Otitis Externa Research Articles

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

External Auditory Canal Erosion at the 6 O'clock Spot.

To report a common site of external ear canal erosion in multiple pathologies, located inferiorly at 6 o'clock. Otology patients who came in 2023 for treatment of external auditory canal erosions. This clinical capsule is an observational report of the external canal's propensity to erosion at the 6 o'clock location. Patient treatments were canalplasty, mastoidectomy, and medical management. Documentation of the propensity to erosion at the 6 o'clock location in the external auditory canal. Locations of the niduses of prior series of external auditory canal pathologies are documented. Eight patients are presented with external auditory canal erosion in 10 ears originating at the 6 o'clock position medial to the bony-cartilaginous junction. No other patient with spontaneous canal erosion presented with their nidus of pathology in another canal location. (A review of 42 case series of 291 patients found that keratosis obturans and bisphosphonate-induced osteonecrosis tended to arise from the same 6 o'clock lateral bony canal location, while 26% of necrotizing otitis externa cases arose there.). The "6 o'clock spot" in the external canal is a common location of canal erosion for spontaneous wax and keratin collections and may be the precursor to keratosis obturans, bisphosphonate-induced osteonecrosis of the ear canal, and necrotizing otitis externa.

Can We Minimize the Risk of Dogs Developing Canine Otitis Externa?-A Retrospective Study on 321 Dogs.

Background: Canine otitis externa is a common presentation in small animal practice. The clinical signs vary individually from patient to patient. Regardless of the expression, they all decrease the quality of life. Therefore, this study aimed to identify factors that showed reduced odds for otitis externa. Methods: Clinical case records were searched for key terms regarding canine otitis. Statistical analyses were applied to evaluate associations with otitis externa. p-values of <0.05 were considered statistically significant. Results: Rhodesian Ridgeback and dogs with underlying infectious diseases had a reduced risk for otitis externa, while Retrievers and dogs with allergies had an increased risk. Furthermore, in the group of dogs with endocrinopathies, those with normal weight showed a reduced risk of developing canine otitis in comparison to those which were overweight. Conclusions: These results show a new point of view to reduce the prevalence of canine otitis by reducing the animals' weight due to an additional risk of otitis in obese or overweight dogs. Furthermore, for the first time, Rhodesian Ridgebacks were identified in our study population to have a lower risk of developing otitis externa. Thus, breeders should reflect-within other responsibilities for the quality of life in their offspring-on breed-specifics about otitis when planning ahead.

In vitro efficacy of lavender oil, otological gel and gentamicin to eradicate biofilm produced by Pseudomonas aeruginosa.

Otitis externa (OE) is one of the most frequently diagnosed dermatological diseases in dogs, having a multifactorial aetiology. Among the bacterial agents associated with canine OE, Pseudomonas aeruginosa is of special concern owing to its frequent multidrug resistance profile and ability to form biofilms related to the infection's chronicity and recurrence. The main objective of this study was to evaluate and compare the antibiofilm activity of two innovative antimicrobials-an otological gel containing a synthetic antimicrobial peptide and Lavandula angustifolia essential oil-with gentamicin (a conventional antibiotic) using biofilm-producing P. aeruginosa isolates obtained from dogs with OE. The biofilm eradication capacity of gentamicin, otological gel and lavender oil was determined against a collection of 12 P. aeruginosa biofilm-producers among 35 clinical isolates obtained from the ear canals of dogs with OE. Also, the antimicrobial activity of the otological gel against P. aeruginosa biofilms was assessed in an invitro model of dog cerumen. Lavender oil showed the best effectiveness after 30 min of contact, eradicating 58.3% (seven of 12) of the isolates, and gentamicin showed full eradication (12 of 12) after 24 h. The otological gel acted more slowly than the lavender oil; yet at 24 h, the antibiofilm capacity of both compounds was similar, with no significant difference between them. It also was found that triglycerides from synthetic cerumen earwax had antipseudomonal activity and, when combined with the otological gel, led to the full eradication of P. aeruginosa. The results of this invitro study indicate that lavender oil and the otological gel may be effective topical treatments for canine OE promoted by P. aeruginosa biofilm-producers, as alternatives to gentamicin.

Effect of ear cleaning on treatment outcome for canine otitis externa.

Ear cleaning is often recommended for management of canine otitis externa (OE). Few invivo studies evaluate how ear cleaning affects treatment outcome. To determine the effect of ear cleaning on canine OE by comparing treatment outcome in cleaned versus noncleaned ears. Twenty-three client-owned dogs with ceruminous or purulent OE. Forty ears were randomised to one of two groups: 20 ears were wiped with dry or saline-moistened gauze (grp1), and 20 external ear canals received manual cleaning (grp2) with a commercial product. One millilitre of a commercial otic suspension containing hydrocortisone aceponate, miconazole nitrate and gentamicin sulfate was applied to affected ears every 24 h for five days. Cytological scores, modified otitis index score (OTIS3), pruritus Visual Analog Scale (PVAS), modified PVAS and client questionnaire were compared on Day (D)0 and D7. There were no statistical differences between cytological scores, modified OTIS3, PVAS, modified PVAS or client assessments between groups at D7. Both groups had significant reduction in all treatment parameters from D0 to D7 with the exception of cytological rod scores that were only significantly decreased in cleaned ears. There was a significant difference in OTIS3 before and after cleaning on D0. Both groups achieved successful outcome regardless of cleaning. Ear cleaning may be more important when rod-shaped bacteria are present.

Aetiologies of Ear Infections Among Patients Who Visited King Fahad Hospital in Al-Baha, Saudi Arabia.

Background Ear infections encompass otitis media (OM) which is a significant cause of hearing loss and otitis externa (OE) which may affect the surrounding tissues leading to serious complications. This study reports the common pathogens causing ear infections. Methods Microbiological, clinical, and demographic data of ear-infected patients who visited King Fahad Hospital in Al-Baha, Saudi Arabia, during the period from January 2019 to June 2023 were enrolled in this study. Result This study enrolled 307 patients aged 1-94 years, with a median age of 40 years (IQR=22-57). Overall, the detectable infection rate was 81.1% (n=249), while 18.9% (n=58) had no identified aetiology.Of all isolates, 178 (58%) were bacterial, while 71 (23.1%) were fungal. Staphylococcus aureus (S.aureus) followed by Pseudomonas aeruginosa(P.aeruginosa), Enterobacteriaceae, andcoagulase-negative Staphylococcus (CoNS) were the main bacterial isolates. Of the total 63 S. aureus isolates, 21 (33%) were methicillin-resistant (MRSA). A cohort of 227 subjects were diagnosed with either OM (n=178; 79.5%), OE (n=46; 20.5%), or both OM and OE (n=3; 1%). Of those with OM, children constituted 89.1% (41/46) as compared to 75.3% (134/178) of adults (p=0.041). The main isolates from OM patients were S.aureus followed by P.aeruginosa and fungi. Of 49 OE patients, 16 (32.7%) had no identified pathogen, while 15 (30.6%) had fungi, and 13 (29.5%) had P.aeruginosa. Conclusions Ear infections in general were mainly bacterial followed by fungal with a considerable proportion of unidentified aetiology. A significant proportion of S.aureus isolates were MRSA.S.aureus followed by P. aeruginosa and fungi were the main causes of OM, while fungi followed by P.aeruginosa were the main causes of OE.

Otomycosis: Epidemio-Clinical and Therapeutic Profile at the Fousseyni DAOU Hospital in Kayes, Mali

Introduction: Otomycosis is a relatively common pathology of the external ear canal, its prevalence is estimated to be 5 to 10% of all otitis externa [1,2, 3]. There are no data on otomycosis at the Kayes Hospital, hence the interest of this study. Methodology: This was a descriptive study with retrospective data collection that spanned the period from January 1, 2021 to December 31, 2023. All patients with clinically suspected otomycosis on otoscopy, otoendoscopy and/or confirmed on mycological examination and with usable medical records were included. Results: We recorded 1156 cases of otitis externa, including 384 cases of otomycosis, i.e. a frequency of 33.2%. Females were the most represented at 51.6% (n=198) with a sex ratio of 0.93. The mean age was 37 years with extremes of 7 and 77 years. The reasons for consultation were: otalgia 44.8% (n=172), pruritus 35.2% (n=135), otorrhea 20% (n=77). The main contributing factors were cleaning the ear with cotton swab, 57.8% (n=221), wearing a turban 26.3% (n=101), and using antibiotic and corticosteroid drops 9.6% (n=37). The otologic examination revealed whitish or blackish deposits, purulent otorrhea and inflammation of the external auditory canal. Mycological examination found yeasts 42.3% (n=122) and molds 57.2% (n=163). Treatment was based on topical antifungals and antibiotics in 69% (n=265) and the combination of antifungal and antihistamine in 31% (n=119). Conclusion: Otomycoses are benign, chronic infectious pathologies. Their occurrence is multifactorial. Cleaning with the cotton swab and wearing the turban were the main causes. Keywords: Otomycosis, Fousseyni DAOU Hospital in Kayes.

Acute Otitis Externa and Cost Analysis in a Tertiary in Malaysia

Acute Otitis Externa and Cost Analysis in a Tertiary in Malaysia

Chemical stability and invitro antimicrobial efficacy of diluted silver sulfadiazine powder and cream over a six-month period.

Silver sulfadiazine (SSD) is commonly formulated into otic preparations to treat otitis externa, although evidence of stability and antimicrobial efficacy with long-term storage is lacking. To evaluate the effect of storage time on chemical stability and invitro antimicrobial activity of SSD diluted in sterile water, including two 1% suspensions using SSD pharmaceutical-grade powder stored at room temperature (RT) in plastic or sterile glass bottles, and a 1:9 dilution using prescription SSD 1% cream stored at RT in a sterile glass bottle. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) assessed chemical stability. Trimethoprim/sulfamethoxazole-susceptible and trimethoprim/sulfamethoxazole-resistant strains of Staphylococcus pseudintermedius (SP), meticillin-resistant (MR) SP, S. schleiferi (SS), MRSS, Pseudomonas aeruginosa, Proteus mirabilis and Escherichia coli evaluated by 24 h time-kill analysis assessed invitro antimicrobial efficacy. Each assessment was performed at zero, one, three and six months of storage. LC-MS/MS showed no significant change in concentration over time for any suspension. When adjusted for time and species/strain, all SSD suspensions showed significant reductions in colony forming units (cfu)/mL at 24 h (p < 0.001). Including all suspensions, a bactericidal effect (minimum 3-log cfu/mL reduction at 24 h) occurred against 94% of total isolates, with failure against 33 of 552 isolates (6%). Bactericidal failure was more likely with the cream-based suspension (p < 0.05) and at six months (p < 0.01). Powder-based and cream-based SSD/sterile water suspensions showed no significant change in concentration and demonstrated invitro antimicrobial activity for six months. Bactericidal failure was more likely with the cream-based suspension and after six months of storage.

Risks for Enlisted Navy Divers Compared to Other Enlisted Sailors: An Examination of Illnesses That May Be Associated With Exposure to Contaminated Water Diving.

Illnesses among Navy divers degrade readiness, decrease manpower levels, and increase costs for medical care. Prior research has shown that Navy divers have high rates of the types of illnesses that might be because of diving in contaminated water. The objectives of this study were to examine medical records of U.S. Navy Sailors from 2016 to 2022 and determine if divers have higher incidence rates of health conditions that might be associated with contaminated water diving compared to non-divers. For this retrospective cohort study, we used data from the Defense Medical Epidemiology Database (DMED). The DMED is operated by the Armed Forces Health Surveillance Division and uses data from the Defense Manpower Data Center to classify occupations. The DMED provides free online access to a de-identified subset of data contained within the Defense Medical Surveillance System.The population was U.S. Navy enlisted males, aged 25 to 29 years. Divers were compared to non-divers using 8 selected diagnoses that may reasonably be associated with diving in contaminated water. During the study period, the database contained a total of 5,474 diver and 827,406 non-diver person-years. Of the 8 diagnoses, the ones with the largest number of cases for divers were upper respiratory infections with 128 and ear disorders with 62. The relative risks (RRs) for divers compared to non-divers were higher for otitis externa (RR = 1.44; confidence interval = 1.03, 2.01) and for ear disorders (RR = 1.15; confidence interval = 0.89, 1.47); for the other 6 diagnoses, the divers had lower rates than the non-divers. The high RRs found for otitis externa and ear disorders support the need to devote resources to better understand the reasons for these higher risks and to develop, test, and implement targeted risk-reduction strategies. Future studies should attempt to link verified contaminated water exposures with adverse health outcomes and calculate risks based on criteria such as age and dive factors.

Therapeutic efficacy of cold atmospheric plasma in four golden retrievers with acute otitis externa.

Cold atmospheric plasma (CAP) is a new therapeutic tool used to treat various skin diseases in humans and animals. To evaluate the effect of CAP in the treatment of canine acute otitis externa (AOE). Four client-owned golden retriever dogs with bilateral AOE. After cleaning with a commercial ear cleanser, right ears (STANDARD group) were treated with an antibiotic/antifungal/corticosteroid combination and left ears (CAP group) were treated with CAP every three days for a total of four treatments. Cytological score and otitis index score (OTIS)3 were recorded for each ear on Day (D)0, D10 and D15. At D10 and D15, owners and investigators recorded an overall assessment. In both groups, OTIS3 and cytological score decreased over the study period. The overall assessment scale ranged from moderate to excellent in both groups. Cold atmospheric plasma treatment showed equal therapeutic effect compared with a commercial topical anti-inflammatory and antimicrobial ear treatment.

Otitis externa caused by an exotic organism – Otodectus cynotis

Otitis externa caused by an exotic organism – Otodectus cynotis

A Retrospective Study (2019-2023) on the Prevalence and Antimicrobial Resistance of Isolates from Canine Clinical Samples Submitted to the University Veterinary Hospital in Stara Zagora, Bulgaria.

The identification of local susceptibility patterns is important for the elaboration of effective local antimicrobial use guidelines and improvement in treatment outcomes. This retrospective study investigated the prevalence of microbial pathogens in dogs over a five-year period (2019-2023) and their antimicrobial resistance patterns with an emphasis on multidrug-resistant strains on the basis of 896 swab samples submitted to the microbiological laboratory at the University Veterinary Hospital, Stara Zagora, Bulgaria. A total of 1247 strains-1046 bacteria and 201 yeasts-were isolated. An increased proportion of Staphylococcus spp. as an agent of infections in dogs along with significant decrease in the share of Streptococcus spp. (from 16.2% in 2019 to 7.7% in 2023) was found. The occurrence of Staphylococcus spp. in otitis externa increased from 53.4% in 2019 to 84.5% in 2023 (p < 0.0001). The resistance of Staphylococcus spp. isolates to amoxicillin/clavulanic acid and cephalexin increased significantly in 2023 vs. 2022. At the same time, increased susceptibility to amikacin was observed in 2023 vs. 2019. For Enterobacteriaceae, significantly decreased resistance against amikacin and marbofloxacin was demonstrated in 2023 compared to 2019. Multidrug resistance (MDR) was present in 405 of 1046 bacterial isolates (38.7%). More than 50% of streptococci and pseudomonads were MDR. Of the MDR staphylococci, 41.7% were isolated from skin lesions and 28.3% were isolated from otitis. More than half of the strains resistant to seven, eight and nine groups of antimicrobial drugs (AMDs) were from wounds/abscesses. The results highlighted the importance of regular local monitoring of the spread of bacterial strains in veterinary clinics and their susceptibility to AMDs with regard to successful therapy outcomes and control on MDR spread.

Knowledge Level and Frequency of Swimming to the Incidence of Otitis Externa in Swimming Athletes in Medan

Highlights: The level of knowledge of respondents who had experienced otitis externa and often do swimming activities had sufficient knowledge about otitis externa. Frequent swimming can cause a person to experience otitis externa. Abstract Introduction: Otitis externa, also called swimmer's ear, is a common disease in swimmers and poses a significant public health problem. Frequent exposure to water for long periods is very susceptible to infection. This study aimed to ascertain the level of knowledge regarding the connection between otitis externa and swimming and investigate whether there was a correlation between the frequency of swimming and the occurrence of otitis externa. Methods: Using a questionnaire, the sample comprised 74 Tirta Prima Medan Swimming Association members in 2022. Apart from evaluating descriptive comparisons of pretest and post-test knowledge levels, this study also conducted a Spearman rank correlation test to determine the correlation between knowledge level and frequency of swimming with the incidence of otitis externa. The chosen significance level (p) was 0.05. Variables were considered related if the p-value was &lt; 0.05 and not considered related if the p-value was &gt; 0.05. The International Business Machines Corporation (IBM) Statistical Package for the Social Sciences (SPSS) version 26.0 for Windows was used for statistical analysis. Results: Of the 74 study participants, pretest knowledge was categorized as follows: good level of knowledge (6.8%) of respondents, sufficient (58.1%), and (35%) poor. In the post-test assessment, respondents showed good (75.7%), sufficient (21.6%), and poor (2.7%) knowledge. The results of the Spearman analysis test showed a significant correlation (p-value = 0.042) between swimming frequency and the incidence of otitis externa. Meanwhile, there was no significant correlation between the level of knowledge about otitis externa and the incidence of otitis externa, with a p-value of 0.785. Conclusion: The level of knowledge for the pretest was sufficient. For the same respondents, the post-test results showed good knowledge. There was a correlation between swimming frequency and the incidence of otitis externa. However, there was no significant correlation between the level of expertise and the incidence of otitis externa at the Tirta Prima Medan Swimming Association.

Otitis in paediatric practice: clinic presentation, diagnosis, role of topical therapy

The article considers the main pathological processes in the outer and middle ear, which are detected at the primary paediatric visit. A particular focus has been placed on the importance of otoscopy and the need for sustainable routing of a child with ear pain. The basic principles for the treatment of acute external and otitis media in children are outlined, and indications for additional examinations and systemic antimicrobial therapy are determined. The benefits of topical combination ear drops in the treatment of acute external and otitis media are presented. The benefits of combination ear drops in the treatment of ear pathology in children from 6 years of age are demonstrated by examples of clinical studies and retrospective analysis of clinical efficacy. Clinical cases from our own observations are presented: a 7-year-old patient with acute non-perforative otitis media and a 12-year-old patient with acute exacerbation of chronic external otitis, myringitis. The combination ear drops containing chloramphenicol, beclomethasone dipropionate (anhydrous), clotrimazole and lidocaine hydrochloride monohydrate demonstrated high clinical efficacy. The combination drug with a beneficial and clinically proven effect can help solve the issue of otitis in children from 6 years of age. The authors have developed a treatment and prevention reminder for ear pathologies in children, which will help the paediatrician explain the main principles of treatment and prevention of otitis media to parents in an easily accessible form. It was concluded that ear pathology is a current and multi-etiological challenge that requires attention and expert knowledge of a paediatrician. The active parental involvement in ear pathology prevention in their child will help their children to grow physically healthy.

CLINICAL COMPLICATIONS OF MALIGNANT OTITIS EXTERNA AND SURGICAL TREATMENT

For clinical complications of malignant otitis externa and its surgical treatment, the introduction addresses a rare and serious condition, characterized by necrotizing infection of the external auditory canal, often associated with comorbidities such as decompensated diabetes mellitus. This condition requires rapid intervention due to the potential for spread to adjacent structures such as the skull and skull base, resulting in serious complications such as facial paralysis, osteomyelitis, and meningitis. Management includes broad-spectrum intravenous antibiotic therapy and, in many cases, surgical intervention to debride necrotic tissue and control infection. Objective: to synthesize recent evidence on the effectiveness of surgical treatments in malignant otitis externa, highlighting clinical outcomes and associated mortality. Methodology: it was structured according to the PRISMA checklist, using PubMed, Scielo and Web of Science databases to search for articles published in the last 10 years. Descriptors included "malignant otitis externa", "surgical treatment", "complications", "mortality" and "intervention". Inclusion criteria were clinical studies and systematic reviews that addressed surgical treatment and clinical outcomes. Exclusion criteria were studies focusing exclusively on non-surgical treatments, isolated case reports and studies with fewer than 10 participants. Results: highlighted the effectiveness of early surgical debridement in reducing mortality and serious neurological complications. The analysis revealed that adjuvant antibiotic therapy and intensive surveillance are crucial for successful management. Conclusion: the importance of a multidisciplinary approach and timely surgical intervention is emphasized to improve outcomes in patients with malignant otitis externa, highlighting the need for further studies to elucidate ideal therapeutic protocols and prevention strategies

In vitro effects of N-acetylcysteine in combination with antifungal agents against Malassezia pachydermatis isolated from canine otitis externa.

Many clinicians prescribe antifungal agents to treat canine otitis externa (OE). However, studies evaluating the antifungal effects of N-acetylcysteine (NAC) and its combinations are limited. The aim of this study was to evaluate the antifungal effects of NAC alone and in combination with other antifungal agents against Malassezia pachydermatis isolated from canine OE. M. pachydermatis samples were collected from 13 dogs with OE. The final concentration of the inoculum suspensions of M. pachydermatis was 1-5×106 colony forming units/mL. The concentrations of the test compounds ketoconazole (KTZ), terbinafine (TER), nystatin (NYS) and NAC were 0.02-300µg/mL, 0.04-80µg/mL, 0.16-40µg/mL and 1.25-20mg/mL, respectively. The minimum inhibitory concentration (MIC) was measured to evaluate the susceptibility of the M. pachydermatis to KTZ, TER, NYS and NAC. The checkerboard testing method and fractional inhibitory concentration index were used to evaluate the effect of NAC in combination with KTZ, TER and NYS against M. pachydermatis. The MIC90 values of M. pachydermatis were 4.6875-9.375µg/mL, 1.25µg/mL, 5-10µg/mL and 10mg/mL for KTZ, TER, NYS and NAC, respectively. The synergistic effects of KTZ, TER and NYS with NAC were identified in 0/13, 2/13 and 0/13 isolates, respectively. NAC had an antifungal effect against M. pachydermatis but did not exert synergistic effects when used with KTZ, TER and NYS. Thus, the use of NAC alone as a topical solution could be considered an effective treatment option for canine OE involving M. pachydermatis.