Common Ear Disease Research Articles (Page 1)

Hearing loss and vertigo occur when there is an imbalance between the two inner ear fluids, endolymph and perilymph. The inner ear is a small delicate structure encased in dense bone deep in the base of the skull, making it challenging to image with high resolution. Because the fluid chambers are so small, there is no reliable way to measure their balance in a living patient to guide therapy. Here, we translated the technology of optical coherence tomography (OCT) for use in the human inner ear. Peering through the otic capsule bone during mastoid surgery, we imaged the lateral and posterior semicircular canals of patients with Ménière's disease or vestibular schwannoma and measured the endolymph-to-perilymph ratio. Compared with normal controls, both patient groups demonstrated increased endolymph and reduced perilymph, a disorder termed endolymphatic hydrops. OCT imaging demonstrated good repeatability for measuring the endolymph-to-perilymph ratio. Our data indicate that increased endolymph-to-perilymph ratios correlated with the degree of hearing loss. Thus, small yet meaningful changes in inner ear fluid balance are detectable with this approach with better resolution than gadolinium-enhanced 3 Tesla magnetic resonance imaging, the current gold standard clinical imaging modality. Our findings support the feasibility of imaging the human inner ear during surgical procedures with OCT and demonstrate the ability to detect endolymphatic hydrops. Moreover, this technique permits the measurement of the fluid chambers within the inner ear in real time during surgical procedures with adequate sensitivity to guide the management of complex but common ear diseases.

Middle ear cholesteatoma is a common ear disease with different manifestations and pathological mechanisms in children and adults.Middle ear cholesteatoma is more severe in children than adults. We aimed to detect the expression of tumor necrosis factor ligand superfamily member 11 (TNFSF11) and tumor necrosis factor receptor superfamily member 11B (TNFRSF11B) and analyze the difference in ear bone destruction in middle ear cholesteatoma in children and adults.Through the comprehensive analysis of related studies, the mechanism of its action in the progression of the disease was expounded, and the theoretical basis for clinical treatment was provided. A total of 18 children and 32 adults with middle ear cholesteatomas were examined. The degree of bone destruction was observed. TNFSF11 and TNFRSF11B expressions in the cholesteatoma and normal external auditory canal skin were detected by immunohistochemistry. Bone destruction was more severe in children with middle ear cholesteatoma. TNFSF11 expression in cholesteatoma was significantly higher in children than adults, whereas expression in external auditory canal skin was not significantly different between groups. Expression of TNFRSF11B in cholesteatoma and external auditory canal skin was not significantly different between children and adults. In children and adults, TNFSF11 in cholesteatomas was not correlated with TNFRSF11B. TNFSF11 expression was positively correlated with the degree of ear bone destruction, unlike TNFRSF11B. TNFSF11 expression in children with cholesteatoma is higher than adults and is involved in the molecular biological mechanism underlying its destructive nature. These findings will help us develop better treatments.

Chronic otitis media (COM) is a common middle ear disease in children and young adults. Dysfunction of the Eustachian tube and bacterial infection are the main causes. This pilot study aimed to describe and compare bacteriomes of the middle ear in children and young adults with serious forms of COM, such as cholesteatoma and retraction pocket (RP) of the tympanic membrane, with bacteriomes in healthy middle ears. Observational study. Clinical practice in a tertiary center. From January 1, 2021 to August 31, 2022. Patients aged 0 to 20 years. In this case-control study, middle ears were swabbed during surgery on children with cholesteatoma (N = 23) or RP (N = 26) and on children indicated for cochlear implant (N = 15, controls). Genomic DNA extraction was followed by creation of a 16S ribosomal DNA gene library and sequencing on a MiSeq instrument. Samples with relative abundance of at least one bacterial genus >20% were considered positive for the specific genus. Bacterial diversity was generally low in the middle ear samples from patients with COM, with DNA content from 1 or 2 bacteria usually dominating in the sample. A significant difference in positivity for one or more bacterial genera was observed between patients with cholesteatoma or RP (38.8%) versus patients indicated for cochlear implants (6.7%). While middle ear bacteriomes in cases of cholesteatoma and RP differed from those of controls, findings in the 2 pathological conditions were similar. These results support the statement that the RP could be a precholesteatoma stage.

Artificial Intelligence in CT Diagnosis: Current Status and Future Prospects for Ear Diseases

BackgroundChronic otitis media is a common middle ear disease that leads to varying degrees of hearing loss and otorrhoea. Tympanoplasty is a common surgery used for the reconstruction of sound conductive pathways in mucosal-type COM.AimsThe study aims to compare the fresh and the dry grafting technique in interlay type-1 tympanoplasty amongst the patients of inactive mucosal type chronic otitis media.ObjectivesThe objectives of the study are to compare graft uptake rate, pre-op and post-op AB gap, residual hearing loss, and average graft epithelialization time between the fresh and the dry grafting technique in interlay type-1 tympanoplasty.MethodsA retrospective cohort study of 48 patients of COM inactive mucosal-type who underwent interlay type-1 tympanoplasty between July 2020 and March 2022.ResultsOut of 48 patients, in 23 patients, the fresh graft was used, while in the rest 25 patients, the dry graft was used. The overall (fresh + dry group) graft uptake rate at the end of three months was 97.9%. The graft uptake rate was 100% with the use of the fresh graft and 96% with the use of the dry graft. The pre-op average air-bone (AB) gap was 12.21 ± 4.23 dB in patients where the fresh graft was used and in patients where the dry graft was used. An overall pre-op average AB gap was 13.35 ± 3.81 dB. The average time for epithelialization was 24.43 ± 4.17 days with the use of the fresh graft and 49.75 ± 6.93 days with the use of the dry graft. It was also statistically significant with a P-value of 0.001.ConclusionsThe fresh graft in the interlay type-1 tympanoplasty shows higher graft uptake rates, reduced epithelialization time, and better hearing improvement compared to dry graft. However, different complication rates are similar with the use of both types of grafts.

With the aging of the population, the deterioration of visual and auditory functions amongst the elderly has attracted much attention. Age-related hearing loss (ARHL) and age-related macular degeneration (AMD) are common eye and ear diseases that seriously affect the quality of life of elderly population. This study utilised a whole cohort sampling method, with a total of 713 participants aged 50 years and older in the community from June 2022 to October 2023, resulting in the inclusion of 620 participants. Demographic information was collected from these participants, and eye and hearing examinations were conducted at Ningde Municipal Hospital affiliated of Fujian Medical University. Spearman's correlation analysis was utilised to investigate the association between ARHL and AMD in patients. Multivariate logistic regression analysis was employed to identify the factors influencing ARHL to provide insights for preventing and treating ARHL and AMD in older individuals. Correlation analysis indicated a significantly positive relationship between ARHL and AMD (P < 0.001). The results showed that age, medical history, AMD and chronic noise exposure were risk factors for ARHL. There were 196 cases of AMD in ARHL patients (82.35%). Spearman's correlation analysis revealed that ARHL was associated with AMD; logistic regression analysis revealed that age, medical history, macular degeneration and history of prolonged noise exposure were risk factors for ARHL. Among them, age, medical history (hypertension, hyperlipidaemia and diabetes mellitus), noise and AMD influence the development of ARHL in the elderly population. Therefore, attention should be paid to controlling risk factors in this population to prevent or reduce the development of ARHL.

BackgroundChronic suppurative otitis media (CSOM) is a common paediatric ear disease in developing countries, typically resulting from an acute otitis media (AOM) that is not promptly diagnosed or treated. Home remedies using herbal medicine in rural villages may contribute to treatment delays and complications.MethodsA cross-sectional study of children from three rural schools was conducted. Children between 6 and 14 years of age were randomly selected and screened by the lead author for CSOM between January and February 2015 by history and physical examination, including otoscopy. Parents of children diagnosed with CSOM were asked additional questions regarding their understanding of this clinical entity.ResultsA total of 461 children with a mean age of 9.8 years were screened and 17 were diagnosed with CSOM (3.6%). The majority (n = 10/17, 59%) of parents reported no understanding of the aetiology of their children’s ear symptoms and the remainder (n = 7, 41%) reported other incorrect aetiologies. Traditional home remedies such as instilling fruit juice are still common in this community. Most parents confirmed to have previously used traditional remedies at least once to treat their children for CSOM.ConclusionApproximately one in 25 school-aged children in rural Rwanda had CSOM at the time of this study. Parental knowledge about the causes, treatments and complications of CSOM is limited.ContributionThis study provided insights into the prevalence of CSOM in school-aged children in the Rwandan district of Bugesera and explored current beliefs and practices among parents of children with CSOM.

Chronic tonsillitis (CT) is a very common ear, nose, and throat disease worldwide, and in severe cases it can cause sleep apnea hypoventilation syndrome, which can affect the patient's health and can even be life-threatening. Low-temperature plasma radiofrequency tonsillectomy is one of the commonly used methods for treating CT with remarkable results, but more detailed reports are lacking. In this study, we aimed to explore the impact of low-temperature plasma radiofrequency tonsillectomy on pain, inflammatory markers, and sleep quality in adult CT patients for clinical reference. A retrospective study was performed on adult patients diagnosed with CT at our hospital between June 2019 and October 2023. Patients were categorized into a control group receiving traditional tonsillectomy and a treatment group undergoing low-temperature plasma radiofrequency tonsillectomy. The groups were compared in terms of baseline characteristics, surgical parameters, visual analogue scale (VAS) scores, 36-item short form (SF-36) health survey questionnaire scores, inflammatory markers, and Pittsburgh Sleep Quality Index (PSQI) scores. Group differences in postoperative complications were also analyzed. There were 160 patients, 80 in the treatment group (50 males and 30 females, mean age 28.90 ± 2.46 years) and 80 in the control group (46 males, 34 females, mean age 28.89 ± 2.01 years). Differences between the two groups in terms of age, sex, duration of disease, smoking history, body mass index, and other baseline characteristics were not statistically significant (p > 0.05). Operation time, intraoperative bleeding, return to normal diet, and pseudomembrane detachment time in the treatment group were all significantly lower than in the control group (p < 0.05). There were no significant differences in VAS or SF-36 scores before treatment (p > 0.05). Post-treatment, both groups had lower VAS scores and higher SF-36 scores in the treatment group compared to the control group (p < 0.05). There were no significant differences in levels of inflammatory markers before treatment (p > 0.05). Both groups showed increased levels of inflammatory markers post-treatment, but the treatment group had lower post-treatment levels of Interleukin-6 (IL-6) and hypersensitive-C reactive protein (hs-CRP) than the control group (p < 0.05). No significant difference was observed between the two groups in PSQI scores before treatment (p > 0.05). Following treatment, both groups had decreased PSQI scores, with lower scores in the treatment group than in the control group (p < 0.05). The complication rate was lower in the treatment group than in the control group, with rates of 8.75% and 23.75%, respectively (p < 0.05). Low-temperature plasma radiofrequency tonsillectomy for adult CT patients offers advantages such as shorter surgical time, reduced intraoperative bleeding, minimal trauma, and fewer postoperative complications. This procedure significantly alleviates pain, improves quality of life, reduces levels of inflammatory markers, and enhances sleep quality.

Otitis media (OM) refers to a common clinical ear disease. Noise seriously damages human hearing function. This study aimed to investigate the effects of various noise types on the hearing function of patients who have recovered from mild OM. A total of 160 patients with mild OM treated at our hospital from May 2020 to May 2023 were retrospectively selected for this study. Based on clinical data, the patients were divided into the non-noise group (n = 80) and the noise (n = 80) group. The hearing thresholds of the two groups were compared across various noise types at 500, 1000, and 2000 Hz. In addition, the hearing thresholds of the noise group were compared under the same conditions. The noise group exhibited significantly higher hearing thresholds at 500, 1000, and 2000 Hz than the non-noise group (P < 0.05). Under traffic, urban construction, and industrial noises, the auditory thresholds at 500, 1000, and 2000 Hz in the noise group were significantly higher than those observed under domestic and speech noises (P < 0.05). Noise shows a close relationship with the hearing function of patients with OM. Traffic, urban construction, and industrial noises greatly influence the hearing function of patients who have recovered from mild OM.

Introduction: Radiological imaging, such as High-resolution Computed Tomography (HRCT) of the temporal bone, has always held significant importance in diagnosing and staging Chronic Suppurative Otitis Media (CSOM). In preoperative cases of CSOM and cholesteatoma, HRCT describes the disease’s extent to aid in surgical approach, while diffusion-weighted Magnetic Resonance Imaging (MRI) sequences can differentiate cholesteatoma from other common inflammatory middle ear diseases. Aim: To determine the role of Diffusion-weighted Magnetic Resonance Imaging (DW-MRI) in differentiating between granulation tissue and cholesteatoma using histopathological findings as a reference standard. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Radiodiagnosis, Sri Manakula Vinayagar Medical College, Puducherry, India, from November 2018 to April 2020. A total of 40 patients who underwent HRCT of the temporal bone for preoperative evaluation of CSOM underwent diffusion sequence MRI, and their findings were compared with intraoperative and postoperative histopathological results. Findings such as soft-tissue masses with scutum and erosion of ear ossicles were analysed in HRCT, while diffusion restriction was observed in DW-MRI in cases of cholesteatoma. Data were collected using a prescribed proforma and analysed using Statistical Package for Social Sciences (SPSS) software version 24.0. Results: The mean±Standard Deviation (SD) age of the patients was 43±20.41 years (27 males, 13 females). The most common presentations in this study were mucopurulent discharge and conductive hearing loss (20 out of 40 patients). Among the 16 patients diagnosed with cholesteatoma through histopathological examination, all (100%) were reported to have diffusion restriction present in the MRI. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of DWI were all found to be 100% in diagnosing cholesteatoma. The sensitivity of HRCT was 81.25% and the specificity was 83.3%. Conclusion: High-resolution computed tomography provides a surgical roadmap indicating the extent of involvement and bony structures, while DW-MRI imaging helps in differentiating cholesteatoma from CSOM. A combined preoperative approach using HRCT and DW-MRI imaging can aid in diagnosing cholesteatoma effectively.

Otosclerosis is a common ear disease causing ankylosis of the stapedio-vestibular joint and conductive hearing loss. Stapedoplasty is the most advisable surgical solution. The restoration of hearing depends on the condition of the patient and the surgery itself. The aim of our work was to compare the surgical and audiological results of stapedoplasty performed with endoscopic versus microscopic technique. This is a retrospective study of 254 patients treated with stapedoplasty with a microscopic approach (91/254) or with an endoscopic approach (163/254) between 2014 and 2021 at our tertiary referral center. Statistical significance of differences between the two methods was determined using the Mann-Whitney test for quantitative variables and the Wilcoxon matched-pairs signed-rank test for repeated measures. Categorical variables were assessed with Fisher's exact test. Both techniques improved the hearing status of patients, with no statistically significant difference between them. There was also no statistically significant difference in reported complications between the two techniques. There is a statistical difference (p < 0.001) in operating time between the two techniques: the endoscopic technique had a mean operating time of 39min versus 45min for the microscopic technique. The two techniques are comparable in terms of results and the choice depends on the surgeon's preferences and experience.

Ear disease is relatively important in veterinary medicine as it significantly affects the quality of life of pets. Two hundred and twenty-one cases of canine ear diseases were collected and collated at the Xi'an Teaching Hospital of Northwest A&F University from 2012 to 2016. An epidemiological analysis was conducted to evaluate the prevalence and causes of various ear diseases in various breeds of dogs in Xi'an. Data were collected and statistically analyzed by reviewing previous cases and obtaining medical history data and laboratory results. This study included the following experiments: systematic examination of the animals' skin, auricular skin scraping test, ear canal endoscopy, and examination of ear canal secretion. The top three dog breeds most commonly afflicted with ear diseases in Xi'an were Toy poodles, Cocker Spaniels, and Golden Retrievers, accounting for 18.5%, 10.4%, and 9.5% of the total cases, respectively. The prevalence was the highest in August and September, with male dogs having a higher prevalence rate than female dogs. Common ear diseases were categorized as otitis externa, otitis media, otitis interna, or ear hematoma. This study determined the prevalence of external otitis, ear hematoma, otitis media, and inner otitis in dogs in the Xi'an area. These results can help expand the current understanding of the development and epidemiology of canine ear diseases and provide a reference for clinical diagnosis, treatment, and prevention.

Objective- To determine the pattern of otorhinolaryngological disorders in geriatric population and to establish a correlation with socioeconomic factors. Methods- A total of 1020 geriatric patients who attended the otorhinolaryngology department were included in the study. They were subjected to brief history, examination and the socioeconomic status. Results were analyzed by using appropriate statistical tests analyzing percentage and proportion. BG. Prasad’s classification was used to categories patients into classes based on the socioeconomic status of an individual. Investigations pertaining to the system involved were carried out and the diagnosis was made according ly. Results- The most common affected organ was ear (33%) and the most common disease diagnosed among geriatric patient assessed was presbycusis (25.2%). Although epistaxis, chronic pharyngitis and malignancy larynx were also commonly diagnosed. Among all patients’ males was on the lead and the middle-class patients mostly attended the otorhinolaryngology department. Conclusion- In present study the male patients formed the major bulk of geriatric patients. The majority of geriatric patients belonged to age group between 60 to 70years and most of them belonged to middle socioeconomic class. The aim of our study was to find out the pattern of otorhinolaryngological diseases in which we observed that most common affected organs among the geriatric patients was ear. Presbycusis out of all disorder was the most common ear disease among geriatric patients.

Background: Otitis media with effusion (OME), the most common ear disease in pediatrics, can lead to hearing loss (HL) and might have a significant impact on a child’s auditory and speech development. Objectives: This study was conducted to indicate the audiologic profile of children with chronic OME who were scheduled for tympanostomy tube placement. Methods: Otoscopy, pure-tone audiometry, and tympanometry assessments were carried out in 663 children (420 males and 243 females) who had a chronic OME diagnosis and were scheduled for ear surgery. They were selected consecutively at Imam Khomeini Hospital, Ahvaz, Iran. Results: The most frequent age groups affected by OME were 12 - 36 months (33.48%) and 36-72 months (31.67%). The majority of children (60.03%) showed retracted tympanic membrane (TM), and the most common color of the TM was yellowish-brown, observed in 74.20% of cases. Before surgery, the majority of patients demonstrated mild conductive hearing loss (61.08%) and a Type B tympanogram (73.75%). The myringotomy site of 61.53% of children was anterior-inferior. Four hundred-eight children indicated serous secretion. The mean pure-tone average before surgery was significantly reduced after surgery (45.23 ± 23.25 vs. 27.83 ± 15.86 dB HL, P = 0.001). This improvement was about 18 and 17 dB in the right and left ears 2 months after surgery, respectively. The postoperative findings also indicated that in 487 children (73.45%), hearing thresholds returned to normal limits. Conclusions: It is essential to address chronic OME promptly to prevent potential long-term impacts on a child’s hearing, speech, and language. Treatment options, such as watchful waiting or surgical intervention, depending on the severity and duration of the condition, are effective procedures in this group of patients.

&#x0D; &#x0D; &#x0D; &#x0D; Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in developing countries, one of which is Indonesia. CSOM is the stage of middle ear disease where there is chronic inflammation of the middle ear and mastoid and tympanic membrane that is not intact (perforation) and found secretions (otorrhea), purulent intermittent, said to be chronic if the disease is intermittent or persists for 2 months or more. Prevalence surveys around the world, show the incidence of CSOM is 65-330 million sufferers with watery ears where 60% of them have conductive hearing loss. This is an important issue for dealing with deafness in developing countries. This study aims to determine the distribution of CSOM sufferers at Waikabubak Hospital in September 2022 – February 2023 based on age, sex, side of the ear infected and type of otorrhea. This research was conducted at the ENT-KL Clinic at Waikabubak Hospital in February 2023 using secondary data from the patient register book. There were 85 CSOM patients recorded in September 2022 - February 2023. The most common incidence happen in adult age 26-45 years old with the number of 30 patients (35.3%). CSOM is more common in women than men with an the number of incidence 43 patients (50.6%). Based on the side of the ear infected with CSOM, it was more common on the unilateral side, with the number of 72 patients (84.7%) and based on the type of otorrhea, the active type was more frequent, with the number of 67 patients (78.8%).&#x0D; &#x0D; &#x0D; &#x0D;

Public perception of common Ear, Nose, and Throat-related diseases in the Makkah region of Saudi Arabia: A cross-sectional study

Glomus tympanicum (GT) is a highly vascular, benign, and slow-growing tumor of the middle ear. It can be confused with other common ear diseases such as acute middle ear infection, otitis media with effusion, ear trauma… It is accurately diagnosed by history and endoscopy. CT scan showing: the presence of eroding jugular bulb is the most important thing to distinguish glomus tympanicum and glomus jugulare and assess the extension of the tumor to make good surgical planning. We present here the three cases in Can Tho ENT hospital: where total excisions were achieved trans-canal endoscopically without embolization. These procedures were safe, quick, and effective due to the better visualization of the surgical field with the endoscope.

Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) were two most common chronic middle ear disease(MED) clinically. Accurate differential diagnosis between these two diseases is of high clinical importance given the difference in etiologies, lesion manifestations and treatments. The high-resolution computed tomography (CT) scanning of the temporal bone presents a better view of auditory structures, which is currently regarded as the first-line diagnostic imaging modality in the case of MED. In this paper, we first used a region-of-interest (ROI) network to find the area of the middle ear in the entire temporal bone CT image and segment it to a size of 100*100 pixels. Then, we used a structure-constrained deep feature fusion algorithm to convert different characteristic features of the middle ear in three groups as suppurative otitis media (CSOM), middle ear cholesteatoma (MEC) and normal patches. To fuse structure information, we introduced a graph isomorphism network that implements a feature vector from neighbourhoods and the coordinate distance between vertices. Finally, we construct a classifier named the “otitis media, cholesteatoma and normal identification classifier” (OMCNIC). The experimental results achieved by the graph isomorphism network revealed a 96.36% accuracy in all CSOM and MEC classifications. The experimental results indicate that our structure-constrained deep feature fusion algorithm can quickly and effectively classify CSOM and MEC. It will help otologist in the selection of the most appropriate treatment, and the complications can also be reduced.

Background Chronic mucosal otitis media is a very common ear disease for which patients attend otolaryngology clinics. Most of these patients present with actively discharging ears. Aims/Objectives This study aims to observe the middle ear space pathology and obtain surgical outcomes as a treatment for patients with advanced chronic mucosal otitis media with a transcanal endoscopic ear surgery approach. Materials and methods: A prospective study was designed, and patients suffering from chronic mucosal otitis media in the active suppurative phase with an air-bone gap larger than 20 dB were included. Results 70 operated ears were included. Underlying macroscopic pathology within the middle ear space was observed: Middle ear granulomas at 58.6%; Tympanosclerosis 41.4%. Blockage of the tympanic isthmus was evaluated, obtaining a blockage rate of 81.4%. At 12 months of evaluation after surgery, a postoperative ABG < 20 dB was achieved in 85.7% of the operated ears. An overall closed tympanic membrane was obtained in 88.6% of the patients. Conclusion This prospective cohort study shows the short-term efficacy of transcanal endoscopic type 3 tympanoplasty with mastoid preservation for managing advanced chronic mucosal otitis media. Clinical trials are required to give more evidence to the present matter.

Otitis externa is an acute or chronic inflammation of the ear canal which also involves the tympanic membrane and pinna. This disease has a prevalence rate of about 10% of all ENT diseases. Aim. This research aims to determine the prevalence and profile of the disease based on demographic characteristics (age, sex, and occupation), chief complaint, type, location, and comorbidities in patients with otitis externa. Methods. This research is a hospital-based retrospective study of patients diagnosed with otitis externa in Universitas Sumatera Utara Hospital Medan for the period January 2020 to December 2021. Data were obtained from medical records then processed using the SPSS program and analyzed using descriptive statistics. Results. The total number of patients in Universitas Sumatera Utara Hospital for the 2020-2021 period who met the study inclusion and exclusion criteria was 291 patients. Found 47.4% male and 52.6% female with a ratio of 1:1.1. The peak age group at 26-45 years was 36.8%. In employment status, 23.0% are self-employed and patients who do not work 22.7% are the majority while 0.3% POLRI of and laborers are a minority. The majority 72.5% come with a chief complaint of pain or tenderness in the ear followed by 10% of the ear that felt full. The most common type of otitis externa was acute diffuse as much as 91.8% with the location of the right ear that was most often complained of as much as 44.7%. Otitis externa disease is commonly found in patients who do not have other comorbidities as much as 87.3%. Conclusion. Otitis externa is a common ear disease that affects all age groups and genders. Most of the patients come with complaints of pain in the right ear and were diagnosed with acute diffuse otitis externa.