilm biomass, with MBECs ranging from 48.8 to 6250 μg mL−1 and reduced (P < 0.01) biofilm formation for up to the 120-h, at concentrations corresponding to the MIC obtained against each isolate. Promethazine was effective against microorganisms associated with canine otitis externa. The data suggest that promethazine presents antimicrobial and antibiofilm activity and is a potential alternative to treat and prevent recurrent bacterial otitis in dogs. These results emphasize the importance of drug repurposing in veterinary otology as an alternative to reduce antimicrobial resistance.

Approach to otitis externa.

To provide family physicians with a practical evidence-based approach to management of otitis externa. The approach described is based on MEDLINE and PubMed literature published between 1993 and 2023. Otitis externa is diffuse inflammation of the external auditory canal and typically occurs from moisture exposure and trauma. Management focuses on eliminating infection, pain management, education, and preventing recurrence. The primary treatment of uncomplicated otitis externa is topical. Complicated presentations may require additional systemic therapy. History taking and physical examination can help differentiate among acute, chronic, and necrotizing otitis externa. At-risk populations, typically those who are immunosuppressed, are more likely to develop necrotizing otitis externa and should be carefully monitored.

Aspergillus otitis externa: A retrospective study of predisposing factors, treatment, and complications.

To study the predisposing factors, treatment, and complications of Aspergillus otitis externa. A retrospective analysis of patients diagnosed with Aspergillus otitis externa at the Department of Otorhinolaryngology, Helsinki University Hospital, between January 2010 and December 2018 was performed. Of the 269 Aspergillus otitis externa (OE) patients, 96 developed otitis media (OM) and 7 developed mastoiditis. Antibiotic and steroid treatment and otological history were risk factors for Aspergillus OE. Systemic diseases and immunocompromising states were more common in mastoiditis patients. Repetitive ear cleaning and topical drugs are primary treatments, but systemic drugs and surgery were needed in resistant and invasive cases. Forty-five novel tympanic membrane (TM) perforations were reported. A strong association between Aspergillus species and final infection types was found; A. niger was the dominant species in OM and in novel TM perforations, whereas A. flavus and A. fumigatus caused mastoiditis. Some of the TM perforations persisted despite treatment. Permanent hearing impairment was associated with OM and mastoiditis. As Aspergillus OE has the potential to cause acute and chronic complications, fungal OE should be suspected early on if the infection persists after conventional treatment. The identification of Aspergillus species could aid in spotting patients at risk for more severe disease and complications. Intensive local treatment is sufficient in most cases of OE and OM but effective topical antifungals are limited. Patients with Aspergillus OM and mastoiditis should be followed up for hearing impairment and permanent TM perforations after the infection resolves. Level 4 (The Oxford 2011 Levels of Evidence).

Comparative performance of video-otoscopy and CT in the diagnosis of external ear disease in cats.

The aim of the study was to compare CT with video-otoscopy for detecting external ear canal masses in cats and to describe CT features of feline external ear disease. This retrospective study evaluated the external ear canals of cats that underwent both CT and video-otoscopy. Two blinded observers reviewed the CT scans and their findings were compared with video-otoscopy results evaluated by one blinded observer. Of the 32 examined ears, 13 had an external ear canal mass detected by both CT and video-otoscopy. No false positives were identified. All 19 ears without masses were correctly identified as true negatives, resulting in perfect agreement for mass detection (kappa = 1.000). On histopathology, 9/13 masses were diagnosed as polyps, 1/13 masses was diagnosed as carcinoma, 2/13 did not undergo histopathology and 1/13 masses seen on video-otoscopy was diagnosed as otitis externa with granulomatous tissue formation. Of the 16 cats examined, 12 had a mass in the external ear canal diagnosed by video-otoscopy: six domestic shorthairs, five Maine Coons and one Oriental Shorthair cat. Of these cats, 11 had a unilateral mass and one had a bilateral mass. There was very low agreement between CT and video-otoscopy for ear canal wall enhancement and erythema (kappa = 0.033), as well as for ear canal thickening and stenosis (weighted kappa = 0.056). There was no significant difference between chronic and non-chronic clinical signs in terms of the presence of ear canal wall mineralisation (P = 0.223). There is high agreement between video-otoscopy and CT in detecting external ear canal masses in cats. However, there is very low agreement between CT and video-otoscopy for ear canal wall enhancement, erythema, thickening and stenosis. The presence of external ear canal mineralisation did not correlate with the chronicity of clinical signs.

Exploring the anti-inflammatory effects of Nigella sativa on cyclooxygenase-2 through the nuclear factor-kappa B pathway in an Aspergillus niger-induced otitis externa mouse model

Exploring the anti-inflammatory effects of Nigella sativa on cyclooxygenase-2 through the nuclear factor-kappa B pathway in an Aspergillus niger-induced otitis externa mouse model

A Study on the Systemic Inflammatory Index (SII) and Related Factors in Patients with Malignant Otitis Externa

Purpose: This study aims to investigate the relationship between systemic inflammatory index and various clinical and microbiological factors in patients with malignant otitis externa (MOE). Materials and Methods: In this retrospective study, patients diagnosed with MOE and treated between January 2017 and March 2023 were examined. The data include clinical evaluations, laboratory tests, and imaging results. All patients underwent computed tomography of the temporal bone, and MOE was staged according to Tengku's radiological classification .SII was calculated using neutrophil, platelet, and lymphocyte counts. Results: 11 patients were examined retrospectively, including 8 males (72.7%) and 3 females (27.3%). The mean age of the patients was 72.3±7.5 years. Comorbidities such as Diabetes Mellitus (DM) and Chronic Kidney Disease (CKD) were associated with higher SII values. CT phases and cranial nerve involvement were also related to high SII values. Microbiological analyses showed that pathogens such as Pseudomonas aeruginosa and Candida tropicalis were associated with high SII values. Conclusion: SII is an important biomarker in evaluating the prognosis and treatment response in MOE. Early diagnosis, a multidisciplinary approach, and personalized treatment strategies are critical in managing MOE. Further studies involving larger patient groups will contribute to validating these relationships and improving treatment processes.

Molecular detection and phylogenetic tree assay of Pseudomonus aeruginosa isolated from otitis cases of cats and humans, Iraq

The aim of this study was toward isolation and identification of P. aeruginosa from cats with otitis externa in Basra city Using culture media, Biochemical tests and Polymerase chain reaction. Pseudomonas aeruginosa was isolated from 46 isolates that involved 32 cases out of 75 of feline otitis externa (21.3%) and in 14 (9.3%) from 75 human samples .the clinical signs of otitis externa were head shaking, scratching, excessive ear wax, malodor, pain during palpation, alopecia and pus and/or blood. Culture was done on Pseudomonas chrome agar revealed positive samples with production of greenish-blue pigmentation by the bacteria .polymerase chain reaction revealed that isolates were Pseudomonas aeruginosa using specific primers for P. aeruginosa identification 16S rRNA and the result was positive for the 15 isolates. a phylogenetic tree analysis of P. aeruginosa was performed using the 16S rRNA gene sequence analysis which illustrated the phylogenetic relationship between P. aeruginosa strains isolated from cats and other related genera. In conclusion, this study confirmed the higher prevalence of P. aeruginosa in otitis externa infection of cats when compared to human. The using of molecular assay and 16S rRNA gene contributed effectively in detection of P. aeruginosa. Therefore, this study suggests the application of molecular techniques in identification of different microorganisms. Additionally, moreover studies are necessary to detect the prevalence of P. aeruginosa in different infections in animals as well as human.

Skin lesion of external auditory canal in a patient with seborrheic dermatitis.

Patient K. turned to a dermatologist with complaints of periodic itching in the scalp skin, face, auricles, external auditory canals with discomfort and discharge from them. Clinical diagnosis: seborrheic dermatitis. At the otolaryngologist consultation, the patient was diagnosed with bilateral external otitis media with the formation of hyperkeratotic casts in both external auditory canals. Seborrheic dermatitis was treated in two stages. At the first stage, itraconazole 200 mg was prescribed orally 1 time per day for the first week of treatment, then 200 mg orally 1 time per day for the first two days of each month for 3 months and externally on the scalp ketoconazole shampoo 2% 2 times a week for 4 weeks, then 1 time in 2 weeks. At the second stage, isotretinoin was administered orally at a dosage of 10 mg per day in an intermittent mode. A positive clinical result was obtained against the background of the therapy. The patient continues to remain under supervision.

Complex trauma sequelae: Mycobacterium goodii and Priestia endophytica Hardware infection in a patient with Ehlers-Danlos syndrome

A 26-year-old man with Ehlers-Danlos syndrome, recurrent otitis externa, and chronic otitis media sustained a left lower extremity amputation and open femur fracture with internal hardware fixation after a motor vehicle collision in Arizona. He presented to the emergency department at our institution with severe left leg pain and purulent discharge despite receiving two unidentified antibiotics upon discharge. Evaluations revealed an abscess and malunion of the femur. Initial cultures yielded scant Priestia endophytica, leading to daptomycin treatment. His condition worsened until Gram-positive bacilli identified as Mycobacterium goodii, a rare nosocomial mycobacterial species, were found. Significant improvement occurred with appropriate antibiotics. This case highlights the challenges in diagnosing and managing M. goodii infections in immunocompromised patients with orthopedic complications and notes P. endophytica as a previously unreported, possibly opportunistic human pathogen.

Preliminary evidence supporting use of UK consensus definitions for necrotising otitis externa

BackgroundInfections of the external ear canal (EAC) exist as a spectrum of disease from severe otitis externa (SOE) to necrotising otitis externa (NOE), but distinguishing between these is challenging. The UK consensus case definition (UKCCD) was established in 2022, but had not yet been assessed in clinical practice. MethodsAll consecutive adult patients undergoing CT to investigate a diagnosis of possible NOE between November 2018 and October 2019 were prospectively included in the cohort. Clinical diagnosis at baseline and the end of 12 months follow-up were compared to the diagnosis defined by UKCCD. Results55 patients were included in the analysis. 27 % (15/55) had an initial clinical diagnosis of NOE, of which 47 % (7/15) did not have changes on CT consistent with NOE. Only 9 % (5/55) patients had an MRI scan performed within 7 days of the baseline CT. At the end of 12 months, 9 % (5/55) patients had a change in diagnosis to or from NOE. All cases diagnosed as NOE by UKCCD had a clinical diagnosis of ‘NOE’ at baseline, while no cases clinically diagnosed as NOE were mislabelled by UKCCD as ‘not NOE’. All cases that had a change of diagnosis in the 12-month period or had an initial CT with no changes consistent with NOE, were captured by the UKCCD category of ‘possible NOE’. Median duration of antibiotics of clinically defined NOE cases were 14 days of intravenous (IQR: 7.3–23.8), 28 days of oral (IQR: 21.0–40.3), and 49.5 days combined (IQR: 29.8–67.3). ConclusionUKCCD has excellent clinical concordance with clinical diagnosis. Further work is warranted to assess its utility for risk stratification of patients presenting with severe infections of the EAC in a larger cohort.

A Study of Hearing Acuity and the Health of the External Auditory Canal Among Earphone Users in Central India.

Background and objective The pervasive use of earphones has raised concerns about its potential impact on hearing acuity and the health of the external auditory canal (EAC). This study aimed to investigate these effects in a sample of individuals in Central India to better understand the associated risks. Materials and methods This observational cross-sectional study was conducted in the Department of Otorhinolaryngology, Acharya Vinoba Bhave Rural Hospital, SawangiWardha. A total of 130 participants aged 15-35 years were divided into two groups: 65 earphone users and 65 non-earphone users. The data collection involved medical histories, clinical examinations, and audiometric testing, including pure-tone audiometry (PTA), impedance audiometry, and otoacoustic emissions (OAE). Participants completed a questionnaire on earphone usage, and EAC health was assessed via physical examinations and photographic documentation. Statistical analyses included descriptive and inferential statistics, with significance set at p<0.05. Results Among earphone users, 45 (69.23%) exhibited hearing loss compared to 11 (16.92%) in non-users (p<0.00001). Noise-canceling earphones were associated with fewer cases of hearing loss (6/45, 13.33%) than non-noise-canceling types (39/45, 86.67%) (p<0.00001). EAC issues were more prevalent in earphone users, with 39 (60%) showing normal conditions versus 52 (80%) in non-users. Impactions of wax, otomycosis, and otitis externa were observed more frequently among earphone users. Conclusions The study highlights a significant association between earphone use and increased risk of hearing loss and EAC issues. Noise-canceling earphones may offer some protective benefits. These findings underscore the need for raising awareness and implementing preventive measures to mitigate potential risks associated with prolonged earphone use.

Pediatric Necrotizing Otitis Externa: A Scoping Review.

This review sought to answer the following research question: What are the characteristics of pediatric necrotizing otitis externa (NOE)? Moreover, we wanted to highlight the clinical importance of the current limitations in the literature. A scoping review was performed to determine what is known about NOE in the pediatric population. Four databases (COCHRANE Library, CINAHL, PubMed, and Scopus) were queried for articles published in English between 1976 to 2022. Variables extracted included comorbidities, demographics, outcomes, and treatment. A total of 20 studies (N = 439) reported sufficient measures to be included in the review. Patients with NOE had a mean age of 10.0 years (range 2 months to 14 years) with a male-to-female gender ratio of 1.1:1. Mean length of hospital stay was 2.9 days (95%CI: 2.7-3.0). Demographics included 45.4% Caucasian, 6.0% African American, and 2.7% Asian/Pacific Islander. Less than 5% of patients had diabetes, while other reported comorbidities included neutropenia (n = 6), anemia (n = 5), dehydration/malnutrition (n = 4), Stevens Johnson Syndrome (n = 2), some form of immunosuppression/organ transplantation (n = 2), thrombocytopenia (n = 2), and leukopenia (n = 2). There have been no reported deaths from NOE in children. In the adult population NOE most commonly affects patients with diabetes, but our review reveals that diabetes does not appear to play as big a role in children. The disease seems to commonly affect patients with immunosuppression or severe health conditions. Complications such as cranial nerve palsies appear to be more common in the pediatric population. Specifically, the role of biopsy and culture in the treatment of pediatric NOE is stressed as they are important in treatment decisions.

Community-Based Intervention for Hearing Loss: Impact of Hearing Screening Programme in Ondo West Local Government Area

Introduction: The spectrum of hearing loss as a public health condition has continued to increase globally both in its pathological as well as demographic status. Consequently, a vast majority of people especially in Nigeria and other low income countries suffer from one psychological, economic, social and cognitive disadvantage of hearing loss to another. Aim: The aim of this study was to investigate the impact of hearing screening programmes as a means of Community-based intervention for hearing loss. Methods: Subjects in the study are patients who submitted for a free hearing screening programme within the months of March and May 2022, organized by the department of Ear, Nose and Throat, University of Medical Sciences Teaching Hospital, Ondo State, Nigeria. The hearing screening was carried out by Otorhinolaryngologist, Audiologists and Speech Therapists using, Otoscope, Tuning Forks, HearWHO mobile app, a well-structured questionnaire etc. Results: Of 356 patients who were screened, 80 presented with hearing related disorders such as hearing loss, tinnitus, canal blockage, polyps, otitis media and otitis externa. Interventions were administered accordingly, on either free or subsidized scale to patients. It was deduced that the majority of these patients would not have presented for hearing screening if it was not a free Community-based programme. Conclusion: Community-based hearing screening programmes enhance early identification of hearing disorders and commencement of hearing healthcare interventions especially in low income countries.

The effect of cold plasma on the treatment of external otitis: an experimental study in rats

In this paper we investigate the influence of cold plasma as novel method on the external otitis treatment which is a frequent cause of earache. 24 infected external auditory canals in 24 rats were categorized in four experimental groups including control, plasma exposed, ciprofloxacin drug and mixed of plasma-ciprofloxacin groups. In plasma group, dielectric barrier discharge was employed as the source of cold plasma in 5 days. All rats were observed with otoscope daily and a scoring system was used to evaluate swelling and effusion of the ear canal. Number of colonies in microbiological culture were counted in each group during the first 5 days after treatment. For the multiple group comparisons of swelling and effusion measured in the external auditory canal, Kruskal–Wallis analysis was applied and one-way anova and Kruskal–Wallis analysis was used for the statistical analysis of the results of the cultures in different days. Also, Tukey and Mann–Whitney tests was applied for multiple comparisons. Our findings show that swelling and effusion were obviously reduced in plasma group compared to control group (P < 0.01). Number of colonies in control group was statistically different from those in drug, plasma, and mixed group on the second to fifth day (p < 0.001). According to the results cold plasma can be introduced as an impressive method for external otitis treatment. Moreover, when cold plasma joined to antibiotic method, it leads to a superior performance respecting plasma or antibiotic method alone.

To Study the Microbiological Florae in Patients of Acute Otitis Externa

To Study the Microbiological Florae in Patients of Acute Otitis Externa

Diagnostic criteria and core outcome set development for necrotising otitis externa, symptomatic evaluation in patients awaiting septoplasty and early versus late tracheostomy in critically ill patients.

Diagnostic criteria and core outcome set development for necrotising otitis externa, symptomatic evaluation in patients awaiting septoplasty and early versus late tracheostomy in critically ill patients.

Single application of clotrimazole cream in the management of fungal otitis externa

Single application of clotrimazole cream in the management of fungal otitis externa