Otitis Externa Research Articles

Incidence of tick as foreign body in ear in Western Pahang and case series

We report the incidence of tick as a manifestation of foreign body in the ear in our centre and how climate change is a contributing factor in the increasing amount of tick densities. The removal of tick can be difficult in centres with limited equipment and expertise. The commonest presentations may include ear pain or ear bleeding. However, in certain occasions, patient may come with its complications, such as otitis externa, otitis media, and rarely, isolated facial nerve palsy. Further discussion includes a case series and the complications and management of the foreign body manifestation.

A clinicopathological study of various aetiologies of headache in otorhinolaryngology

Background: Headache is one of the most common complaints with which a patient presents to an outpatient clinic. Because of the wide range of clinical presentations and etiologies, evaluation of headache is often a challenging problem for the clinician. In our study, we are finding out the possible aetiologies of headache in patients attending the otorhinolaryngology department. Methods: The patients underwent history taking and ENT examination involving hematological, radiological investigations and all data were recorded by in Microsoft excel Sheet and analyzed with the help of SPSS 20 software for windows. Results: The 128 (35.9%) patients had otomastoiditis, 120 (33.6%) patients had nasal mass, 33 (9.2%) patients had sinusitis, 29 (8.1%) patients had laryngeal cancer, 14 (3.9%) patients had tongue cancer, 2 (0.6%) patients had parapharyngeal mass and 31 (8.7%) patients had normal findings. Conclusions: Most common pathologies associated with headache in ENT are otitis externa followed by sympatomatic deviated nasal septum.

External Auditory Canal Squamous Papilloma Presenting with Otitis Externa and Severe Bony Erosion.

We present a case of a 68-year-old lady with an insidious progressive history of otorrhea, otalgia, and reduced hearing for 3months. She was treated for malignant otitis externa and was treated with systemic antibiotic but showed subtherapeutic response to treatment. She underwent examination under anaesthesia and biopsy with tumour debulking of the right ear via posterior auricular approach and histopathological examination revealed squamous papilloma of the external auditory canal. She recovered well after surgery and was asymptomatic during follow-up.

Diagnostic accuracy of eosinophil-to-lymphocyte ratio and eosinophil-to-neutrophil ratio as biomarkers for differentiating between fungal and bacterial infection in necrotising otitis externa.

Necrotizing otitis externa (NOE) is a serious, progressive, and potentially life-threatening infection of the external auditory canal, affecting soft tissue and bone. The most common organism causing NOE is Pseudomonas Aeruginosa and less common are Fungal infections. When managing a patient with NOE, a culture is taken from the EAC in order to tailor the appropriate antimicrobial treatment, however commonly, the culture is sterile. Inflammation biomarkers may be used as adjuncts to inform on the differential diagnosis and as prognostic markers. To characterize and compare values and ratios of components of the complete blood count (CBC) at admission, at patients with positive swab culture. A retrospective study of NOE patients was conducted. We included all patients admitted between the years 2001-2023, for whom a culture swab tested positive. We compared CBC findings at hospitalization between bacteria and fungi-positive culture patients. Eosinophils-to-Neutrophils Ratio (ENR) was significantly lower in the fungal group compared to the bacterial group 0.023 ± 0.02 and 0.04 ± 0.03, respectively (p-value = 0.025). Eosinophils-to-Leukocyte Ratio (ELR) was significantly lower in the fungal group compared to the bacterial group 0.058 ± 0.04 and 0.12 ± 0.1 respectively (p-value = 0.009). For definition of ELR ≤ 0.1 we found that, sensitivity was 88% (95%CI = 0.679-0.979) and NPV 90% (95%CI = 0.709-0.982). For definition of ENR ≤ 0.03 sensitivity was 88% (95%CI = 0.679-0.979) and NPV 88% (95%CI = 0.679-0.979). Lower values of ELR and ENR in patients with NOE are associated with fungal infection and can serve as a tool in adjusting an appropriate antimicrobial therapy in cases of sterile or when no culture is available.

Diagnosis and medical treatment of otitis externa in a ragdoll cat: A case report

Otitis is a disease that is often found due to the cat's ears being unclean and causing earwax to build up along with fluid. Otitis is caused by inflammation of the epithelium of the ear canal and also surrounding structures such as the external auditory meatus and pinna. A 3-month-old Ragdoll cat, male, with white and black hair on the ears, was examined with complaints of head tilting and frequent head shaking, pus in the ears, and inflammation. Clinical examination revealed erythema. The ear wax swab examination results showed an Otodectes cynotis mite infection. The results of the bacterial culture examination showed the presence of Klebsiella sp bacterial infection. The animal was diagnosed with otitis externa. Treatment for otitis externa is given by Dexamethasone, Erlamycetin® (Chloramphenicol 1%), Ivermectin, and lidocaine. The accumulated earwax is also cleaned using a cotton bud and saline. Five days after therapy the cat showed recovery.

Antimicrobial effect of chamomile-containing over-the-counter ear and eye drops.

Chamomile (Matricaria chamomilla) is a plant with known antimicrobial, anti-inflammatory, and analgesic properties. Homeopathic drops containing chamomile extract are often used for ear pain and chronic ear infections. We aimed to evaluate the antimicrobial effect of over-the-counter eardrops containing chamomile against organisms causing bacterial conjunctivitis and otitis externa. Liquid cultures of Streptococcus aureus and Pseudomonas aeruginosa were exposed to increasing concentrations of eardrops containing chamomile extract. Liquid cultures of S. aureus and Streptococcus pneumoniae were exposed to increasing concentrations of chamomile eye drops for 5, 10, 15, and 45 min. Colony forming units (CFUs) were assessed after 18 h. Viability assays for these organisms were performed using the resazurin microdilution assay. We observed a reduction in the number of P. aeruginosa CFUs when the bacteria were exposed to any of the three concentrations of the chamomile drops as early as 5 min, with maximal reduction upon exposure to the 30% concentration at 45 min. Reduction in S. aureus CFUs, on the other hand, was observed for all three concentrations as maximal in the 5 min of exposure. We observed a marked reduction in the number of S. aureus CFUs upon exposure to any of the three preparations of chamomile-containing eye drops, which was almost immediate at 10% concentration. Streptococcus pneumoniae reduction happened at 5 min and continued through the 45-min observation period for all three concentrations. Our findings suggest that over-the-counter ear drops containing chamomile extract could potentially be used as a non-prescription treatment for mild cases of otitis externa and bacterial conjunctivitis.

A pilot study of antimicrobial effects and ototoxicity of a Norway spruce (Picea abies) resin-based canine otic rinse product.

Norway spruce (Picea abies) resin-based products are used in human medicine. A resin-based otic rinse also could be useful in supportive care of canine otitis externa (COE), yet information on its antimicrobial effect against canine pathogens or ototoxicity is lacking. To investigate the antimicrobial properties and ototoxicity of a commercial resin-based otic product. Antimicrobial effect was evaluated using a standardised challenge test on Staphylococcus pseudintermedius, Corynebacterium auriscanis, Pseudomonas aeruginosa, Escherichia coli, Malassezia pachydermatis, and Streptococcus halichoeri strains to measure reduction in growth after 24 h exposure to the product. Effect on cell morphology was investigated by exposing S. pseudintermedius, C. auriscanis, P. aeruginosa and M. pachydermatis to the product in 20% and 100% (v/v) concentrations for 6, 24 and 48 h, and evaluating cells by transmission (TEM) and scanning (SEM) electron microscopy. An invitro microbial kill-rate assay also was performed. Auditory brain stem response test, clinical evaluation and postmortem histological evaluation of ear canals were undertaken on experimental guinea pigs treated with the test product or saline controls. The product showed >log 5 growth reduction for all strains in the challenge test. TEM and SEM images showed clear changes in the cells' inner structures and deterioration of cells, and 100% (v/v) test product exposure induced microbial killing in 1-2 h. Ototoxicity was not detected in guinea pigs. The product may be an option in supportive care of COE because of antimicrobial effects and lack of ototoxic properties in a guinea pig model.

Bacteriology of Otitis Externa in a Tertiary Health-care Institution in Nigeria

Abstract Background: Otitis externa is the inflammation of the external auditory canal (EAC); it may be acute, subacute, or chronic in nature and the causative agents are usually bacteria, though occasionally fungi. Aim: This study aimed to determine the prevalence of bacterial acute otitis externa (AOE) and the pattern of bacterial isolates in AOE. Material and Methods: This was a cross-sectional, hospital-based study involving 100 patients with otitis externa. Patients were recruited from ear, nose, and throat (ENT) outpatient clinic using consecutive sampling technique until the required sample size was achieved. The discharge from discharging ears was taken with ear swabs and evaluated for microbial agents. Data analysis was done using SPSS-IBM version 25. Results: A total of 100 patients were recruited; the patients aged from 4 to 57 years (mean age is 18.78 ± 10.67) years, with a male-to-female ratio of 1:1.1. One hundred and twenty-four external ear discharge samples were cultured among 100 study groups, of which bacteria was isolated in 77 (62.1%) and no bacterial agent was isolated in 47 (37.1%). Pseudomonas aeruginosa 32 (41.6%) was the most common bacteria isolated, followed by Staphylococcus aureus – 13 (16.9%); others include Proteus mirabilis – 7 (9.0%), Escherichia coli – 4 (5.2%), Streptococcus pneumonia – 4 (5.2%), Klebsiella pneumoniae – 3 (3.9%), Streptococcus pyogenes – 3 (3.9%), and Enterobacter aerogenes – 2 (2.6%). Conclusion: Otitis externa affects all age groups and genders; bacteria are a more prevalent causative agent. The common predisposing factors are the use of objects in scratching or cleaning EAC, use of earpiece, and swimming. The prevalence of bacterial otitis externa was 7.1%, and Gram-negative aerobes are the most prevalent.

Antimicrobial susceptibility pattern of bacteria isolated from patients with Otitis externa attending a tertiary health-care institution in Sokoto, Nigeria

Abstract Background: Otitis externa is the inflammation or infection of the skin of the external auditory canal, may be acute, subacute, or chronic and usually manifests by itching of the ear, otalgia, otorrhoea, aural fullness, and hearing loss. The causative agent is usually bacteria and occasionally fungi but may be associated with a variety of noninfective systemic or local dermatological conditions such as eczema, seborrhea, and contact dermatitis. Aim: This study aimed to determine the risk factors, bacterial profile, and antimicrobial susceptibility pattern of the isolates from patients with Otitis externa. Methods: A descriptive cross-sectional hospital-based study was conducted on 100 patients with Otitis externa. The ear discharge specimens were collected and analyzed by standard microbial techniques. The antibiotic susceptibility profiles were determined for 12 different antibiotics by the standard disk diffusion method. Data were analyzed with SPSS version 25 and the P < 0.05 was considered statistically significant. Results: The age of the 100 participants ranges from 4 to 57 years with a mean age of 18.78 ± 10.67 standard deviation, and the commonly affected age group was 11–20 years. Pathogens were isolated from 77 (62.1%) of the patients. The predominant isolate was Pseudomonas aeruginosa 32 (41.6%), followed by Staphylococcus aureus 13 (16.9%), others include Proteus mirabilis 7 (9.0%), Peptostreptococcus species 5 (6.5%), Escherichia coli 4 (5.2%), Streptococcus pneumonia 4 (5.2%), Klebsiella pneumonia 3 (3.9%), Streptococcus pyogenes 3 (3.9%), Enterobacter aerogenes 2 (2.6%), Fusobacterium species 2 (2.6%), and Bacteroides 2 (2.6%). Ofloxacin showed good susceptibility to isolated aerobes 65 (95.6%), followed by gentamicin 52 (76.5%) and ceftriaxone 50 (73.5%). All isolated anaerobes showed 100% susceptibility to metronidazole and clindamycin. Bacterial isolates identified in this study showed a trend of multiple drug susceptibility, majority (70%) being susceptible to three or more antimicrobials. Conclusions: Majority of the bacterial isolates were susceptible to more than one antimicrobial agent, hence efforts to isolate microorganisms and determine the susceptibility pattern should be strengthened to improve the treatment outcome of Otitis externa instead of the usual trend of empirical treatment.

Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections.

We describe detection of the previously rarely reported gram-positive bacterium Auritidibacter ignavus in 3 cases of chronic ear infections in Germany. In all 3 cases, the patients had refractory otorrhea. Although their additional symptoms varied, all patients had an ear canal stenosis and A. ignavus detected in microbiologic swab specimens. A correct identification of A. ignavus in the clinical microbiology laboratory is hampered by the inability to identify it by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Also, the bacterium might easily be overlooked because of its morphologic similarity to bacterial species of the resident skin flora. We conclude that a high index of suspicion is warranted to identify A. ignavus and that it should be particularly considered in patients with chronic external otitis who do not respond clinically to quinolone ear drop therapy.

Exposure to blue light reduces antimicrobial resistant Pseudomonas aeruginosa isolated from dog ear infections.

Pseudomonas aeruginosa is a leading cause of canine otitis externa. Enrofloxacin is often applied topically to treat this condition, although recalcitrant and recurring infections are common. There is evidence that exposure to blue light (400-470 nm) has a bactericidal effect on P. aeruginosa and other microorganisms. In the present study, we tested the biocidal effect of blue light (375-450 nm), alone or in combination with enrofloxacin, against six isolates of P. aeruginosa from dogs with otitis externa (5 of which were resistant to enrofloxacin). Treatment of planktonic cell cultures with blue light resulted in significant (p < 0.5) reductions in Colony Forming Units (CFU) for all seven strains tested, in some cases below the limit of detection. The greatest bactericidal effect was observed following exposure to light at 405 nm wavelength (p < 0.05). Exposure to blue light for 20 min usually resulted in a greater reduction in Pseudomonas aeruginosa than enrofloxacin treatment, and combination treatment typically resulted in the largest reductions in CFU. Analysis of the genome sequences of these strains established that enrofloxacin resistance was likely the result of a S466F substitution in GyrB. However, there was no clear association between genotype and susceptibility to blue light treatment. These results suggest that blue light treatment, particularly at 405 nm wavelength, and especially in combination with enrofloxacin therapy, could be an effective treatment for otherwise recalcitrant canine otitis externa caused by Pseudomonas aeruginosa. It may also provide a way of extending the usefulness of enrofloxacin therapy which would otherwise be ineffective as a sole therapeutic agent.

Evaluation of canine tympanic membrane integrity using positive contrast computed tomography canalography.

The assessment of the integrity of the tympanic membrane (TM) can be a diagnostic challenge in patients with otitis externa and/or otitis media (OM) under an otoscopic examination. In computed tomography (CT), the TM is not always visualized. However, a positive contrast canalography using conventional radiography has been previously described to evaluate the TM integrity. This single-center study aimed to describe the positive contrast canalography technique in CT and its usefulness in identifying TM integrity in 11 dogs. Dogs with clinical signs of ear disease underwent CT canalography following a systematic protocol. The presence of contrast medium and contrast homogeneity within the tympanic cavity was assessed, confirming TM rupture when contrast medium was present in the tympanic cavity. CT canalography was performed in 16 ears, and in 7 of the 16 ears (44%), there was a contrast in the tympanic cavity, confirming TM rupture (positive CT canalography result). In two of the seven cases (29%), rupture of the TM was identified in both otoscopic and CT canalography. In the remaining five of the seven (71%) positive CT canalography results, tympanic membrane rupture was identified only by CT canalography. In conclusion, a positive contrast CT canalography is a complementary and safe technique to assess TM integrity, with a potentially higher sensitivity than otoscopic examination for the diagnosis of TM rupture in dogs.

External Otitis: Epidemiological, Clinical, Etiological, and Therapeutic Aspects at the Oto-Rhino-Laryngology Department of Mamou Regional Hospital

External Otitis: Epidemiological, Clinical, Etiological, and Therapeutic Aspects at the Oto-Rhino-Laryngology Department of Mamou Regional Hospital

Инфекционные заболевания у пациентов с сахарным диабетом: обзор литературы

Diabetes mellitus is associated with increased susceptibility to infectious diseases. This is due to the fact that uncontrolled hyperglycemia is accompanied by impaired innate and adaptive immune response, micro- and macroangiopathies, neuropathy, and decreased urine antibacterial activity. Furthermore, complications of diabetes mellitus such as neuropathy and peripheral vascular disease can lead to skin ulceration with secondary bacterial infections. Bacteria can invade any organ of the human body, with the most common foci of infection in diabetes mellitus being the urinary tract, respiratory tract, skin, and soft tissues. Some infectious diseases are specific to patients with diabetes mellitus, such as malignant external otitis media, foot infections, and nasopharyngeal mucormycosis. Infectious processes may be the first manifestations of diabetes mellitus or provoking factors for inherent complications such as diabetic ketoacidosis and hypoglycemia. Glucose control can be an alternative tool in infection control not only in patients with diabetes mellitus. In addition, controlling hyperglycemia offers the potential to improve the outcome of some infectious diseases.

Fungal Agents Causing Chronic Otitis Externa with Their Antimicrobial Susceptibility Pattern at RMCH

Fungal Agents Causing Chronic Otitis Externa with Their Antimicrobial Susceptibility Pattern at RMCH

Efficacy and safety of topical combination therapy in patients with acute otitis externa

To study the structure of the microbial landscape in patients with acute otitis externa, as well as to evaluate the efficacy and safety of the combined drug chloramphenicol/clotrimazole/beclomethasone/lidocaine (Candibiotic) as an empirical therapy of this disease. In this retrospective study of real clinical practice, outpatient records of 963 patients who applied to the KDO of the Sverzhevsky Research Clinical Institute of Otorhinolaryngology with symptoms of otitis externa in the period from 2017 to 2022 were selected. Additional analysis was carried out on the clinical records of patients who received the combined drug Candibiotic. The endpoints of this analysis included data on the clinical and microbiological efficacy of therapy, as well as safety information. According to microbiological testing, 60.6% of microorganisms belonged to bacterial flora, 26% were bacterial-fungal associations, 11.6% were monofungal flora, in 1.8% of cases there was no growth of microorganisms. The most frequently isolated microorganisms were: Pseudomonas spp (n=291; 29.16%), Staphylococcus spp. (n=214; 21.4%), Candida spp. (n=194; 19.4%), Aspergillus spp. (n=133; 13.3%). Most of the patients (71.0%) received Candibiotic. In 69.7% of patients, the resolution of the clinical symptoms of otitis externa occurred within 7 days of therapy with Candibiotic. Complete eradication of microorganisms occurred in 87% of cases. Adverse events were recorded only in 3 (0.04%) cases. The study demonstrated an extremely high level of clinical efficacy and safety of therapy in patients with acute external infectious otitis who received the Candibiotic, which can be used as an initial empirical therapy in patients with otitis externa.

Efficacy of afoxolaner or the combination of afoxolaner with milbemycin oxime against Otodectes cynotis in naturally infested dogs

Otodectes cynotis, commonly known as "the ear mite," is a highly contagious ectoparasite and a significant cause of otitis externa in canines. The objective of the current study was to determine the efficacy of the isoxazoline afoxolaner (Nexgard®), and the combination of afoxolaner with milbemycin oxime (Nexgard Spectra®), in dogs naturally infested with O. cynotis. In total, 32 infested client-owned dogs from two different sites in Greece were included. The animals were randomly divided into four equal groups based on their infestation score. Group 1 served as the negative control, group 2 received one oral administration of Nexgard (Day 0), group 3 received two monthly oral administrations of Nexgard (Days 0, 30), and group 4 received two monthly oral administrations of Nexgard Spectra (Days 0, 30), according to label instructions. Otoscopic examinations for mites and observations on debris/cerumen in the ears were carried out on Days 0, 15, 30, and 45. A quantitative assessment of ear mites by ear duct flushing and live mite counts was performed on Day 45. The results demonstrated that a single oral dose of afoxolaner and two monthly doses of afoxolaner or afoxolaner with milbemycin oxime resulted in a 99.9% reduction in live mite counts compared to the untreated control group by Day 45. Additionally, treated dogs showed improved clinical symptoms, such as ear cerumen/debris decrease, while untreated dogs experienced worsening symptoms over the study duration. No adverse events were reported. Overall, these results support the use of afoxolaner-based products to treat O. cynotis infestation in dogs.

A Rare Complication of Chronic Otitis Media: Septic Thrombosis of the Transverse Sinus and Meningoencephalitis due to a Parameningeal Infection. A Case Report

BACKGROUND: Septic cerebral venous sinus thrombosis or septic cavernous thrombosis is an extremely rare disorder, with 2 to 13 cases per million per year, following the introduction of antibiotics and advances in diagnostic imaging. It is a complex pathology, difficult to diagnose and life threatening. It has a high risk of otoneurologic sequelae, and it requires follow-up by various specialties, as treatment is medical and surgical, including neurology, internal medicine, intensive care, otorhinolaryngology, and infectiology, among others. Due to the low occurrence of septic cavernous thrombosis, the diagnosis may be erroneous or delayed, increasing complications and mortality. It is essential to perform a complete physical examination with emphasis on the ophthalmological, otological, rhinosinusal and neurological examinations, which is why this case is described. THE CASE: We describe a 77-year-old male patient, with history of high blood pressure, nasopharyngeal carcinoma in remission, bilateral hearing loss, prostatic hyperplasia, otitis media, and chronic mastoiditis. He was admitted due sudden onset of difficulty standing, gait instability, mutism, unquantified fever spikes, headache, and vertigo. The initial laboratory tests only revealed a complete blood count with leukocytosis. A simple brain computed tomography (CT) scan did not show relevant findings; therefore, a lumbar puncture (LP) was carried out due to suspicion of bacterial meningoencephalitis. Analysis of cerebrospinal fluid (CSF) showed pleocytosis with a predominance of polymorphonuclear cells, hypoglycorrhachia and hyperproteinorrachia. Empirical antibiotic therapy was started with Vancomycin and Cefepime. At day five since onset of symptoms, he did not have improvements of his symptoms, so a new LP was carried out and antibiotic therapy was escalated. In the CSF it was found an increased cellularity with greater hypoglycorrhachia, persistent hyperproteinorrachia, and cellular shift to lymphocyte predominance. A contrast-enhanced magnetic resonance imaging (MRI) of the brain was requested, showing pyogenic ventriculitis and decreased flow at the left transverse sinus, suggesting possible thrombosis, which was later confirmed with a contrast-enhanced brain angio-MRI. Furthermore, due to the otological involvement, a CT scan of the ears was performed, which showed severe bilateral otomastoiditis with bilateral mastoid cholesteatomas, bilateral otitis externa, and osteomyelitis of the left petrous apex. A diagnosis of a septic thrombosis of the left transverse sinus, in the context of meningoencephalitis secondary to a parameningeal focus, was made. Treatment with Meropenem 1 gr intravenously every 8 hours and Vancomycin 1 gr every 8 hours was continued up to 28 days. During the hospitalization, otorhinolaryngology did a mastoidectomy and continued outpatient antibiotic management with Ciprofloxacin for seven more days. The patient did not require anticoagulation, and at follow-up he was notably recovered, and in control studies the recanalization of the thrombosis was confirmed. CONCLUSION: Septic cerebral venous sinus thrombosis is a rare pathology, but with a high associated morbidity and mortality, which requires multidisciplinary management. It is vital to know its pathophysiology and predisposing factors to include it in differential diagnoses when managing a patient with meningeal symptoms.

Arcanobacterium canis strain DSM 25104 isolated from an English bulldog suffering from otitis externa: complete genome sequence.

Many species of the genus Arcanobacterium are known as opportunistic pathogens and have been isolated in association with infectious diseases in humans and animals. Here, we present the complete genome sequence of another opportunistic pathogenic representative, namely Arcanobacterium canis, isolated from the otitis externa of an English bulldog.

Is it now time to iron out the wrinkles? Health of Shar Pei dogs under primary veterinary care in the UK

BackgroundThe Shar Pei is a common dog breed with a distinctive appearance caused by hyaluronosis that has been linked with several health conditions. Anonymised primary-care veterinary clinical records were explored to extract data on the demography, common disorders and mortality of Shar Pei in the UK in 2013.ResultsThe study population of 455,557 dogs included 1913 (0.42%) Shar Pei. The mean adult bodyweight was 22.26 kg. The most prevalent fine-level precision disorders were entropion (prevalence 17.88%, 95% CI: 16.16-19.59), otitis externa (16.36%, 95% CI: 14.70-18.02), ear disorders (6.69%, 95% CI: 5.57-7.81), aggression (5.23%, 95% CI: 4.23-6.22), and pyoderma (4.29%, 95% CI: 3.38-5.19). The most prevalent disorder groups were ophthalmologic (prevalence = 22.27%, 95% CI: 20.40-24.13), dermatological (21.01%, 95% CI: 19.19-22.84), aural (18.66%, 95% CI: 16.92-20.41), traumatic injury (7.53%, 95% CI: 6.35-8.71) and behavioural (7.21%, 95% CI: 6.05-8.37). The median longevity of 190 Shar Pei that died during the study period was 7.28 years (IQR 5.04-10.05, range 0.04-15.04). Of 184 deaths with a recorded method of death, 157 (85.33%) deaths involved euthanasia and 27 (14.67%) deaths were unassisted. Among 136 (71.58%) deaths with a recorded biomedical cause of death, the most common causes of death at group level precision were neoplasia (15.44%, 95% CI: 9.37-21.51), renal disorders (13.24%, 95% CI: 7.54-18.93), and behavioural disorders (11.03%, 95% CI: 5.76-16.29).ConclusionsAlmost one fifth of Shar Pei receive veterinary care each year for entropion, a condition linked strongly with the extreme conformation of thickened and folded skin and bristly hair that characterises the Shar Pei breed. Several other common disorders are also linked to hyaluronosis. Current UK legislation can help support efforts to avoid breeding or acquiring animals with extreme conformations and to promote adequate veterinary care for already-owned animals with extreme conformations.