Cerumen Research Articles

The Influence of Personal Listening Devices on Hearing in Egyptian University Students: A Cross-Sectional Study

Background: Improper use of personal listening devices (PLDs) is associated with an increased risk of hearing loss. The purpose is to investigate the use of PLDs among university students and their impact on hearing. Methodology: A study involved 310 University students, surveyed on their PLDs habits. They shared their daily PLD use, volume level, and duration of use. Participants also discussed PLD-related hearing issues and other risk factors for hearing loss. Screening used the Five-minute hearing test (FMHT) and the “Hear WHO” app. Positive cases in both tests received diagnostic pure-tone audiometry (PTA). Results: About 70% used in-earpiece PLDs for studying, 53% used them for over 5 years. Also 83% used PLDs for over 60 mins daily, and 72% used them above volume level 6. Most (74%) were low-risk users. 10.6% tested positive for hearing loss in both screenings, with 1.6% confirmed by PTA. A shift in the 4 kHz average hearing threshold was noted. Tinnitus was reported by 49%, and ear pain by 42% of students. Higher risk PLD use predicted tinnitus, ear pain and excessive ear wax in multivariable analysis. Conclusions: Students' high-volume PLD use is linked to auditory problems like tinnitus and ear pain. Regular hearing screenings are recommended.

Molecular detection and phylogenetic tree assay of Pseudomonus aeruginosa isolated from otitis cases of cats and humans, Iraq

The aim of this study was toward isolation and identification of P. aeruginosa from cats with otitis externa in Basra city Using culture media, Biochemical tests and Polymerase chain reaction. Pseudomonas aeruginosa was isolated from 46 isolates that involved 32 cases out of 75 of feline otitis externa (21.3%) and in 14 (9.3%) from 75 human samples .the clinical signs of otitis externa were head shaking, scratching, excessive ear wax, malodor, pain during palpation, alopecia and pus and/or blood. Culture was done on Pseudomonas chrome agar revealed positive samples with production of greenish-blue pigmentation by the bacteria .polymerase chain reaction revealed that isolates were Pseudomonas aeruginosa using specific primers for P. aeruginosa identification 16S rRNA and the result was positive for the 15 isolates. a phylogenetic tree analysis of P. aeruginosa was performed using the 16S rRNA gene sequence analysis which illustrated the phylogenetic relationship between P. aeruginosa strains isolated from cats and other related genera. In conclusion, this study confirmed the higher prevalence of P. aeruginosa in otitis externa infection of cats when compared to human. The using of molecular assay and 16S rRNA gene contributed effectively in detection of P. aeruginosa. Therefore, this study suggests the application of molecular techniques in identification of different microorganisms. Additionally, moreover studies are necessary to detect the prevalence of P. aeruginosa in different infections in animals as well as human.

Prevalence and Pattern of Ear Disease Among Primary School Students in Samoa: Preliminary Results from ENT Clinic Outreach to Urban, Rural and Remote Settings.

Objectives: To assess the prevalence and pattern of ear disease among students attending primary school in urban, rural, and remote regions of Samoa in order to develop an evidence-based national school ear and hearing health program. Methods: Retrospective clinical data review of all primary school students seen by the Ear, Nose & Throat Clinic of Samoa during school-based outreach visits from March 2022 to April 2024. A purposefully designed spreadsheet was created to extract the following information from the clinical records: school location (urban, rural, remote), gender (male, female), age (years), age category (0-4, 5-9, 10-14, 15+ years), right ear diagnosis, left ear diagnosis. Data were entered into the SPSS statistical software package for descriptive statistical analysis and association tests of significance. Results: A total of 1491 primary school students were seen for ear health examinations (51.1% male, 48.9% female), with a mean age of 9.1 years (SD = 2.3). Five primary schools were included, representing urban (n = 865), rural (n = 258), and remote (n = 368) settings. Overall, 682 (45.7%) students had normal ear examination results for both ears, 237 (15.9%) had an ear pathology in 1 ear only, and 568 (38.1%) had ear pathology in both ears. Bilateral ear pathology was significantly higher among students who were in the 5 to 9 age group (P < .00001), female (P = .035), and from rural settings (P = .0001). The most common pathology was impacted cerumen (36.8%), followed by otitis media with effusion (7.5%). Overall prevalence of chronic suppurative otitis media (CSOM) was 2.6% (n = 39 students). Following the school visits, no further intervention was required for 1180 students (79%), mostly due to successful cerumen and foreign body removals for 468 students (31.4%). Conclusion: Impacted cerumen is a significant issue among Samoan school-aged students, and future school-based ear health programs should include staff members trained in cerumen removal. CSOM prevalence suggests an avoidable burden of disease that must be addressed.

ThP7.14 - CSF Leak or Ear Wax? Logical Thinking in Emergency Management of a Collapsed Patient With Heat stroke

Abstract A man in his 60s presented to RESUS by ambulance on the hottest day of the year with suspected STEMI and collapse at home. The patient was intubated and unresponsive (GCS 5), with global rigors. Hospital ECG showed sinus tachycardia. Body temperature was in excess of 41°C, confirmed on central temperature monitoring. Bilateral clear fluid was noted to be discharging from both ear canals. Query CSF leak was indication for CT head, which was unremarkable. Considering this, efforts were focused on optimising body temperature. This was done with the use of ice packs and fans as well as continuous misting of cool water over the exposed patient. Improvement was shown with temperatures decreasing to 38°C. In questioning the cause of the “clear fluid,” a swab of it placed on an icepack swiftly returned the fluid to its natural consistency of ear wax. As a result of the extraordinarily high body temperatures, ear wax had melted in both ear canals and started to leak out, giving the impression of a CSF leak. This was simply identified at the bedside to refute the idea of a CSF leak. As CSF leak was the indication for a CT head, this could have been avoided with rapid cooling initiated earlier. Unfortunately, this patient later died due to heat stroke. Whilst avoiding the delay of a CT head most likely would not have changed the prognosis for this patient, it is useful to note the importance of logical thinking in an emergency setting.

The Emerging Future of Mobile Audiometry: A Prospective Validation Study of the Mimi Hearing Test Application.

The objective of this study is to assess the accuracy of the Mimi Hearing Test (MHT) mobile application in the detection of air conduction (AC) thresholds and in screening for moderate hearing loss. Prospective clinical study. Tertiary care center. Participants with or without a varying degree of hearing loss, aged 18 years and over, without cognitive impairment and without active otorrhea or earwax impaction at the time of the hearing assessment were included. Subjects with a ranging severity of hearing loss underwent a conventional in-booth audiogram as well as mobile-based screening with MHT in a quiet room (45.5 dB background noise) on the same day. Both regular over-the-ear and noise-canceling headphones were tested with MHT. Comparisons of AC thresholds between conventional audiometry and mobile-based audiometry at discrete frequencies and with pure-tone averages (PTA) were performed. A total of 75 adults (mean age: 56.2 yr, 54.7% male) were recruited and 63 used for analysis. Of the thresholds measured with MHT using regular headphones, 44.0% were within 10 dB of the conventional audiogram, compared to 39.3% using noise-canceling headphones. MHT demonstrated best accuracy at high frequencies (4-8 kHz). When screening for moderate hearing loss (PTA >40 dB HL), MHT demonstrated a sensitivity and specificity of 100.0% and 80.2%, respectively. MHT is reliable for identifying moderate hearing loss but lacks precision in detecting thresholds at low frequencies. Noise canceling headphones seem to improve its precision at 4,000 Hz only.

Assessment of Outer and Middle Ear Pathologies in Lilongwe, Malawi.

Outer and middle ear pathologies are known to disproportionately affect low-income countries but data is limited. We aim to quantify the prevalence rate of patients presenting with middle/outer ear pathologies at ABC Hearing Clinic and Training Centre in Lilongwe, Malawi. Audiological consultations (adult and paediatric) from 2018-2020 were reviewed for outer and middle ear pathologies. Secondary outcomes included patient type (private vs. community) compared to otoscopy findings, tympanometry findings, need for follow up, and follow up compliance. Out of 1576 patients reviewed, the proportion of abnormal cases' was 98.2%, with 41.4% being unilateral and 57.4% bilateral. Eighty-three percent presented with outer/middle ear pathologies. 68% of those presented with a pathology often associated with some degree of conductive hearing loss (occluding wax, perforation, discharge, Type B/Type C tympanogram). Average age was 29 + 0.527 years; 41.6% private and 58.2% community patients. Cerumen impaction was most common finding (51%). Higher rates of otoscopic abnormalities and type B tympanograms were noted in community vs. private patient (~40% vs. ~30%; ~70% vs. ~30%). Adherence to follow up was higher for community vs. private patients (29% vs. 17%); ~70% reported subjective improvement upon follow up. The majority required multiple interventions on follow up. Secondary follow up was recommended in 64.8%. A significant disease burden of outer and middle ear pathologies was identified. Further research is required to understand the disease burden and promote health policy.

Clinical Practice Guideline: Age-Related Hearing Loss.

Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantationcandidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life (QOL). (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related QOL at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.

Clinical Practice Guideline: Age-Related Hearing Loss Executive Summary.

Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition. The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with an explanation of the support in the literature, the evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the Guideline Development Group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. The GDG offered the following KASas an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.

Clinical and Epidemiological Profile of Otorhinolaryngology Diseases at a Tertiary Hospital in Morang District: A Descriptive Cross-Sectional Study

Introduction: Otorhinolaryngology, dealing with disorders of the ears, nose, throat, and related structures, poses significant health challenges. However, there is a dearth of extensive clinical and epidemiological data on these ailments in the specific geographic area under study. Understanding the characteristics of otorhinolaryngology diseases is crucial for effective healthcare planning and resource allocation. Objective: This study aimed to determine the clinical and epidemiological profile of otorhinolaryngology diseases at a tertiary hospital in Morang District, Nepal. Methodology: An observational descriptive cross-sectional study was conducted at the Otorhinolaryngology department of a tertiary hospital in eastern Nepal from January 15 to February 15, 2024. Data from 600 patients presenting at the department over one month were meticulously analyzed. Results: The median age of patients was 28 years, with the most prevalent age group being 21- 30 years (23%). A majority (56%) were male, and belonged to the Brahmin/Chhetri caste (44.3%). Most patients (85%) initially visited the hospital through OPD, with ear-related issues (35.2%) being the most common complaint. Epistaxis (10.3%) was the most frequent diagnosis, followed by allergic rhinitis (9%) and ear wax issues (8.2%). The prevalence of carcinoma was 12(2%). The majority (77.3%) underwent medical treatment. Outpatient admissions were observed in 68(13.3%) of cases, with emergency admissions accounting for 42(62.6%). Conclusion: Epistaxis, allergic rhinitis, and ear wax problems were commonly encountered. Most patients underwent medical treatment, with only a minority requiring hospital admission, primarily through outpatient services.

A comparative study on the efficacy of over-the-counter wax solvents versus distilled water for managing ear cerumen

Abstract Background: Ear wax, or cerumen, is a naturally occurring hydrophobic waxy substance frequently encountered in otorhinolaryngology practices. Despite the abundance of water- and oil-based ceruminolytic agents available nowadays, there remains a lack of consensus regarding the preferred agent type, composition, or ideal treatment duration. Aims and Objectives: The study aimed to assess the efficacy of using distilled water as a wax-softening agent for ear wax removal and determine its advantages compared to over-the-counter (OTC) ceruminolytics. Materials and Methods: This double-masked, randomized prospective cohort study enrolled 236 patients seeking treatment for ear wax-related concerns at the Ear, Nose, Throat outpatient department. The cohort exclusively consisted of cases involving right ear wax, which were then randomly allocated into two groups: group A received distilled water ear drops, whereas group B received OTC ceruminolytic ear drops containing a combination of paradichlorobenzene with turpentine oil, benzocaine, and chlorbutol. Evaluation of patients took place pre- and post-intervention, focusing on three key parameters: the total duration required for ear suctioning, any additional instrumentation employed, and the occurrence of pre-procedure and post-procedure complications. Results: Out of the total 118 participants in the study, they were randomly distributed with 67 males and 51 females in group A and 63 males and 55 females in group B. During the pre-intervention complication assessment, nine subjects in group A reported ear blockage, whereas four subjects in group B did so. Additionally, two subjects in group A complained of pain, whereas none in group B did. Furthermore, five subjects in group A developed otitis externa, compared with three in group B. The average time required for ear suctioning to visualize the tympanic membrane was 9.24 ± 2.50 min in group A and 9.68 ± 2.18 min in group B. During the intervention, nine subjects in group A experienced pain during wax removal, whereas only six patients in Group B reported pain. After the interventions, five patients in group A complained of increased ear pain compared with seven in group B. Mild post-interventional pain was managed with an as-needed dosage of nonsteroidal anti-inflammatory drugs Statistically significant differences were observed in the study parameters between the subjects of the two groups. Conclusion: This study confirms that distilled water can serve as a viable method for dispersing wax, proving its efficacy comparable with commercially available OTC ceruminolytics.

Cerumen impaction: Prevalence and associated factors in the United States population.

To examine the prevalence of cerumen impaction in a nationally representative sample of the US population and the association of cerumen impaction with sociodemographic factors, hearing loss, and tinnitus. The cohort included 14,230 individuals aged ≥12 years who completed otoscopy and audiometry in NHANES (2005-2016). Cerumen impaction (partial/complete) was determined by otoscopy. Hearing level was defined by speech-frequency pure-tone average (PTA). Multivariable regression analysis was performed to identify factors associated with cerumen impaction. The prevalence of any cerumen impaction was 18.6% [95% CI: 17.3%-19.9%] among individuals ≥12 years and 32.4% [29.9%-35.1%] among those ≥70 years. The prevalence of bilateral partial and complete cerumen impaction was 6.3% [5.6%-7.1%] and 1.2% [1.0%-1.9%], respectively. Any cerumen impaction was associated with male sex (OR 1.77 [1.5-2.1]), identifying as Black race (vs. Caucasian, OR: 1.78 [1.5-2.9]), lower level of education (OR: 0.84 [0.71-0.98]), and older age (OR: 1.02 [1.01-1.03]). After adjusting for sociodemographic and clinical factors, complete impaction was associated with increased PTA (right ear: β = 4.1 dB [2.4-5.8 dB], left ear: β = 1.9 dB [0.46-3.4 dB]), but not with tinnitus. Cerumen impaction is highly prevalent in the US population, especially among older adults, and has disproportionate sociodemographic impacts. Complete impaction is associated with a small, statistically significant elevation in PTA, but there is no association with tinnitus. These findings emphasize the need to implement and disseminate best practices for ear hygiene and cerumen management broadly and equitably. 2B.

Current Rehabilitative Concepts in Ear Nose and Throat Department, University of Medical Sciences Teaching Hospital (UNIMEDTH): Challenges Encountered

Introduction: Unaddressed communication disorders are multidimensional, affecting individuals physiologically, psychologically and emotionally. The quality of life of these individuals can be improved with rehabilitative measures, justifying this study. The study therefore aims to assess the impact of rehabilitation on these patients, determine the challenges and proffer possible solutions. Methods: Eighteen months prospective study on audiological and speech disorders among ENT patients in the University of Medical Sciences Teaching Hospital, Ondo State, from April 2021 to September 2022 was carried out. History was taken, general examination and full E.N.T. examinations were done. Those with audiological disorders from canal blockage due to foreign bodies, debris and impacted wax had ear syringing. Others with persistent audiological condition were further evaluated and treated accordingly, with Hearing Aids trial and fitting inclusive. Patients with speech disorder had speech therapy after baseline audiological screening. Data were represented in tables and figures. P value &lt; 0.05 was statistically significant. Results: 930 patients presented at the ENT clinic. 537 (57.74%) females and 393 (42.26%) males. Of this, 405 (43.55%) patients had audiological conditions while 23 (2.47%) had speech disorders. Impacted wax, tinnitus, hearing loss, foreign body in the ear and delayed speech development were commonest. 297 had syringing while 105 patients were further evaluated. 369 of 405 patients were successfully rehabilitated. 3 stroke patients had good speech recovery. Predominant challenges encountered were unavailability of instruments and uncooperativeness of elderly patients. Weekly savings and incorporation of dedicated relatives for home therapy ensures solutions respectively. Conclusion: Rehabilitation in E.N.T., though gradually progressive, is beneficial. The guiding concept is patience.

Cerumenolytic Effects of Carbamide Peroxide in Patients with Ear Wax Obstruction.

Accumulated and compacted ear wax or cerumen can cause conductive hearing loss, discomfort and vertigo, and infection. This study investigates the effect of Carbamide peroxide (CP) compared with Phenol glycerin (PG) ear drops on cerumen. This experimental study investigated the effect of PG and CP ear drops on cerumen in ex vivo and in vivo phases. In the ex vivo phase cerumen degredation was scored following PG and CP treatments. In the in vivo phase, 29 patients with bilateral cerumen impaction were randomly entered the study. PG and CP were applied 3 times a day (each time 5 drops) for 4 days by patients. After treatments, the time of cerumen removal was measured. Instant changes showing degredation of cerumen (grade 1) was evident when it was exposed to CP, on the other hand degredation changes (grade 1) in cerumen treated with PG was only evident after 20 min incubation at 37 oC, while grade 3 degredation was evident in cerumen treated with CP after the same time incubation. Although the time needed for removal of cerumen was lower in CP treatment (54.10±31.77) compared to PG treatment (67.10±35.54), the difference was not statistically significant. Based on the literature and our results, carbamide peroxide is suggested as a proper treatment for patients with EAC obstruction caused by cerumen compaction, because not only it is significantly effective in cerumen degredation, but also no side effects have been reported.

Ayurvedic approach towards Karnagata Rogas

The Uttamanga or head occupies the first place among the vital organs of the body. It is due to its substratum of vital and sense organs which includes eyes, ears, nose, oral cavity and CNS. Shalakya Tantra one among the Astangas of Ayurveda deals with the anatomically, physiology, pathology and management pertaining to Jyanendriyas. The ears are one of the Jyanendriya. An ear is the organ that enables hearing and body balancing using the vestibular system. The organ of ear is situated deep below the body surface and inaccessible for inspection with naked eye or palpate. It can be facilitated with the help of modern aids like head mirrors, otoscope, various speculums, mirrors etc and the disorders can be understood on Ayurvedic line i.e., site, underlying Doshas, Dushyas, Lakshanas and should be treated with Ayurvedic line of management. Asatmyendriyartha Samyoga of Indriya i.e Ayoga, Atiyoga and Mithya Yoga of Srotrendriya causes Roga. Factors that affecting ear health are prolong usage of ear phones (particularly when the volume is set close to the maximum), exposure to loud noise/sounds (movie theatres, concerts, firecrackers etc), impacted ear wax, insertion of sharp or unclean particles into the ear, instillation of contaminated solutions, swimming in polluted water, recurrent upper respiratory tract infections, allergies, nutritional deficiency. Noise above 70 dB over a prolonged period of time may start to damage hearing. Loud noise above 120 dB can cause immediate harm to ears. In this article an attempt is made on the understanding Nidana, Samprapti, signs and symptoms and management of Karna Rogas mentioned by various Acharyas in Ayurveda.

Otoscopic Abnormalities for the U.S. Population Aged 6-80+ Years: Prevalence and Consequences for Hearing.

U.S. national data for otoscopic examinations of 13,055 individuals aged 6-80+ years included in the National Health and Nutrition Examination Survey surveys for 2011-2012, 2015-2016, and 2017-2020 were analyzed and described. Analyses were primarily descriptive and relied on prevalence estimates, supported by logistic-regression analyses, and distribution-free medians. Otoscopic examinations were performed by trained technicians with review and supervision by a clinical audiologist. Effects of age, sex, and race/ethnicity were also examined. Overall, the prevalence of abnormal otoscopy was approximately 12%-15% with higher prevalence among males at most ages and for both sexes for age ≥ 60 years. Typically, 93% or more of the observed abnormalities were due to excessive or impacted cerumen, mainly the former. Logistic-regression analyses for the 6-19-year-olds found that only race/ethnicity affected the odds with non-Hispanic Blacks and Asians have higher odds for otoscopic abnormalities than non-Hispanic Whites. For 20- to 69-year-old adults, the odds of having abnormal otoscopic findings were about twice as high for males versus females, 60-year-olds versus 20-year-olds, and non-Hispanic Blacks versus non-Hispanic Whites. Overall, the effect of otoscopic abnormalities on the pure-tone averages for 500, 1000, 2000, and 4000 Hz and 3000, 4000, and 6000 Hz were negligible (< 3 dB), and this did not vary substantially with sex, race/ethnicity, or age. Abnormal otoscopy, typically excessive cerumen, was observed in about 12%-15% of the individuals in this national sample, but the presence of such abnormalities had minimal effect on hearing sensitivity.

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

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

Influence of Cuticular Waxes from Triticale on Rumen Fermentation: A Metabolomic and Microbiome Profiling Study.

Cuticular wax, a critical defense layer for plants, remains a relatively unexplored factor in rumen fermentation. We investigated the impact of cuticular wax on rumen fermentation using triticale as a model. In total, six wax classes were identified, including fatty acids, aldehydes, alkane, primary alcohol, alkyresorcinol, and β-diketone, with low-bloom lines predominated by 46.05% of primary alcohols and high-bloom lines by 35.64% of β-diketone. Low-wax addition (2.5 g/kg DM) increased the gas production by 19.25% (P < 0.05) and total volatile fatty acids by 6.34% (P > 0.05), and enriched key carbohydrate-fermenting rumen microbes like Saccharofermentans, Ruminococcus, and Prevotellaceae, when compared to non-wax groups. Metabolites linked to nucleotide metabolism, purine metabolism, and protein/fat digestion in the rumen showed a positive correlation with low-wax, benefiting rumen microbes. This study highlights the intricate interplay among cuticular wax, rumen microbiota, fermentation, and metabolomics in forage digestion, providing insights into livestock nutrition and forage utilization.

Characteristics of pediatric patients claimed with acute upper respiratory infection during otorhinolaryngology consultations: A descriptive study of a large Japanese medical claims database

This study aimed to clarify other diseases claimed simultaneously with acute upper respiratory infection (URI), antibiotic prescriptions, and examinations associated with infectious diseases in pediatric patients with acute URI insurance claims at otorhinolaryngology outpatient visits. Pediatric patients who visited an otolaryngology department between 2019 and 2021 and were definitively diagnosed with URI were selected using a large Japanese medical claims database. Patient backgrounds, antibiotic use, and examinations were descriptively evaluated. In total, 8010 patients were included in the analysis. The median number (interquartile range) of diseases claimed in the same month as acute URI was 4 (3–6). Only 519 (6.5 %) patients were claimed as acute URI alone. Regardless of the prescription of antibiotics, the most commonly redundantly claimed disease in these patients was allergic rhinitis, followed by acute bronchitis, acute sinusitis, and earwax impaction. The frequently prescribed antibiotics were third-generation cephalosporins, macrolides, and penicillins with extended-spectrum, including amoxicillin which was recommended by the Japanese manual; the proportion of patients with examinations was low (2.9–21.7 %). Among patients with acute URI, diagnoses requiring antibiotics were also claimed; therefore, when evaluating acute URI using the Japanese medical claims database, care must be taken in patient selection. Moreover, the implementation rate of examinations necessary for diagnosis was low, so there is an urgent need to develop an environment where examinations can be conducted in outpatient settings.

Knowledge, Attitudes, and Practices of Self-ear cleaning among the General Population in KSA

Introduction: Cerumen or ear wax is a normal secretion from sebaceous and ceruminous glands found in the external auditory canal with an antimicrobial effect. Self-ear cleaning practice is reported among different populations with different tools that may be harmful to the ear. Aim: The current study aimed to assess knowledge, attitudes, and practices of self-ear cleaning among the general population in KSA. Methods: A descriptive cross-sectional survey based on an online structured questionnaire distributed over Saudi Arabia’s different regions was conducted during the period from……. to … . The final questionnaire was uploaded online using social media platforms till no more responses were added. The first section concerns demographic characteristics such as gender, age, education, and income. The second section is continuing questions about self-ear cleaning and awareness. The third covered data about self-ear cleaning practices and complications. Results: A total of 503 eligible participants completed the study questionnaire, 210 (41.7%) from the western region, 147 (29.2%) from the central region, 78 (15.5%) from the southern region, and others from other regions. Participants’ ages ranged from 18 to about 60 years with a mean age of 27.5 ± 12.9 years old. A total of 304 (60.4%) participants were females. A total of 324 (64.4%) of the participants had an overall good knowledge and perception of self-ear cleaning. Exactly 420 (83.5%) practice self-ear cleaning, and most of them (95.5%) do it for both ears; ear sticks were the most commonly used tools (61.9%) followed by tissues (28.8%). Conclusion: The study has shown that the public is highly aware of the risks, methods, and tools used in self-ear cleaning. More than three-quarters of people surveyed reported using ear sticks to clean their ears, and the majority of them experienced no negative symptoms or complications after cleaning. Keywords Self-ear cleaning, practice, knowledge, awareness, prevalence, attitude, complications, Saudi Arabia.

Prevalence of Cerumen Impaction and Associated Factors Among Primary School Pupils at an Urban District in Northern Tanzania.

Cerumen impaction is a public problem of great concern due to associated hearing impairment. Despite cerumen impaction being one of the commonest causes of hearing loss among primary school children, there is no any published study to date from northern Tanzania focused on this topic. This study aimed to address this gap. A cross-sectional study design was used where 307 primary school pupils were recruited using a multistage cluster sampling technique and it was conducted from January to July 2023. Data was collected using Swahili translated semi-structured questionnaires. The prevalence of cerumen impaction was 10.7% with the right ear being mostly affected (57.6%). A statistically significant association was found between prevalence of cerumen impaction and mother's education level though no association was found between sex, residence, father's education level and mother's occupation status. Predisposing factors like history or presence of ear infection, habit of cleaning ears and using hearing aids or earphones showed a statistically significant association The commonest clinical presentation was otalgia (36.4%) and washing ears with water (71.5%) was the commonly applied method of cleaning the ears apart from hospital based interventions. The commonest method of wax removal for those who visited health facilities was ear syringing (42.9%). Lesser prevalence of cerumen impaction was found in this study though majority had previous history of impacted wax. Cotton bud was the commonest predisposing factor for cerumen impaction. The commonest clinical presentation among those with impacted cerumen was otalgia though some pupils reported asymptomatic cerumen impaction.