Otitis Research Articles

Molecular Epidemiological Characteristics of Staphylococcus pseudintermedius, Staphylococcus coagulans, and Coagulase-Negative Staphylococci Cultured from Clinical Canine Skin and Ear Samples in Queensland

Background/Objectives: Infections in dogs caused by methicillin-resistant staphylococci (MRS) present limited treatment options. This study’s objective was to investigate the molecular epidemiology of Staphylococcus spp. cultured exclusively from clinical canine skin and ear samples in Queensland, Australia, using whole-genome sequencing (WGS). Methods: Forty-two Staphylococcus spp. isolated from clinical canine skin and ear samples, from an unknown number of dogs, were sourced from two veterinary diagnostic laboratories between January 2022 and May 2023. These isolates underwent matrix-assisted laser desorption ionisation– time of flight bacterial identification, minimum inhibitory concentration testing using SensititreTM plates and WGS. Phylogenetic trees and core genome multilocus sequence typing (cgMLST) minimum spanning trees (MSTs) were constructed. Results: The isolates included methicillin-resistant and -sensitive S. pseudintermedius (MRSP: 57.1%, 24/42; and MSSP: 19.1%, 8/42), methicillin-resistant and -sensitive S. coagulans (MRSC: 14.3%, 6/42; and MSSC: 2.4%, 1/42) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS: 7.1%, 3/42). Thirty-nine isolates were included after WGS, where all MRS harboured the mecA gene. Eighteen sequence types (STs) were identified, including three novel MRSP and six novel MSSP STs. MRSP ST496-V-VII (23%; 9/39) and MRSP ST749-IV-(IVg) (12.8%; 5/39) were commonly isolated. Phylogenetic analysis of single nucleotide polymorphisms showed that MRSP, MRSC and MSSC were similar to globally isolated staphylococci from canine skin and ear infections. Using cgMLST MSTs, MRSP isolates were not closely related to global strains. Conclusions: Our findings revealed a genotypically diverse geographical distribution and phylogenetic relatedness of staphylococci cultured from clinical canine skin and ear samples across Queensland. This highlights the importance of ongoing surveillance to aid in evidence-based treatment decisions and antimicrobial stewardship.

Hearing loss in patients with Morquio A syndrome: A scoping review.

Hearing impairment is a prevalent clinical feature in Morquio syndrome (mucopolysaccharidosis IVA or MPS IVA) patients, often presenting in diverse forms: conductive, sensorineural, or a combination known as mixed hearing loss. The mixed form entails a blend of both conductive and sensorineural elements, typically exhibiting a progressive trajectory. This scoping review aimed to comprehensively analyze available evidence pertaining to the pathophysiology, classification, epidemiology, and clinical management of hearing loss in individuals with MPS IVA. Targeted literature was searched using MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web of Science, the Cochrane Library, Trip Medical Database, Embase, ScienceDirect, and Google Scholar, with a second search cycle to identify gray literature. A systematic search strategy using Medical Subject Headings keywords was implemented: "Hearing Disorders" OR "Hearing Loss" AND "Mucopolysaccharidosis IV" or "Hearing Disorders" OR "Hearing Loss" AND "Mucopolysaccharidosis IV." The identified bibliography was uploaded to COVIDENCE platform for information management. Articles were screened by 3 independent reviewers following the eligibility criteria. Twenty-seven articles met the inclusion criteria, spanning information from 568 patients across 16 different countries. None of the studies had complete epidemiological information. Only 2 studies provided sufficient data to address the pathophysiology, while 3 addressed management and treatment. Hearing loss was reported in 210 of 568 patients. A total of 19.2% of patients reported recurrent ear infections. None of the studies reported vertigo, tinnitus, or dizziness in the patients. Pure-tone audiometry was the primary test used to diagnose and monitor auditory impairment in patients with Morquio syndrome. Five hundred sixty-eight patients with MPS IVA were identified, of whom 210 (37%) developed hearing loss, the most common of which was moderate. Despite the lack of information on the diagnosis and management of hearing loss in Morquio syndrome, this study found that approximately one-third of participants exhibited some form of auditory impairment, with the majority of these cases being sensorineural in nature.

Exploring the landscape of congenital and idiopathic neutropenia in Moroccan children: a comprehensive retrospective analysis.

Congenital neutropenia (CoN) is a heterogeneous group of inborn errors of immunity (IEI) characterized by recurrent infections and early onset of neutropenia (NP). This study aimed to investigate the demographic and clinical data of children with CoN and idiopathic neutropenia (IN) in Morocco. We performed a retrospective study of patients with CoN and analyzed the clinical and laboratory findings of patients with CoN and IN diagnosed between 1999 and 2018 in a clinical immunology unit of a large pediatric hospital. We identified 88 patients, 51 with IN and 37 with CoN. Fifty-seven percent were males, and 43% were females, ranging from 1month to 19years. The median age at onset was 8months, and the median at diagnosis was 36months. Consanguinity was observed in 57% of the cases, and a history of recurrent infections in the siblings was found in 27.3%. The most common infectious complications were ear, nose, and throat (ENT) infections, skin and soft tissue infections, and lung infections. Patients with CoN were classified into seven syndromes: 9 with severe congenital neutropenia, 11 with cyclic neutropenia, 6 with glycogen storage disease type 1b, 5 with poikiloderma with neutropenia, 3 with Griscelli syndrome, 2 with Hermansky-Pudlak syndrome type II, and 1 with Cohen syndrome. This study provides a comprehensive overview of CoN and IN in a pediatric cohort from Morocco, representing the country's most considerable single-center investigation of these conditions. Our findings highlight the significant burden of CoN, accounting for 5% of IEI in the Moroccan registry, a proportion higher than in some neighboring countries. The study emphasizes the early onset and severity of bacterial infections in CoN patients, underlining the critical need for timely and accurate diagnosis.

Characterization, prognostic factors, and clinical profile of ear infections by Turicella otitidis: Revealing the emerging rise of a controversial pathogen.

Environmental changes and modifications in leisure habits have facilitated the emergence of new bacteria responsible for causing ear infections with different presentations. In this context, Turicella otitidis is a pathogen for which isolated cases of external and middle ear infections have been reported. However, our experience indicates a resurgence in its occurrence in recent years. The main objective of this study is to examine the possible connection between T. otitidis and the most frequent clinical ear manifestations, as well as the associated demographic characteristics. Additionally, it seeks to analyze the temporal evolution of the frequency of T. otitidis isolates and determine the overall antibiotic sensitivity pattern of this microorganism. A retrospective cohort study was conducted, including samples of ear exudates with T. otitidis from patients in the departments of Otorhinolaryngology, Pediatrics, and Emergency over the past seven years (2017-2024). Cultures were taken using fluid collection devices from the external ear in cases of diffuse external otitis (DEO) or through active, wet perforation in patients with acute otitis media (AOM) or chronic suppurative otitis media (COM). The bacterial cultures were grown using the PCR method. 67 patients (71 ears) were included, with a mean age of 19.45±22.30years, and 62.69% (n=42) being pediatric patients. The most frequent presentation was acute suppurative otitis media (AOM), accomplishing recurrent acute otitis media (rAOM) criteria in 32.35% of cases, followed by diffuse external otitis (DEO) in 41.79% (n=28) of the cases. The relationship between T. otitidis and age, and between T. otitidis and the risk of rAOM, was statistically significant (p<0.001 and p=0.01, respectively). Additionally, chronic adenoiditis/adenoid obstruction combined with age was significantly related to the risk of recurrent infections (p=0.02). Conversely, there was no significance when studying age with the risk of rAOM caused by T. otitidis alone (p=0.77). This study highlights the importance of preventing and treating ear infections caused by Turicella otitidis, especially in the context of migration and changes in leisure habits. The pathogenic role of T. otitidis is debated, suggesting its involvement in various ear infections with antibiotic resistance. Preventive measures should include maintaining good ear hygiene, regular monitoring, and appropriate antibiotic selection based on susceptibility profiles. Further research is needed to clarify its pathogenic role and its relationship with factors such as age and adenoid obstruction. Despite limitations, this study expands knowledge on these emerging infections and raises questions for future research.

Reducing antibiotic duration for acute otitis media: clinician, administrator, and parental insights to inform implementation of system-level interventions.

This qualitative study aimed to understand facilitators and barriers to implementation of interventions to improve guideline-concordant antibiotic duration prescribing for pediatric acute otitis media (AOM). Clinicians and clinic administrators participated in semi-structured qualitative interviews, and parents of children 2 years of age or older with a recent diagnosis of AOM participated in focus groups. The Practical Robust Implementation and Sustainability Model (PRISM) guided the study. Interviews were analyzed using the Rapid Assessment Process. Denver Health and Hospital Authority (Denver, CO) led the study. Recruitment occurred at Vanderbilt University Medical Center (Nashville, TN) and Washington University in St. Louis Medical Center (St. Louis, MO). Purposeful sampling was used to recruit clinicians and administrators for qualitative interviews. Convenience sampling was used to recruit parents for focus groups. Thirty-one participants (15 clinicians, 4 administrators, and 12 parents) engaged in interviews and focus groups. Factors influencing antibiotic prescribing included patient history, years of practice, familiarity with the patient, concerns with patient medication adherence, and practice type. Clinicians endorsed electronic health record modifications and clinician prescribing feedback as methods to improve patient care and reduce the durations of prescribed antibiotics. Suggestions for intervention optimization and education needs were also obtained. Findings suggest that clinicians and administrators support reducing prescribed antibiotic durations for AOM and are receptive to the proposed interventions. More education is needed to increase parent awareness about antibiotic stewardship and AOM treatment options. RELAX: Reducing Length of Antibiotics for Children with Ear Infections (RELAX), NCT05608993, https://clinicaltrials.gov/study/NCT05608993.

Functional Characterization of FgAsp, a Gene Coding an Aspartic Acid Protease in Fusarium graminearum.

Aspartic proteases (APs), hydrolases with aspartic acid residues as catalytic active sites, are closely associated with processes such as plant growth and development and fungal and bacterial pathogenesis. F. graminearum is the dominant pathogenic fungus that causes Fusarium head blight (FHB) in wheat. However, the relationship of APs to the growth, development, and pathogenesis of F. graminearum is not clear. Therefore, we selected the FGSG_09558 gene, whose function annotation is aspartate protease, for further study. In this study, FGSG_09558 was found to contain a conserved structural domain and signal peptide sequence of aspartic acid protease and was therefore named FgAsp. The function of FgAsp in F. graminearum was investigated by constructing the knockout and complementation mutants of this gene. The results showed that with respect to the wild type (PH-1), the knockout mutant showed a significant reduction in mycelial growth, asexual spore production, and sexual spore formation, highlighting the key role of FgAsp in the growth and development of F. graminearum. In addition, the mutants showed a significant reduction in the virulence and accumulation level of deoxynivalenol (DON) content on maize whiskers, wheat germ sheaths, and wheat ears. DON, as a key factor of virulence, plays an important role in the F. graminearum infection of wheat ears, suggesting that FgAsp is involved in the regulation of F. graminearum pathogenicity by affecting the accumulation of the DON toxin. FgAsp had a significant effect on the ability of F. graminearum to utilize various sugars, especially arabinose. In response to the stress, hydrogen peroxide inhibited the growth of the mutant most significantly, indicating the important function of FgAsp in the strain's response to environmental stress. Finally, FgAsp plays a key role in the regulation of F. graminearum growth and development, pathogenicity, and environmental stress response.

“Think Beyond Trauma!” Multiple Epidural Hematoma in Sickle Cell Disease: A Conundrum

Epidural hematoma is conventionally thought to occur secondary to trauma. Atraumatic/spontaneous epidural hematoma is of rare occurrence and the etiology spans from dural vascular malformations, neoplasms, and coagulopathy to sinus, middle ear, and orbital infections. Occurrence of atraumatic epidural hematoma in sickle cell disease is rarely reported as opposed to frequent neurological complications, such as ischemic stroke seen in 54% of cases, followed by intracerebral, subarachnoid, intraventricular, or subdural hemorrhages. This study reports the case of an eight-year-old male with Sickle cell disease (SCD). He suffered from fever followed by splenic sequestration and multiple spontaneous epidural hematomas without mass effect and successfully managed with conservative treatment.

Modifiable risk factors for developing otitis media with effusion in children under 12 years in high-income countries: a systematic review

ObjectiveTo systematically assess the modifiable risk factors for developing otitis media with effusion (OME) in children under 12 years.MethodsWe searched Embase, MEDLINE, INAHTA database, CENTRAL, CDSR and Epistemonikos for cohort...

Effects of different potassium doses on yield and quality of two sweet corn hybrid combinations (Zea mays var. saccharata) in Ho Chi Minh City

The study aimed to determine the appropriate amount of potassium for two newly selected sweet corn hybrid combinations of the Department of Genetics and Plant Breeding, Nong Lam University, Ho Chi Minh City. The experiment was conducted in the winter-spring crop of 2023 - 2024 in Thu Duc, Ho Chi Minh City with 4 potassium levels (70, 90, 110, and 130 kg K2O/ha) and 2 combinations of sweet corn hybrids BN191, BN211 and control variety (Golden Cob). The results showed that different rates of potassium affected the yield, quality and resistance to pests and diseases of sweet corn hybrid combinations. The potassium dosage of 130 kg K2O/ha gave the highest fresh ear yield, low pests, and infection rate and highest Brix for the two selected hybrid combinations and the Golden Cob variety.

The occurrence of opportunistic pathogenic Pseudomonas species in bathing ponds.

The aim of this study is to evaluate opportunistic pathogenic bacteria of the genus Pseudomonas in anthropogenically impacted bathing waters, primarily focusing on bathing ponds. The findings include the detection of these bacteria, their susceptibility to selected antibiotics, and the determination of the Exotoxin A (exoA) gene using PCR method. P. aeruginosa was present in most samples, albeit in low concentrations (1-14CFU/100mL). The presence of P. otitidis, which is associated with ear infection, in this type of bathing water, was not rare (up to 90CFU/100mL). This species would not be detected by the standard methods, including tests on acetamid medium, used for P. aeruginosa in water. The isolated strains of P. otitidis lack the exoA gene and exhibited higher resistance to meropenem compared to P. aeruginosa.

"Does My Kid Have an Ear Infection?" An Analysis of Pediatric Acute Otitis Media Videos on TikTok.

With the rise of social media, online platforms have become a common way to access healthcare information. This study examines the quality of pediatric acute otitis media (AOM) videos on TikTok, a popular short-form video social media platform. A TikTok search was conducted between 8/18 and 8/19/2023 using pediatric AOM hashtags: #pediatric acute otitis media management, #kid ear infections remedy, #child ear infections treatment, and #kid ear infection. Data collected include number of views/shares per day, uploader type (nonmedical influencer, lay individual, and medical professional), and content categories. The Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-AV) and DISCERN questionnaire measured understandability, actionability, and quality of videos. Multivariable linear regression models were used (significance set at ≤0.05). Of 166 videos, 38.6% (64) of uploaders were medical professionals, and 32.5% (54) were nonmedical influencers. Nonmedical influencer videos were viewed and shared significantly more than those by medical professionals (p < 0.05). Controlling for covariates, physicians were more likely to produce more beneficial and higher quality videos as compared with nonmedical influencers (β = 2.4 and 1.3, p < 0.01, respectively). However, physicians did not have significantly different ratings for understandability compared with nonmedical influencers (β = 0.45, p > 0.05). AOM content on TikTok is often geared toward caretakers of symptomatic children. Although physician-created AOM content was significantly higher quality, these videos reached a statistically smaller audience than those from nonmedical influencers. Addressing misinformation on social media platforms requires physicians to reach larger audiences by producing more actionable and understandable content. NA Laryngoscope, 134:5184-5192, 2024.

Association of Hearing Loss Onset and Etiology with Psychosocial Outcomes Among US Older Adults.

Understand the differential association of onset and etiology of hearing loss with psychosocial outcomes among older adults. This is a cross-sectional cohort study based on 2017-2020 National Health and Nutrition Examination Survey. Adults aged ≥70 years who completed audiometric testing and questionnaires on onset and etiologies of hearing loss were included (n = 612). Outcomes included report of social avoidance and major depressive disorder (MDD, PHQ-9). Multivariable regression was utilized to examine differential associations of onset and etiology of hearing loss on psychosocial outcomes while adjusting for relevant factors. In this nationally representative sample of US older adults with hearing loss, 20.8% [95%CI: 14.5-29.0%] reported social avoidance due to hearing loss and 7.2% [95%CI: 4.3-11.8] reported symptoms suggestive of MDD. Multivariable regression demonstrated self-reported onset of hearing loss between ages 6-19 years (OR:2.49 [95%CI: 1.52-4.10]) and 20-59 years (OR:1.95 [95%CI: 1.07-3.55]) was associated with higher avoidance of social interaction than reported onset at ≥70 years. Those with onset between 20-59 years (OR:4.28 [95%CI: 1.17-15.6]) and 60-69 years (OR:5.68 [95%CI: 1.85-17.5]) were more likely to report symptoms consistent with MDD than those with onset at ≥70. Multivariable regression did not demonstrate increased risk of avoiding social interactions or MDD due to hearing loss from noise exposure, ear infection, or ear disease versus aging alone. There was an association between earlier hearing loss onset with social avoidance and MDD. This suggests a need for research to investigate the impact of earlier diagnosis and intervention for hearing loss on psychosocial outcomes. 2b Laryngoscope, 134:5073-5079, 2024.

Misdiagnosis of a fungus ball in the middle ear as chronic suppurative otitis media

Background: Middle ear infections caused by fungi are commonly identified through laboratory tests like fungal smears, culture, and DNA detection. There are two types of ear infections caused by fungi: middle ear fungal infections and fungal otitis media. Both fungal otitis media and fungus balls in the middle ear are increasingly rare. Case Description: A middle-aged immunocompetent woman suffered from long-term recurrent pus formation in the middle ear and associated hearing loss. Physical examination revealed a perforation in the pars tensa of the tympanic membrane; a pure tone audiometry test revealed mild conductive hearing loss. The woman had previously self-medicated with oral antibiotics and/or ear drops multiple times in the past. She did not have a history of diabetes mellitus. She was diagnosed with chronic suppurative otitis media and surgical treatment (tympanoplasty) was advised. Otoscopy-guided tympanoplasty revealed a fungal mass with a cheese-like consistency filling the entire mesotympanum, and important structures such as the ossicular chain and the facial nerve were unharmed. Lesions were meticulously excised from the tympanic cavity of the affected ear. The patient no longer experienced pus formation in the middle ear and loss of hearing was restored after the surgery. After tympanoplasty, the patient did not experience any symptom recurrence during the 10-month follow-up period. Conclusions: If a patient has good immune function and no history of diabetes mellitus, despite repeated antibiotic use resulting in a diagnosis of chronic otitis media, doctors should consider the possibility of a fungal infection in the middle ear.

Double Triangular Cartilage Excision in Otoplasty Revisited.

Prominent ears negatively impact the psychological and social health of individuals. Despite the availability of different surgical correction methods for this congenital condition, many of these techniques might result in significant risks of complications and the condition often reappears. Herein, we present log-term outcomes of our suture-free method that employs various strategies to reduce these risks and prevent recurrences. We analyzed the results of patients who had a bilateral double triangular cartilage excision otoplasty as an outpatient procedure. This previously described technique is designed to correct prominent ears by precisely removing sections of cartilage to reshape the ear mechanically without the need for sutures through the cartilage. We documented any complications after surgery and gathered feedback from patients over an extended follow-up period. A total of 146 patients (292 ears) met the inclusion criteria. The mean age was 23.2 ± 5.3 years. The mean follow-up period was 22 months. Complications were as follows: 3 ears (1.02%) showed superficial skin tissue necrosis at the front of the ear and 17 ears (5.8%) needed further surgery due to unsatisfactory ear rotation. Additionally, 2.73% experienced wound dehiscence, 0.68% had hematomas, 1.02% had external ear infections that were treated with local and systemic antibiotics, 4.1% developed hypertrophic scars, and 8.2% experienced temporary paresthesias. Patients reported being satisfied with the final outcomes at follow-up. Double triangular cartilage excision otoplasty is a safe procedure with few complications, low recurrence rates, and good patients' satisfaction at long-term follow-up. This sutureless technique should be included as an alternative to the existing surgical techniques and added to the skill set of surgeons. IV.

Exploring the impact of tobacco consumption on the respiratory health of two Dutch skeletal populations (1300–1829 CE)

ABSTRACT This study explored the influence of tobacco consumption on the respiratory health of two historical Dutch populations (1300–1829 CE). We conducted a macroscopic examination of 235 skeletons for which tobacco consumption status was known, focusing on the presence of sinusitis, ear infection, and pulmonary inflammation. Our goal was to investigate the correlation between respiratory diseases and tobacco consumption. Despite all conditions being prevalent in the total sample (sinusitis: 50.2%, ear infection: 23.2%, pulmonary inflammation: 14.1%), almost no significant correlation was found between disease and tobacco consumption. Our findings suggest that additional factors, such as exposure to second-hand smoke and unsanitary living/working environments, may have also impacted respiratory health. However, our interpretations are difficult to confirm due to the limitations of macroscopic analysis in determining tobacco consumption status. Future research should consider employing biomolecular techniques and expand beyond respiratory diseases to enhance our understanding of historical health implications of tobacco use.

Rare complication of varicella-zoster virus infection: a case report of vernet syndrome in clinical and radiological evidence.

Vernet syndrome is a neurological disorder rarely seen in association with varicella-zoster virus (VZV) infection in ear. This report presents a 61-year-old man demonstrating neuropathy of cranial nerve XI, X, and XI. Subsequent serological and radiological examinations revealed Vernet syndrome due to VZV infection, a rare complication of a common infection. Notably, the current report features in the resolutions of inflammatory processes around the right jugular foramen evidenced by serial magnetic resonance (MR) images. This report highlights the potential values of radiological assessment in VZV-induced Vernet syndrome regarding the diagnosis and clinical follow-up. In addition, prompt clinical intervention can lead to favorable outcomes in VZV-induced Vernet syndrome.

Infectious morbidity and white blood cell count associated with grade repetition and school absenteeism.

Infections can impair cognitive development, but their role on adverse childhood educational outcomes is unknown. We examined the associations of infectious morbidity and inflammatory biomarkers with grade repetition and school absenteeism. We followed 2762 Colombian children aged 5-12 years for a school year. We quantified inflammatory biomarkers at enrolment and prospectively recorded incidence of gastrointestinal and respiratory infections, doctor visits and absent days from school using pictorial diaries. We estimated adjusted relative risks (ARR) with 95% confidence intervals (CI) for grade repetition and absenteeism by infectious morbidity burden and inflammatory biomarker categories, and percentages of the associations mediated through absenteeism. Morbidity was associated with increased risk of grade repetition. ARR (95% CI) of grade repetition comparing high versus no incidence of gastrointestinal, respiratory and ear infections were, respectively, 2.17 (1.00, 4.72), 2.31 (1.28, 4.16) and 2.57 (1.13, 5.86). Infections also predicted school absenteeism, which mediated 35%, 31% and 38% of the corresponding morbidity-grade repetition associations. Elevated white blood cells (WBC), especially granulocytes, were related to increased grade repetition and school absenteeism risks. Childhood infections and elevated WBC are associated with grade repetition and school absenteeism. Absenteeism does not fully explain the morbidity-grade repetition associations.

A Comparative Study between Preoperative Computed Tomography and Intraoperative Ossicular Chain Status in Patients of Chronic Suppurative Otitis Media at RIMS, Ranchi

ABSTRACT Background: Chronic suppurative otitis media (CSOM) is a persistent middle ear infection often leading to conductive hearing loss due to ossicular chain damage. Accurate preoperative assessment using high-resolution computed tomography (HRCT) is crucial for surgical planning. This study compares preoperative HRCT findings with intraoperative ossicular chain status in CSOM patients. Aims and Objectives: To evaluate the correlation between preoperative computed tomography scans and intraoperative ossicular chain status in CSOM patients. Methodology: The study included 60 CSOM patients aged 12 to 60 years attending the ENT department at Rajendra Institute of Medical Sciences, Ranchi. Preoperative HRCT was performed, and intraoperative findings were compared. Data analysis was conducted using SPSS version 17.0. Results: Ossicular erosion was observed in 61.7% of cases, predominantly affecting the incus. HRCT showed high sensitivity and specificity in detecting ossicular chain damage, aligning with intraoperative findings. Conclusion: HRCT provides valuable preoperative insights but should complement intraoperative assessment. Combining both approaches ensures accurate diagnosis and effective management of CSOM.

Aseptic Otogenic Lateral Sinus Thrombosis – A case report

Background: In pre-antibiotic era Lateral Sinus Thrombosis (LST) was the second most common intracranial complication of otitis media with almost 100 % mortality. Now the trend has been changed. Easy availability of antibiotics has made this complication very rare. Mortality rate is also drastically reduced with alteration of the presentation of the disease. Objectives: The aim of this case report is to focus on the altered presentation of the disease, do analysis and explain the reasons behind that. Case Summary: It was a 65 years old, physically well build &amp; psychologically sound gentleman admitted in the department of ENT-Head &amp; Neck Surgery through Emergency with severe pain in left temporal region and concomitant history of discharge from Left ear in October, 2023. He was diagnosed as a case of LST otogenic in origin on MRI and MRV of brain. Conclusions: Otogenic LST, though has become a rare entity, can still happen with different presentation. Therefore, keeping a high level of suspicion is essential for any patient coming with severe earache and middle ear infection. Though antibiotics are available as OTC (over the counter)choosing a wrong antibiotic, not adequate in terms of dosage and duration; candirectthe clinical course towards a potentially dangerous catastrophe. Bangladesh J Otorhinolaryngology 2024; 30(1): 39-43

Prevalence and Etiology of Otomycosis in West Libya

Fungal otitis media is a frequently case facing otolaryngologists due to its recurrence and long-Fungal otitis media is a frequent condition faced by otolaryngologists due to its recurrence and long-term treatment period. The infection starts in the outer ear canal and may reach the inner ear. The aim of this study was to isolate and identify the fungal species causing inflammation of the auditory canal, identify the main causes and contributing factors to the spread and increased incidence of ear fungal infection, and determine the relationship between otomycosis occurrence and age, gender, and diabetes. Additionally, the study aimed to compare the incidence of otomycosis among different areas. A total of 205 ear swabs were collected from patients visiting national clinics and hospitals. The samples were cultured on Sabouraud dextrose agar and Czapek-Dox agar and incubated at 30°C for a week. Nine fungal species belonging to four genera were isolated: Aspergillus spp., Alternaria spp., Penicillium spp., and Candida spp. The current study showed a predominance of Aspergillus spp. isolates, with a rate of 82.67%, making it the main cause of fungal ear infection; however, Penicillium spp. was the least prevalent. Among the fungal species, A. niger was dominant, with a prevalence rate of 41.16%. The prevalence of ear infection was higher in females (62.82%) than in males (37.17%), and the infection was most common in the age group from one to twenty years (39.35%), while it was less frequent in older age groups. In coclusion, The study concluded that otomycosis is widely prevalent in western Libya, with Aspergillus niger as the predominant etiological agent.