External Canal Research Articles

Microbiology of normal external auditory canal.

To isolate and characterize bacteria and fungi from the healthy ear and to obtain susceptibility profiles on each bacterial isolate. Prospective. Specimens were collected from the external canals and cerumen of healthy subjects. Species-level identification was obtained by combining phenotypic and genotypic data. End-point minimal inhibitory concentration testing was performed using National Committee for Clinical Laboratory Standards recommended methods. One hundred sixty-four subjects were cultured. Seventeen canal and 16 cerumen specimens showed no growth. One hundred forty-eight cerumen specimens yielded 314 organisms, including 23 fungi. One hundred forty-seven canal specimens yielded 310 organisms, including 7 fungi. Of 291 bacteria isolated from cerumen, 99% were Gram-positive. Of 302 bacteria isolated from the canal, 96% were Gram-positive. Staphylococci were 63% of both the cerumen bacteria and the canal bacteria. Coryneforms represented 22% of the bacteria in cerumen and 19% in the canal. Turicellaotitidis was the primary coryneform isolated from both the canal and the cerumen. Streptococci-like bacteria were 10% from the cerumen, 7% from the canal. In both cerumen and canal, Alloiococcusotitis was more than 95% of the streptococci-like bacteria. Fifteen gram-negative organisms were isolated from the canal and cerumen, including four Pseudomonas aeruginosa strains. The percentages of Staphylococcus epidermidis isolates that had high-level resistance (> or =8 microg/mL) were as follows: to neomycin, 28% from cerumen and 11% from the canal; to oxacillin, 28% from cerumen and 25% from the canal; and to ofloxacin, 15% from cerumen and 19% from the canal. Turcellaotitidis and A. otitidis were present with a much higher frequency than previously described, lending evidence that they be considered normal otic flora. Corynebacterium auris, previously reported only in children, was isolated from normal adults.

Metastatic prostatic adenocarcinoma of the temporal bone

Otolaryngol Head Neck Surg 2001;125:561-2.

Management of congenital atresia ear

A total of 3 out of 5 cases of major congenital ear malformation seen in out patient department in two years in 1997 and 1998 were operated for functional reconstruction of external auditory canal, middle car and ossicular chain. 2 cases of bilateral malformation of auricle grade 2 were advised otoplastic repair prior to tympanoplasty. Out of the 3 cases operated by anterior transatretic bone approach, 2 cases had good hearing improvement in air conduction threshold of up to 30 db hearing level (averages of 0.5, 1.2 and 3 khz). One case developed external canal stenosis by six months post operatively and drop in hearing. There was no facial nerve injury in any of the cases. This paper analyses the importance of facial nerve delineation preoperatively based on its embryological development and ils relationship with temporal bone and membranous labyrinth. It also focuses on the various parameters like timing of surgery, importance of (CT) scanning, use of facial nerve monitor and surgical expertise and experience which govern the surgical intervention and its results in congenital car atresia.

Rare Developmental Disorder of the Sound-Conducting System of the Skeleton from an Early Medieval Cemetery in Poland: Endoscopy and CT findings

Anomalies of the sound-conduction system can affect the external auditory canal, the mastoid, the middle ear cavity, the ossicle and the labyrinthine windows. Complete agenesis of the external auditory canal may be caused by an anomaly of the tympanic bone. Embryologically, the definitive external auditory canals begin to form medially at the level of the tympanic membrane. An arrest in this developmental process may leave an atretic plate laterally, which caused a complete external canal atresia. The middle ear may be extremely hypoplastic and the ossicle are present as rudimentary osseus mass (Valvassori, Buckingham 1995). Endoscopic and CT investigation of the skull of the female giant show that she also suffered from the developmental disorders of the left ear. Key Words: Developmental disorder of ear, Middle Ages, Poland, Endoscopy and CT Findings. The material comes from an early medieval cemetery in Ostrow Lednicki, Lednogora dated between the end of the 11 th and beginning of the 14th century A.D. The skeleton belonged to a giant woman, who died aged between 25 and 30. This skeleton was examined three times. In 1977 by Szymczyk et al., who wrote: 'The massivity and large diameters of the skull and of the postcranial bones may be explained by hormonal discretion deviation, especially of the pituitary gland. Proof of that, among the other things, are the morphologic changes of sells turcica. It should be stressed that no x-rays were published with this article, nor was any information given that they had been taken. In 1998 (Gladykowska-Rzeczycka and al.) this skeleton was examined in more detail morphologically, by x-ray and CT. Because of the information from Szymczyk et al. (1977) no control of the cranial cavern was made. Our morphological investigation shows, except for the characteristic traces for gigantism and acromegaly (fig 1), stenosed foramen and small fossa, of the left jugular vein and obliterated left porus acusticus externus (fig. 2). X-ray and CT examination showed other than changes caused by gigantism, slightly flattened sells turcica, extensive sclerotisation of the left temporal bone and obliterated external auditory canal, partial ossification of the left lateral part of the occipital bone and sclerotic remodeling of the sphenoid sinuses (fig. 3,4). Radiologic diagnosis was widespread osteoma. As is well known, classification of osteomas is very differentiated (Steinbock 1976). According to Ortner and Putschar (1981) osteoma belongs to osteoblastic tumors, and is a benign lesion of mostly dense lamellar bone with vascular channels, but practically without marrow spaces. There are three types of osteoma: 1) the so called ivory osteoma, usually located on the outer table of the cranial vault, not more than 2 cm in diameter, 2) a horseshoe-shaped or circular overgrowth of cortical bone on the inner aspect of the bony auditory canal. The maximal thickness does not exceed 5 mm, and 3) a more formidable osteoma most commonly consisting of a tumorous bony proliferation projecting into paranasal sinuses. The lesion begins with fibrosus proliferation made up of fibrous tissue and woven bone trabeculae. As the lesion matures it becomes more solidly bony with lamellar bone predominating. As the localization of widespread osteoma in temporal bone (pars petrosa) is rather rare we decided to control the cranial cavity by endoscopy. It shows: deposits of hardened soil mainly located in the left part of the cranial cave, sells turcica and in the sphenoid sinuses. After cleaning the next endoscopy showed a relatively small number of the foramina of the lamina cribrosae of the ethmoidal bone, unchanged sells turcica, slightly developed sclerotisation on the posterior wall of the left sphenoid sinus and two-chamber right sphenoid sinus, some little smooth (3 x 4 x 3 mm) tubercles on the clivus near the dorsum sellae and slightly more massive pars petrosa of the left temporal bone (mainly in its posterior part). …

極めて稀な両側外耳道癌症例

We report an extremely rare case of bilateral primary carcinoma of the external auditory meatus. A 50-year-old man suffered 1 month from left-ear discharge and otalgia. Examination revealed a tumor of the left ear canal and a biopsy showed well-differentiated squamous cell carcinoma. The patient underwent 60 Gy radiotherapy and left subtotal temporal bone resection. A tumor with irregular swelling of the right external canal was found 8 months after the first diagnosis. Biopsy of the right external canal confirmed the same squamous cell carcinoma. Genetic examination that the carcinoma of the right ear was probably not a metastatic from the carcinoma of the left ear.

In vitro and in vivo antimicrobial activity of topical ofloxacin and other ototopical agents.

Ototopical agents are extensively used for otitis externa (OE), acute otitis media identified by otorrhea in patients who have tympanostomy tubes (AOM-TT) and chronic suppurative otitis media (CSOM). The quinolones have particular value as ototopical agents because of the broad spectrum of antibacterial activity of importance in otic diseases and the high concentrations of antibacterial activity at the site of infection. A survey of literature on in vitro activity and microbiologic efficacy in clinical trials of quinolone otic products for OE, AOM-TT and CSOM. OE: Floxin otic and Cortisporin TC otic suspension were equally effective in eradicating the three major pathogens Pseudomonas aeruginosa, Proteus mirabilis and Staphylococcus aureus. CSOM: Ofloxacin otic was effective in an open label trial in uniform eradication of S. aureus, P. aeruginosa, Proteus mirabilis and Enterobacter spp. AOM-TT: Ofloxacin otic and amoxicillin/clavulanate (by mouth) were equivalent clinically; rates of eradication of initial pathogens were similar for Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, but ofloxacin otic was superior in eradication of S. aureus and P. aeruginosa In each of the studies of OE, CSOM and AOM-TT, ofloxacin otic solution was effective in eradicating the bacterial pathogen from the site of infection: equivalent to Cortisporin for children with OE; superior to amoxicillin/clavulanate for patients with AOM-TT who had acute drainage; and effective in eradicating bacterial pathogens from the external canal of patients with CSOM.

Oculoauriculofrontonasal syndrome in a nine-month-old male

Oculoauriculofrontonasal syndrome (OAFNS) was initially described in 1983. Since that time there have been 18 patients reported in the literature with this rare presumed autosomal recessive syndrome. Individuals with OAFNS have clinical features in common with both the oculoauriculovertebral spectrum and the frontonasal dysplasia sequence. We present a nine month old Caucasian male with OAFNS. The patient was delivered at 38 weeks gestation to a healthy 39-year-old (G3P3) mother. The patient's parents were non-consanguineous and his two older brothers were unaffected. The remainder of the family history was non-contributory. A chorionic villus sampling was performed due to advanced maternal age and a normal 46, XY male karyotype was found. A cleft lip and a possible cerebral mass were identified by routine prenatal ultrasound. At birth, the patient was small for gestational age and had multiple congenital anomalies including bilateral cleft lip and palate, left pre-auricular skin tag, severely hypoplastic right pinna without an external canal, severely everted and hypoplastic left upper eyelid, notched broad nasal tip, ocular hypertelorism, and micrognathia. Further evaluations showed an extra cervical rib on the left, hemivertebrae at T3-4, agenesis of the posterior corpus callosum with a midline lipoma, an extra renal pelvis on the left, a small patent foramen ovale, and severe hearing loss. A high-resolution chromosome analysis (550 band level) including a FISH probe study for the 22q11 deletion was normal. At nine months of age, the patient had significant feeding difficulties. Height, weight and head circumference was below the third percentile. His developmental milestones were within normal limits. The above findings are consistent with the diagnosis of OAFNS.

Squamous Cell Carcinoma of Temporal Bone: Four Case Reports

We report the CT findings of four cases of squamous cell carcinoma, paying special attention to the epicenter of the lesion and the pattern of bony destruction. All four patients had a past history of chronic otitis media. Squamous cell carcinoma affected mainly the hypotympanum and inferior wall of the external auditary canal, and in all cases revealed an irregular pattern of bony destruction. Irregular destruction of the tegmen tympani occurred in two cases. In cases of squamous cell carcinoma, CT findings suggesting involvement of the promontary are usually noted.

Healing large tympanic membrane perforations using hyaluronic acid, basic fibroblast growth factor, and epidermal growth factor

Large tympanic membrane perforations usually require a surgical tympanoplasty for closure. Reducing surgical costs and risks has encouraged investigators to examine nonsurgical office procedures for healing these perforations. Growth accelerators are the most promising agents. We study here the closure of large acute perforations using weekly applications of 1 mg of 1% hyaluronic acid (HA), 0.4 μg basic fibroblast growth factor (bFGF), or 1.0 μg epidermal growth factor (EGF) directly to the tympanic membranes of the experimental ears. Control ears were treated with 0.1 mL Vasocidin. Complete closure was obtained in 100% of the ears treated with HA and EGF and 85.7% of those treated with bFGF by day 21, compared with 63.6% of the controls by day 32. Moderate-to-severe ipsilateral and contralateral external canal hypertrophy was noted in 14.2% and 37.5% of the ears treated with bFGF and HA, respectively, but was not seen in ears treated with EGF or in the control group. (Otolaryngol Head Neck Surg 1999;121:43-7.)

Hydroxyapatite canal wall reconstruction/mastoid obliteration

The controversy regarding removal of the posterior external canal wall during mastoid surgery spans many decades. There are inherent advantages and disadvantages to either removing or not removing the canal wall. The operation must be tailored to the patient and his or her unique situation. We describe our experience with external canal wall reconstruction and mastoid obliteration with hydroxyapatite in an effort to derive the best of both philosophies. Hydroxyapatite has been used in 3 different forms including granules, a preformed canal wall prosthesis, and with a block of hydroxyapatite sculpted to fit the individual defect. A total of 36 patients with up to 54-month follow-up are reported. Details of the techniques used, with advantages and pitfalls, are described. (Otolaryngol Head Neck Surg 1999;120:345-9.)

乳突非削開鼓室形成術後の外耳道真珠腫例

Cholesteatomas rarely develop postoperatively as a complication of ear surgery for noncholesteatomatous disease, although the disease is not infrequently seen to recur following surgery for cholesteatomatous middle ear. It has been reported that lateralization of the tympanic graft and postoperative stenosis of the external auditory canal favor the formation of cholesteatomas.This paper presents a case of an external auditory canal cholesteatoma that developed postoperatively in the ear following tympanoplasty without mastoidectomy. A 56-year-old man, who had undergone bilateral tympanoplasty elsewhere 13 years previously for persistent otorrhea and hearing loss, presented in 1998 with episodic hearing loss and ear discharge in his right ear. Examination of the ear showed a crust located in the posterosuperior part of the auditory canal. A CT scan revealed a round soft tissue density in the external canal, of which the posterior osseous part appeared to be eroded. The lesion was compatible with cholesteatoma in the external auditory canal. The patient underwent an excision of the cholesteatoma and canaloplasty. The patient has been free of his disease for six months postoperatively.It is suggested that a canal skin incision permits development of an inclusion cyst, giving rise to the formation of cholesteatoma in the external auditory canal.

Groin injuries in sport: treatment strategies.

Groin pain in athletes is a common problem that can result in significant amounts of missed playing time. Many of the problems are related to the musculoskeletal system, but care must be taken not to overlook other more serious and potentially life threatening medical cases of pelvis and groin pain. Stress fractures of the bones of the pelvis occur, particularly after a sudden increase in the intensity of training. Most of these stress fractures will heal with rest, but femoral neck stress fractures can potentially lead to more serious problems, and require closer evaluation and sometimes surgical treatment. Avulsion fractures of the apophyses occur through the relatively weaker growth plate in adolescents. Most of these will heal with a graduated physical therapy programme and do not need surgery. Osteitis pubis is characterised by sclerosis and bony changes about the pubic symphysis. This is a self-limiting disease that can take several months to resolve. Corticosteroid injection can sometimes hasten the rehabilitation process. Sports hernias can cause prolonged groin pain, and provide a difficult diagnostic dilemma. In athletes with prolonged groin pain, with increased pain during valsalva manoeuvres and tenderness along the posterior inguinal wall and external canal, an insidious sports hernia should be considered. In cases of true sports hernia, treatment is by surgical reinforcement of the inguinal wall. Nerve compression can occur to the nerves supplying the groin. In cases that do not respond to desensitisation measures, neurolysis can relieve the pain. Adductor strains are common problems in kicking sports such as soccer. The majority of these are incomplete muscle tendon tears that occur just adjacent to, the musculotendinous junction. Most of these will respond to a graduated stretching and strengthening programme, but these can sometimes take a long time to completely heal. Patience is the key to obtain complete healing, because a return to sports too early can lead to chronic pain, which becomes increasingly difficult to treat. Management of groin injuries can be challenging, and diagnosis can be difficult because of the degree of overlap of symptoms between the different problems. By careful history and clinical examination, with judicious use of special tests and good team work, a correct diagnosis can be obtained.

Vestibular Schwannoma: Unusual Recurrence Presenting as an External Auditory Canal Mass

Vestibular schwannomas (VS) commonly are limited to the internal auditory canal (IAC) and cerebellopontine angle. Extension to labyrinth is less frequent, and involvement of the middle ear or external acoustic canal (EAC) is very rare. In this report we present the case of a 41-year-old woman with a VS, which recurred after a previous surgical removal 4 years before. The tumor involved the IAC, cochlea, vestibule, semicircular canals, cavum tympani, mastoid cells, and EAC. Total removal of the tumor was achieved by a transotic approach, without neurological sequela.

Surgical Management and its Post-operative Complications in Congenital Aural Atresia

The post-operative complications and hearing results of surgical intervention for congenital aural atresia were investigated. Seventy-five ears with congenital aural atresia were operated on for hearing loss from 1982 to 1996. Tympanoplasty was performed on 37 ears and canaloplasty on the remaining 38. Hearing improvement rates were 70.3% and 31.6%, respectively. The post-operative complications included stenosis of the created auditory canal (29.3%), deterioration of the improved hearing (21.3%) and infection (12.0%). Reoperations were performed on 6 cases for restoring hearing, 16 for stenosis and 6 for infection. Reoperative findings demonstrated that scar formation in the canal caused the stenosis of the newly formed external canal and that lateralization of the new tympanic membrane and subsequent detachment from the ossicles caused the deterioration of improved hearing. Using cartilage and pedicled skin flap prevented stenosis at the orifice of the newly formed external canal. Maintaining hearing improvement requires creating a wide ear canal using as many pedicle flaps as possible and attaching a new tympanic membrane firmly to the ossicles.

The Occlusion Effect and Ear Canal Sound Pressure Level.

Comparisons were made between changes in the audibility of bone-conduction stimuli to differences in the sound pressure present in the external auditory canal when ears were occluded. Fifteen listeners with normal middle ear function were tested using pure tones of 250, 500, and 1000 Hz, delivered via a bone-conduction oscillator placed on the mastoid process and the frontal bone. At all three frequencies, and both sites of stimulation, ear canal sound pressures were greater in the occluded than in the unoccluded conditions. Concurrently, the test signals were detected at lower intensities, although the changes in audibility and external canal sound pressure levels were not unity. The occlusion effect was attenuated slightly when the skull was vibrated from the frontal bone.

Impacted aural foreign body requiring endaural incision and canal widening for removal

Foreign bodies of the ear are a common finding in children. The majority of these can be removed relatively easily. We present a case which required endaural incision and widening of the external meatus before the foreign body could be successfully removed. Entrapment of the hard, oval-shaped, smooth and slippery foreign body deep to the hour-glass narrowing of the external canal, proximity of the object to the tympanic membrane and localised tissue oedema were the indications for the surgery. This case demonstrates the danger of unskilful attempts to remove aural foreign bodies.

Experimental models of aural cholesteatomas in Mongolian gerbils.

Mongolian gerbils have a remarkable propensity for the development of aural cholesteatoma; canal cholesteatomas develop spontaneously in aged animals. In the present study, cholesteatomas were produced in a single species, Meriones unguiculatus, by three different methods of induction: 1) external canal ligation (ECL), 2) eustachian tube obstruction (ETO) by electrocautery, and 3) application of propylene glycol (PG) into the middle ear. Each method of induction resulted in cholesteatomas with characteristic features and success rates. With ECL, cholesteatomas could be induced in all ligated ears; stage III and IV cholesteatomas were seen in 4 of 12 ears after 8 weeks. With ETO, cholesteatomas were seen in 7 of 9 animals 8 weeks after induction. With PG, cholesteatomas developed in 2 of 7 animals 4 weeks after induction, although keratin accumulation in the external auditory canal could be found in all animals injected. Although epithelial hyperplasia of the external auditory canal was most prominent in the ECL group, it was also seen in the ETO and PG groups. Keratin accumulation in the ECL or PG group was much greater than that in the ETO group. Thickening of the tympanic membrane, which was most prominent in the PG group, was quite variable in the other groups. Adhesions of the tympanic membrane began at the prominence of the cochlea in the ECL group. In contrast, adhesions in the PG group usually began at the superior bulla, the area in which PG was applied. Each of the three methods of inducing cholesteatoma may be helpful in investigating different clinical aspects of this disease.

Epidemiology and pathogenesis of chronic suppurative otitis media: implications for prevention and treatment

Despite advances in public health and medical care, chronic suppurative otitis media is still prevalent around the world. It is most common in developing countries and in certain high risk populations in developed nations, as well as among children who have tympanostomy tubes inserted. Since this chronic infection is caused by persistent acute otorrhea, which in turn is usually secondary to acute otitis media, prevention should be directed toward prompt and appropriate treatment of the acute middle-ear infection. Repair of chronic perforations should prevent recurrence, since reinfection is due either to reflux of pathogenic organisms from the nasopharynx into the middle ear, or water contamination from the external canal. Information from epidemiological studies, which show that populations can be categorized into highest, high, low and lowest prevalence, can be helpful in setting national priorities for prevention and treatment.

Exchange Rates of Gases Across the Tympanic Membrane in Rhesus Monkeys

The exchange rates of CO2 and He across the tympanic membrane were estimated in 5 monkeys. For these experiments, the monkey was anesthetized and one arm of a polyethylene ?T? tube was introduced into the external canal of the test ear and sealed to the ambient environment with wax. One arm of the T tube was attached to a pressure transducer and the other to an argon gas source via a valve. Silica tubing sealed within the probe provided periodic gas samples for composition analysis by an online mass spectrometer. Prior to each experiment, the probe was washed with Argon. In 5 experiments the probe was sealed within the external canal of animals with physiological middle ear gas compositions, and in 5 experiments the probe was sealed within the external canal of animals whose middle ears were partially washed with He. The gas in the probe was sampled and analyzed at 10-min intervals for up to 4 h. The results documented a significant increase in the percentage composition of CO2 but not He in the experiments conducted with physiological middle ear gas compositions, and increases in both He and CO2 in the experiments conducted after the middle ear was washed with He. Estimated, average exchange constants for He and CO2 were 0.0005

Inflammatory diseases of the ear.

The inflammatory diseases of external and middle ear are one of the commonest conditions encountered by the pediatric physician. Inner ear inflammations are less common and need special and urgent attention. Special management in each case requires detailed history, examination, necessary investigations and appropriate referral to otolaryngologist when necessary. The article is aimed to help formulate a plan in managing the inflammatory conditions of ear. Otalgia constitutes the most prominent of the symptoms in external and middle ear inflammations whereas vertigo, tinnitus and sensory hearing loss form the symptom complex for inner ear infections. It is necessary to understand the basic pathophysiology of the inflammatory condition to be able to institute a targetted treatment. The audiometry impedance studies, microbiology of discharge and occasionally ABR and CT scan from the mainstay of investigative workup. The treatment is specific and based on the precise diagnosis. It often requires the help of an otolaryngologist. Decisions may have to be made with regards to the need for any surgical intervention particularly in acute otitis media, an external canal abscess or an acute mastoiditis. A case of chronic otitis media with facial palsy or vertigo (labyrinthitis being a possibility) needs urgent intervention.