Otalgia Research Articles

Kimura's Disease in Temporal Bone: A Case Report.

To publish a rare case of Kimura's Disease in Temporal Bone. A 27year-old male presenting with history of right ear pain and discharge for 2months was thoroughly evaluated by clinical evaluation, hematological, radiological and histopathological study. Clinical examination revealed a bulge in posterior-inferior quadrant right side of tympanic membrane. HRCT temporal bone revealed a heterogeneous attenuating focal lesion is noted in the region of right middle ear cavity, mastoid antrum mastoid air cells in continuation with the superior aspect of right jugular foramen with erosions and bone destructions, involving the mastoid air cells and sinus plate. Patient was managed surgically with right side canal wall down mastoidectomy and Type 1 Tympanoplasty. Histopathological examination showed focal ulcerated stratified epithelium, dilated elongated congested blood vessels and hemorrhage. Diagnosis was made as Kimura's disease.

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.

Pseudomonas Infection Outbreak Associated with a Hotel Swimming Pool - Maine, March 2023.

Treated recreational water venues (e.g., pools and hot tubs) located at hotels represent one third of sources of reported treated recreational water-associated outbreaks; when these outbreaks are caused by Pseudomonas aeruginosa, they predominantly occur during January-April. On March 8, 2023, the Maine Center for Disease Control and Prevention (Maine CDC) initiated an investigation in response to reports of illness among persons who had used a swimming pool at hotel A during March 4-5. A questionnaire was distributed to guests who were at hotel A during March 1-7. Among 35 guests who responded, 23 (66%) developed ear pain, rash, or pain or swelling in feet or hands within days of using the pool during March 4-5. P. aeruginosa, a chlorine-susceptible bacterium, was identified in cultures obtained from skin lesions of three patients; a difference of two single nucleotide polymorphisms was found between isolates from two patients' specimens, suggesting a common exposure. Hotel A management voluntarily closed the pool, and Maine CDC's Health Inspection Program identified multiple violations, including having no disinfectant feeder system, all of which had been identified during a previous inspection. Because chlorine had been added to the pool water after the pool was voluntary closed, environmental samples were not collected. The pool remained closed until violations were addressed. Health departments can play an important role in reducing the risk for outbreaks associated with hotel pools and hot tubs. This reduction in risk can be achieved by collaborating with operators to ensure compliance with public health codes, including maintaining chlorine concentration and otherwise vigilantly managing the pool, and by disseminating prevention messages to pool and hot tub users.

An unusual presentation: temporomandibular tissue herniation through congenital foramen of Huschke.

The herniation of temporomandibular tissue through the foramen of Huschke into the external auditory canal is a rare clinical anomaly. This paper describes one such case and provides an overview of the relevant literature. This paper elaborates upon the aetiology, clinical assessment, management and associated complications. A 54-year-old woman presented with a 3-month history of right ear pain and a polypoid lesion in her right ear canal. This lesion expanded during a Valsalva manoeuvre, and imaging demonstrated a defect in the antero-superior aspect of the canal with herniation of soft tissue. The patient was managed conservatively as the symptoms resided. Ear canal lesions that protrude or change in size with a Valsalva manoeuvre could be due to a persistent foramen of Huschke. In symptomatic cases needing surgical intervention, a variety of materials may be used to close the defect. Titanium mesh, with or without cartilage overlay, appears to be the most popular choice.

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.

Tinnitus prevalence and associated risk factors among university students: A cross-sectional study.

Tinnitus is a common medical condition that affects an individual's quality of life. It affects 5%-43% of the global population. Only a few research studies have been conducted in Palestine, so knowledge of tinnitus prevalence and risk factors is limited. The purpose of this study was to determine tinnitus prevalence and risk factors among young university students in Palestine. A cross-sectional study of Palestinian university students was done utilizing an online self-administered questionnaire. The questionnaire for the study was developed using the European School for Interdisciplinary Tinnitus Research-Screening Questionnaire. A logistic regression analysis of the associations between tinnitus and influencing factors was performed to determine the effects of various clinically relevant variables on the likelihood of experiencing tinnitus. A total of 728 participants responded to the questionnaire aged 20.0 ± 2.0. The overall prevalence of tinnitus was 31%. Having a relative with tinnitus, gastroesophageal reflux, depression and anxiety, hearing difficulties, vertigo, tympanic membrane perforation, chronic otitis, acoustic trauma, head and neck radiotherapy, dental surgery, ear surgery, ear pain, headache, neck pain, temporomandibular joint pain, balance disorders, and nasal septal deviation were significantly associated with tinnitus. The logistic regression analysis showed that suffering from frequent vertigo (at least once per year), from slight hearing difficulty, temporomandibular joint pain, performing ear surgery, and having depression and anxiety is associated with an increased risk of having tinnitus. The current study concluded that tinnitus is common among Palestinian university students. Furthermore, the study identified several major risk factors for tinnitus. It is critical to explore the possibly modifiable risk factors for tinnitus in order to have a better understanding of the condition and eventually minimize its prevalence.

Breathe In, Breathe Out: Yoga’s Healing Touch on Sinusitis-induced Psychological Comorbidities

Sinusitis, characterized by inflammation of the nose and paranasal sinuses, commonly presents with symptoms such as nasal congestion, discharge, facial pain, and headache. The aim of this report is to highlight the potential benefits of Bhastrika (bellows breath) and Jala Neti (nasal cleansing with saline solution) as interventions to alleviate sinusitis-induced psychological comorbidities. This case report focuses on a 26-year-old female patient diagnosed with sinusitis who presented with severe headache, blurred vision, ear pain, and facial discomfort. A comprehensive evaluation confirmed the diagnosis of sinusitis, and the patient expressed a desire for nonpharmacological interventions due to personal preferences and concerns about medication side effects. The patient was prescribed a 6-month intervention comprising Bhastrika and Jala Neti, which involved the practice of bellows breath and nasal cleansing with saline solution. Regular practice of these techniques was observed, and the patient reported significant improvement in self-rated psychological symptoms, including reduced headache frequency, improved vision clarity, decreased ear pain, and alleviation of facial discomfort. These interventions may contribute to the overall improvement in psychological well-being experienced by the patient in this case. Further research is warranted to explore the effectiveness of these interventions in a larger population and to elucidate the underlying mechanisms through which they exert their therapeutic effects.

Socioeconomic inequalities in health problems in the first two years of life: Pelotas (Brazil) birth cohort, 2015.

Brazil is characterized by an unfinished agenda of health inequalities, which impact health problems in the childhood. This study aimed to evaluate the socioeconomic inequalities of health problems in the early childhood. This is a prospective study, using data from the birth cohort carried out in the city of Pelotas (Rio Grande do Sul State, Brazil) in 2015. The outcomes were health problems presented at 12 and 24 months: cough, breathing difficulty, diarrhea, ear pain, pneumonia, urinary infection, hospitalization, and other health problems. Socioeconomic inequalities were measured applying the slope index of inequality (SII) and the concentration index (CIX), with wealth index and maternal schooling being the socioeconomic variables. The inequalities in the number of health problems were evaluated by Poisson regression. The perinatal sample comprised 4,275 children. At 12 months approximately 74% of the children presented 1 or more health problems, while at 24 months, approximately 44% presented 2 or more health problems. For all period, the mean number of health problems was 2.9 (standard deviation = 2.0). Higher frequencies were observed for children belonging to the poorest income quintile and with lower maternal education, except for 1 or more health problems at 24 months. The greatest absolute and relative inequality was observed for 2 or more health problems at 12 months (SII: -0.23, 95%CI: -0.29; -0.18 and CIX: -0.19, 95%CI: -0.25; -0.14). There is an opposite dose-response relation for the risk of accumulation of health problems according to maternal schooling (1.07, 95%CI: 1.04; 1.09) and wealth categories (1.03, 95%CI: 1.01; 1.04), in the full adjusted models. The study confirms inequalities due to health problems in Brazilian children, especially in the first year of life.

Prevalence of Gram positive bacteria in the affected individuals of Otitis media with effusion from the indigenous population of Southern Punjab, Pakistan: first report.

Otitis media with effusion (OME) is a type of otitis media (OM) characterized by the presence of fluid behind intact tympanic membrane and is one of the most common diseases of early childhood. It is an infectious disease associated with the presence of many pathogenic bacteria in the middle ear of affected individuals. This study was aimed to determine the prevalence of Gram-positive bacteria from the middle ear of OME patients in the population of Southern Punjab, Pakistan. The incidence of OME under comprehensive healthcare setting was investigated in patients who consulted at the department of ear, throat and nose, Bahawal Victoria Hospital (BVH), Bahawalpur, from December, 2019 to May, 2021. Ear swabs were taken from affected and normal individuals. After culturing bacteria from the ear swabs, microscopic analysis and biochemical tests were performed to characterize the cultured Gram-positive bacteria. Out of 352 patients examined, 109 (30.9%) patients had OME. Age of the participants ranged from 14 to 50 years; individuals between the ages of 14 and 22 years had the highest infection rates, while individuals between 40 and 50 years had the lowest rate of infection. Tympanic membrane perforation, fever, cough, sore throat, ear pain and hearing problem showed association with symptoms of OME. Microscopic analysis and biochemical characterization showed the presence of streptococci and staphylococci in all the studied samples. The most frequently isolated bacteria were Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus with percentage of 53.3%, 20% and 13.3% respectively. Enterococcus faecalis (6.6%) and Staphylococcus epidermidis (6.6%) were also identified in the studied samples. This study will help in the better medical administration of OME affected individuals.

Simultaneous occurrence of facial neurinoma in internal auditory canal and middle ear paraganglioma in patient. Unusual combination and difficult surgical task

The 59-year-old patient complained of hearing loss on the left, ear murmur for a long time, periodic pain and discomfort in the left ear, dizziness for 6 months. She was found to have concurrent vestibular schwannoma in the internal auditory canal and temporal bone paraganglioma. Both tumors were removed in one operation. The schwannoma was removed by translabirinth access due to preoperative deafness, while the glomus tumor was removed during this access. Postoperative biopsy showed the presence of two unrelated diseases: paraganglioma (ICD-0 code 8690/3) and schwannoma (ICD-0 code 9560/0).

Effectiveness of Kabat Rehabilitation, Kinesio-taping Combined with Neuromuscular Facilitation Techniques in Management of Subacute Bell’s Palsy: A Case Report

A comprehensive physiotherapy protocol for treating individuals with Bell’s palsy including neuromuscular facilitation techniques is essential to enhance therapeutic effects and significant outcomes for individuals with subacute Bell’s palsy. The purpose of the present case report was to explore the distinct effects of Kabat rehabilitation, Kinesio-taping, and neuromuscular facilitation techniques for treating Bell’s palsy. It underscores the necessity for additional integrated research in this domain. Hereby, the authors present a case of a 34-year-old male suffering from Bell’s palsy with a history of left ear pain and heaviness on the left side of the face for 1.5 months. The patient reported to Neurophysiotherapy Outpatient Department (OPD) and was recruited after thorough assessment and screening followed by informed consent and was given an intervention of 40 minutes per session, 5 times per week for 4 weeks. Baseline and post-assessments were done for facial functions with the House-Brackmann Facial Outcome Scale (HBFS) and Facial Disability Index (FDI). After 4 weeks of intervention, there were significant improvements between baseline and post-intervention scores on the HBFS and FDI. The result of the present report was to provide a more potentiate intervention to improve facial outcomes in individuals with Bell’s Palsy. Emphasis should be placed on experimental studies with larger sample sizes to observe more significant results.

COVID-19 Symptoms Time Trend: Comparison Between 2020, 2021, 2022 and 2023 Years in a General Medicine Office in Toledo, Spain

Background: It is not well known if there have been changes in the clinical-epidemiological characteristics during the evolution of COVID-19 from 2020 to 2023. Objective: To know the variations the clinical features of cases of COVID-19 from 2020 to 2023. Methodology: Descriptive analysis and comparison of secondary data of cases of COVID-19 from previous studies in 2020, 2021, 2022 and 2023 years, all of them carried out in the same population of patients treated in a general medicine office in Toledo, Spain. Results: 100 COVID-19 cases were included in 2020, 42 in 2021, 46 in 2022, and 76 in 2023. The statistically significant differences between the symptoms were: 1) ENT symptoms (anosmia / ageusia, odynophagia, dysphonia, rhinorrhea, sneezing, nasal congestion, pharyngeal dryness-mucus, ear pain, epixtasis) were significantly more frequent in 2021, 2022 and 2023 versus 2020. And 2) Digestive symptoms (anorexia, nausea / vomiting, diarrhea, abdominal pain) were significantly less frequent in 2022 and 2023 versus 2020 and 2021. Conclusion: In the general practice setting in Toledo (Spain), from 2020 to 2023, a variation in the clinical presentation of COVID-19 is observed, with a tendency to predominate ENT symptoms and to present fewer digestive symptoms from 2021. This trend clinical presentation carries the risk that it can make one forget prevention measures, the careful evaluation of symptoms, and epidemiological control.

Integrated management of Ardita in 32 years old patient

Bell's palsy accounts for sixty to seventy-five percent of facial paralysis. It is described as acutely onset paresis. Either gender experiences it equally frequently. Although the incidence rises with age, it can affect any age group. In 6-8% of cases, a positive family history is present. Pregnant women and diabetics (angiopathy) are more at risk for Bell's palsy. In contemporary science, treatment options include vitamins, mast cell inhibitors, and steroids. It is associated with Ardita, Vataja Nanatmaja Roga, according to Ayurveda. In this study, a 32-year-old male patient presented with mouth deviation to the left, difficulty closing his right eye, ear pain, and headaches that had persisted for ten days at the Shalakya OPD of Dr. D.Y. Patil College of Ayurveda and Research Center in Pimpri, Pune. After a history and examination, Bell's palsy was the diagnosis. The patient received local treatment with Netra Tarpana therapy, Swastika Sali Pinda Sweda, Nasya, and Shamana Chikitsa, utilizing a variety of Ayurvedic formulations. The patient was also administered vitamins and allopathic steroids. All of the disease's symptoms and indicators improved, which was a remarkable outcome. Therefore, we are using an integrative approach in this study to manage Bell's palsy as soon as possible.

A review on the impacts of COVID-19 on the auditory system: Implications for public health promotion research.

Currently, there are few studies on the relationship between COVID-19 and the auditory system. In the current study, a review of the studies conducted in the fields of etiopathology, clinical manifestations, research, and treatment of hearing loss caused byCOVID-19 was conducted, which can be used as a baseline for future studies. We utilized the research approach suggested by Arksey and O'Malley to carry out this scoping review. Search was conducted in Farsi and English with a focus on the onset of hearing loss in patients with COVID-19 through Medline and PubMed, and Google Scholar search engine. Studies included were those involving adult patients diagnosed with COVID-19 who experienced hearing loss, ear pain, ear discharge, and otitis media. Studies were eligible for inclusion if there was a description of the otologic dysfunction, specifically onset, duration, or clinical outcomes. Among 90 studies identified, 35 studies were included in the review process. Our findings suggest several possible mechanisms for sudden sensorineural hearing loss (SSNHL) in COVID-19 patients, and COVID-19 infection could have deleterious effects on the inner ear, specifically on the hair cells of the cochlea despite patients being asymptomatic and early identification of SSNHL in COVID-19patients can save the hearing and also patient. Hearing loss in COVID-19 infection has not received much attention by health care professionals. Sensorineural hearing loss (SNHL), tinnitus, and/or vertigo have been shown to occur during and following COVID-19 infection. Due to lack of research studies, and the inconsistency and even contradictory of the findings, it remains questionable whether COVID-19 contributes to the high incidence of hearing loss. The proper understanding of the mechanisms behind hearing loss in COVID-19 infections needs further research. However, it seems likely that SNHL could be included among the manifestations of those-called "long COVID" syndrome.

Decision Making in Complicated Chronic Otitis Media- Squamous Active Disease on Surgical Approach: How it Influenced the Outcome?

Chronic Otitis Media (COM) with complications is a common clinical entity in Otorhinolaryngology, but advances in antibiotics and surgical techniques have reduced complication rates and mortality. Management warrants surgical disease clearance, the choice of surgical approach of which may vary. Endaural approach is a less commonly performed approach in view of its complexity and surgical expertise. This case report presents a 13-year-old female with COM-squamous active type with cerebellar abscess, managed with Lempert's endaural mastoidectomy. The patient presented with long-standing left sided purulent ear discharge, ear pain, headache, and vomiting. Diagnosis included bilateral COM-squamous active type with left cerebellar abscess, status post suboccipital craniotomy. Endaural mastoidectomy was performed to circumvent the pseudomeningocoele and achieve disease clearance. Postoperative follow-up showed well-healed scars and no evidence of disease recurrence. Chronic Otitis Media with complications requires surgical management to prevent disease progression and related complications. Surgical approaches for disease clearance include post aural and endaural techniques. Lempert's endaural approach provided a superior view of the middle ear and mastoid, facilitating disease clearance and simplifying postoperative care with enhanced cosmesis. Although endaural approach demands surgical expertise, it can be a viable option for complicated cases. In this case, Lempert's endaural canal wall down mastoidectomy effectively managed COM-squamous active type with cerebellar abscess, offering a clear view of the disease epicenter with limited bone removal. The endaural approach, in the hands of an experienced surgeon, can be a feasible alternative for surgical clearance in complicated COM cases, providing favorable outcomes with superior visibility and cosmesis.

Multi-channel active noise reduction system realizes the local area sound field control of the subway driver's cabin

Aerodynamic noise, air conditioning fan noise, and wheel-rail noise during subway operation have an adverse effect on drivers' physical and emotional well-being and can jeopardize the safe operation of vehicles. On the basis of the original passive acoustic treatment, multi-channel active control technology is used to manage the local sound field in order to further enhance the acoustic comfort of subway drivers' working environment. The multi-channel active noise reduction system installed on the driver's seat is described in this paper. In order to properly prevent the issues of ear pain and obstruction brought on by prolonged use of noise-canceling headphones, the system integrates reference sensors, error sensors, speakers, and a power amplifier within the headrest. The noise in the carriage is picked up using a multi-channel reference signal, and a low delay and anti-interference algorithm is investigated in accordance with the wide frequency band's characteristics and the abrupt change in sound pressure level when the vehicle is running. The test results demonstrate the system's ability to stabilize under situations of abrupt changes in driving noise and in-car broadcast, as well as to successfully minimize noise in the head area of subway drivers.

Age and Gender Differences with Clinical Presentation of Patients with Histopathological and CT-Scan Confirmed Parapharyngeal Mass

Background: Parapharyngeal Mass can occur in different age and gender group with varied clinical features. Objective: The purpose of the present study was to see the age and gender differences with clinical presentation of patients with histopathological and CT-scan confirmed parapharyngeal mass. Methodology: This was a cross sectional type of study. This study was carried out in the Department of Radiology and Imaging at Dhaka Medical College, Dhaka, Bangladesh. This study was carried out from January 2014 to December 2016. Clinically suspected cases of para pharyngeal space mass lesions attended in the otolaryngology and Radiology & Imaging department of Dhaka Medical College, Dhaka, Bangladesh were enrolled in this study. The patient in this study was evaluated according to the management plan for surgery followed in Otolaryngology department, which includes History, Clinical examination, CT-scan and Histopathology. Detail history about the illness, chief complains taken in formatted history sheet. All patients were undergone CT examination of neck in the Department of Radiology and Imaging at Dhaka Medical College, Dhaka. After resection of the mass, the specimen was sent to histopathological examination to the Department of Pathology at Dhaka Medical College, Dhaka, Bangladesh. Results: Male and female ratio was 2.57:1. Maximum 54% patients were belonged to 21-40 years’ age group followed by 38% 41 and above age group and 8.0% up to 20 years’ age group. Mean (±SD) age of the patients was 37.76 (14.82). Presence of mass, fever, malaise, pain, otalgia or fullness in ear, dysphagia, facial nerve dysfunction, trismus, dyspnea and deviation of tongue were the main presenting features of this study. Out of all lesions 58% were in left parapharyngeal space and 42% were in right. Of all patients, 20% had nerve sheath tumour (14% schwannoma & 6% neurofibroma), 6% had paraganglioma, 14% had chronic nonspecific lymphadenitis, 12% had tuberculosis, 16% had squamous cell carcinoma (invasion from adjacent spaces). Parotid pleomorphic adenoma (6%) & mucoepidermoid carcinoma (4%). Rests had, lipoma (4.0%), branchial cleft cyst (4.0%), lymphoma (6.0%), and abscess (2.0%). After histopathological evaluation 24% were malignant and 76% were benign. Conclusion: In conclusion majority of the study population are young adult male presented with mass, fever and malaise. Journal of Current and Advance Medical Research, January 2023;10(1):25-30

A Pilot Study to Determine the Safety and Efficacy of Repeated Hyperbaric Oxygen Therapy in Multiple Myeloma Patients Undergoing High-Dose Therapy and Autologous Stem/Progenitor Cell Transplantation

Background Serum erythropoietin (EPO) negatively impacts hematopoietic stem cell homing and engraftment. Hyperbaric oxygen (HBO) therapy can reduce serum EPO in healthy volunteers and when given prior to stem cell infusion may improve engraftment after hematopoietic stem cell transplant (HSCT). We previously performed a phase II trial randomizing patients with multiple myeloma undergoing high dose melphalan and autologous HSCT 1:1 between a single HBO treatment and no HBO. HBO was given as 100% oxygen, 2.5 ATA for a total of 90 min, in a single treatment on Day 0 prior to the transplant. A total of 99 patients were enrolled with 52 randomized to HBO. HBO significantly reduced EPO levels for the first 24 hours after auto transplant, but EPO levels quickly rebounded by 48 hours after transplant. We hypothesized multiple HBO treatments will keep EPO levels low during the duration of stem cell homing (i.e: the first 72 hours after HSCT) and may improve neutrophil and NK cell recovery. Methods We performed a pilot study to evaluate the safety and tolerability of multiple HBO treatments during autologous HSCT. Patients with multiple myeloma undergoing autologous HSCT were eligible. Patients received HBO therapy, consisting of hyperbaric oxygen at 2.5 ATA for a total of 90 minutes breathing 100% oxygen on days 0 (prior to HSCT), 1, and 2 of transplant. The primary objective of this pilot study was to determine the safety of repeated HBO therapy in the setting, as defined by treatment limiting toxicity (TLT) including occurrence of seizure disorder, pneumothorax, death, or any irreversible grade Ill or any grade IV toxicity within 24 hours of HBO therapy. Secondary objectives were to determine the effects of multiple HBO therapy on neutrophil count recovery and the effect of multiple HBO on serum EPO. Results 10 patients have been enrolled that are evaluable for the primary objective. All patients had multiple myeloma and 4 were female. 9/10 patients successfully completed all 3 HBO treatments and 1/10 completed HBO on days 1 and 2 only because of ear pain on day 0. No patients experienced treatment limiting toxicity. The median times to neutrophil and platelet engraftment was 12 days (range 11-14) and 16 days (range 14-28), respectively. The median length of hospitalization was 13 days (range 12-16). Febrile neutropenia occurred in 3/10 patients with just one incidence of documented infection. This was significantly less than the rate of febrile neutropenia in patients receiving a single treatment of HBO or no HBO (81% and 47%, respectively, p<0.05). 3 patients required red blood cell transfusion and 5 platelet transfusion. Conclusions Multiple HBO treatment were well tolerated without treatment limiting toxicity during autologous HSCT for multiple myeloma.

Evaluation of the efficacy and tolerability of the combination of lidocaine + phenazone in the local therapy of acute otitis media at the doperforative stage in adults

Introduction. Acute otitis media is a widespread multifactorial disease characterized by inflammatory changes in the mucosa of all parts of the middle ear. One of the most important tasks in the early stages of the disease is adequate anesthesia of patients. The article provides a retrospective assessment of the efficacy (speed of analgesia) and tolerability of topical use of Otipax® (lidocaine + phenazone) in adult patients with acute otitis media before perforation, the timing of its use is justified.Aim. To assess the efficacy and tolerability of topical Otipax® in adult patients with pre-perforated acute otitis media prescribed by a physician in routine practice.Materials and methods. Outpatient maps of 50 adult patients with acute otitis media were analyzed.Results. In almost all 50 patients after the use of Otipax®, the analgesic effect occurred after 3 minutes. The analgesic effect remained on average for 35–40 minutes, then the pain gradually resumed, but in dynamics there was a decrease in its intensity. Hearing loss and ear congestion were initially noted in all patients, by the 3rd visit these complaints persisted, but their intensity was significantly lower, on the 10th day of observation there were no subjectively impaired hearing in any of the patients, which corresponded to acumetric and tuning fork data. The anti-inflammatory effect of Otipax® after a day provided a significant decrease in the intensity and area of hyperemia and infiltration of the eardrum. After 10 days, almost all patients had no otoscopic signs of otitis media. No adverse events were reported during the follow-up period.Conclusions. The use of Otipax® (lidocaine + phenazone) ear drops complies with the clinical guidelines of the Ministry of Health of the Russian Federation in 2021 for the treatment of patients with acute otitis media before perforation, effectively and safely, is the method of choice for reducing ear pain in patients already at the primary appointment.

External auditory canal cholesteatoma: classification and management

Background: External auditory canal cholesteatoma (EACC) is a disease characterized by the accumulation of keratin in the ear canal and erosion of the bony wall. Etiologically, it may be primary or secondary. It presents with ear discharge and pain. Distinction from similar conditions is crucial for appropriate treatment. This study evaluates the EACC. Its purpose is to suggest categories based on disease extent. This study aimed to evaluate the presentation, diagnosis, and treatment of EACC. The goal was to classify EACC based on disease severity and propose treatment approaches. Methods: A retrospective review of medical records for patients diagnosed with EACC over ten years. Clinical data were examined for the presentation, clinical findings, etiology, and treatment. We simplified the approach by dividing the disease into three categories: Category 1, confined to the ear canal; Category 2, eroded the canal wall; Category 3, extended to adjacent structures. Results: 18 patients were included in the study. Ear discharge and otalgia were the most common symptoms. Etiological classification of the disease identified most as secondary EACC. Two cases were assigned to Category 1, six to Category 2, and ten to Category 3. Conclusions: Common symptoms of EACC are ear discharge, pain, and hearing loss. Our study categorizes the condition into three categories based on severity, extension, and treatment strategies. Most cases were assigned to category 3 and extended into adjacent structures.