Left Ear Canal Research Articles

Condicionantes otológicos en termometría timpánica con infrarrojos en niños

ObjectiveTo evaluate the influence of different otoscopic findings on body thermometry in children using an infra-red tympanic thermometer Patients and methodsBody temperature was measured on healthy right and left ear canals with Thermoscan systems. Moreover, it was determined on children with altered otoscopy, comparing to normal contralateral ear. To assess its diagnostic fiability, accuracy ratios were calculated in different temperatures ResultsTemperature measured bilaterally did not offer differences, and intra/interassay variation ratios were always less than 0,34%. Acute otitis externa increased tympanic thermometry a mean of 0,36 degrees C (p<0,001), and cerumen and previously radical surgery decreased a mean of 0,62 and 0,53 degrees C, respectively (p<0,001) ConclusionsThe conditions mentioned before modify body thermometry if measured by infrared tympanic thermometer. So, this system must be avoided in these circumstances. Otitis media, fluid in middle ear, tympanic perforation and ventilation tubes did not modify thermometric results

頭部外傷後耳小骨離断の２例

Two cases of the ossicular disruption due to head injury were surgically treated in our department. These two cases also showed conductive hearing loss after the injury. An exploratory tympanotomy was carried out in these two cases.In the first case, there was a fracture in the left external ear canal, and the fracture led to the middle ear with a fracture of the long process of incus.In the second case, there was ossific change and adhesion between the malleus and scutum. Almost normal hearing was obtained after tympanoplasty modified 3 types in both cases.It is difficult to confirm the presence of lesion by conventional hearing and imaging tests. Preoperative approaches to this disease are mentioned from these cases and literature.

Otitis media in a llama

A 7-month-old female llama was examined because of chronic otitis media and externa of 7 months' duration. Radiographically, the tympanic bullae appeared thicker than normal, and the ventral borders were poorly defined; the left external acoustic meatus (ear canal) appeared to be narrower than the right. The llama was treated with penicillin, and the ear canals were lavaged daily. Contrast radiography was performed on day 15 to determine the shape and size of the ear canals and evaluate the integrity of the tympanic membranes. Contrast medium was visible radiographically in the left tympanic bulla, indicating that the left tympanic membrane was ruptured, but the right tympanic membrane appeared to be intact. The left ear canal was narrower than the right, and the bony ear canals had a well-defined sigmoid shape. The right ear improved with medial treatment alone, but the left ear did not. Therefore, lateral ear canal resection was performed. After surgery, however, exudate was still evident in the left ear canal, and the llama became more lethargic and more reluctant to eat. Lateral bulla osteotomy was attempted, but no purulent material was obtained, and curettage of the bulla resulted in hemorrhage. Because of this and because of the llama's poor physical condition, a decision was made to euthanatize the llama. The sigmoid shape of the bony ear canal and the multicompartmental nature of the tympanic bulla make surgical treatment of otitis media and externa in llamas difficult. Further study of surgical treatments for otitis media in llamas is needed.

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.

Early unilateral auditory deprivation increases 2-deoxyglucose uptake in contralateral auditory cortex of juvenile Mongolian gerbils

The effects of early onset, unilateral conductive hearing loss on tone-induced 2-deoxyglucose (2-DG) uptake in the auditory cortex of juvenile Mongolian gerbils ( Meriones unguiculatus) were studied. Atresia of the left ear canal was induced at postnatal day 9 (P9) to achieve reversible auditory deprivation prior to onset of hearing (around P12). Atresia either persisted (ATR, n=4) or the canal was opened 15 min before the 2-DG experiments (RE, n=4) at P27. Control animals were either non-deprived (CON, n=4), or their left ears were plugged acutely (PAX, n=4). In PAX, 2-DG uptake in primary auditory cortex (AI) and anterior auditory field (AAF) was lower in right than in left AI and AAF. In contrast, in ATR and RE, uptake was significantly higher on the right side contralateral to the atresia. Hence, atresia during early development leads to plastic changes resulting in an interhemispheric imbalance of functional metabolism in favor of the auditory cortex contralateral to the manipulated ear. Distances between tone-induced 2-DG labeling in AI and AAF were increased in PAX, but smaller in ATR in the right compared to the left hemisphere, suggesting effects of atresia also on spatial relations in cortical tonotopic maps.

Yolk Sac Tumor of the Temporal Bone: Report of a Case

Yolk sac tumor (endodermal sinus tumor) is rarely encountered in the temporal bone. Facial nerve paralysis can be a primary manifestation of this condition. Histologically, the tumor can be difficult to diagnose, although elevated levels of alpha fetoprotein can facilitate its identification. In this report, we describe the case of an 18-month-old girl who developed peripheral VIIth nerve palsy and a polypoid mass in the left external ear canal 3 months following myringotomy. Computed tomography and magnetic resonance imaging revealed that the tumor involved the left external ear canal, middle ear space, and mastoid air cells. Biopsies were consistent with a yolk sac tumor. Special staining demonstrated that only a very few tumor cells were positive for alpha fetoprotein, despite the markedly elevated level of alpha fetoprotein in her serum. The patient was treated with chemotherapy, which included cisplatin, etoposide, and bleomycin. Within a period of weeks, she experienced a complete reversal of her left VIIth nerve palsy, a marked decrease in her serum alpha fetoprotein levels, and a dramatic resolution of the tumor as demonstrated radiographically. Such a successful chemotherapeutic response in this case argues against surgical intervention in other cases, particularly in view of the risk of serious complications with surgery.

Conductive Hearing Loss Produces a Reversible Binaural Hearing Impairment

Conductive hearing loss, produced by otitis media with effusion, is widespread in young children. However, little is known about its short- or long-term effects on hearing or the brain. To study the consequences of a conductive loss for the perception and processing of sounds, we plugged the left ear canal of ferrets for 7-15 months during either infancy or adulthood. Before or during plugging, the ferrets were trained to perform a binaural task requiring the detection of a 500 Hz tone, positioned 90 degrees to the right, that was masked by two sources of broad-band noise. In one condition ("control"), both noise sources were 90 degrees right and, in the second condition ("bilateral"), one noise source was moved to 90 degrees left. Normal ferrets showed binaural unmasking: tone detection thresholds were lower (mean 10.1 dB) for the bilateral condition than for the control condition. Both groups of ear-plugged ferrets had reduced unmasking; the mean residual unmasking was 2.3 dB for the infant and 0.7 dB for the adult ear-plugged animals. After unplugging, unmasking increased in both groups (infant, 7.1 dB; adult, 6.9 dB) but not to normal levels. Repeated testing during the 22 months after unplugging revealed a gradual return to normal levels of unmasking. These results show that a unilateral conductive hearing loss, in either infancy or adulthood, impairs binaural hearing both during and after the hearing loss. They show scant evidence for adaptation to the plug and demonstrate a recovery from the impairment that occurs over a period of several months after restoration of normal peripheral function.

The effects of attenuation of frequency segments on binaural localization of sound.

Perceived location of tonal stimuli d and narrow noise bands presented in two-dimensional space varies in an orderly manner with changes in stimulus frequency. Hence, frequency has a referent in space that is most apparent during monaural listening. The assumption underlying the present study is that maximum sound pressure level measured at the ear canal entrance for the various frequencies serves as a prominent spectral cue for their spatial referents. Even in binaural localization, location judgments in the vertical plane are strongly influenced by spatial referents. We measured sound pressure levels at the left ear canal entrance for 1.0-kHz-wide noise bands, centered from 4.0 kHz through 10.0 kHz, presented at locations from 60 degrees through -45 degrees in the vertical plane; the horizontal plane coordinate was fixed at -90 degrees. On the basis of these measurements, we fabricated three different bandstop stimuli in which differently centered 2.0-kHz-wide frequency segments were filtered from a broadband noise. Unfiltered broadband noise served as the remaining stimulus. Localization accuracy differed significantly among stimulus conditions (p < .01). Where in the vertical plane most errors were made depended on which frequency segment was filtered from the broadband noise.

Hemodynamic and thermal responses to head and neck cooling in men and women.

Personal cooling systems are used to alleviate symptoms of multiple sclerosis and to prevent increased core temperature during daily activities. The objective of this study was to determine the operating characteristics and the physiologic changes produced by short term use of one commercially available thermal control system. A Life Support Systems, Inc. Mark VII portable cooling system and a liquid cooling helmet were used to cool the head and neck regions of 12 female and 12 male subjects (25-55 yr) in this study. The healthy subjects, seated in an upright position at normal room temperature (approximately 21 degrees C), were tested for 30 min with the liquid cooling garment operated at its maximum cooling capacity. Electrocardiograms and scalp and intracranial blood flows were recorded periodically during each test sequence. Scalp, right and left ear, and oral temperatures and cooling system parameters were logged every 5 min. Scalp, right and left ear canal, and oral temperatures were all significantly (P <0.05) reduced by 30 min of head and neck cooling. Oral temperatures decreased approximately 0.2-0.6 degrees C after 30 min and continued to decrease further (approximately 0.1-0.2 degrees C) for a period of approximately 10 min after removal of the cooling helmet. Intracranial blood flow decreased significantly (P < 0.05) during the first 10 min of the cooling period. Both right and left ear temperatures in the women were significantly lower than those of the men during the cooling period. These data indicate that head and neck cooling may be used to reduce core temperature to that needed for symptomatic relief of both male and female multiple sclerosis patients. This study quantifies the operating characteristics of one liquid cooling garment as an example of the information needed to compare the efficiency of other garments operated under different test conditions.

Anosognosia in Parietal Lobe Syndrome

Patients with right parietal lesions often deny their paralysis (anosognosia), but do they have "tacit" knowledge of their paralysis? I devised three novel tests to explore this. First, the patients were given a choice between a bimanual task (e.g., tying shoe laces) vs a unimanual one (e.g., threading a bolt). They chose the former on 17 of 18 trials and, surprisingly, showed no frustration or learning despite repeated failed attempts. I conclude that they have no tacit knowledge of paralysis (or, if such knowledge exists, it is not available for this particular task). Second, I used a "virtual reality box" to convey the optical illusion to the patient that she was moving her paralyzed left hand up and down to the rhythm of a metronome, and yet she showed no sign of surprise. Third, I irrigated patient BM′s left ear canal with cold water, a procedure that is known to shift that patient′s spatial frame of reference by stimulating the vestibular system. Surprisingly, this allowed her "repressed" memory of paralysis to come to the surface; she said she had been paralyzed continuously for several days. I suggest that the vestibular stimulation produces these remarkable effects by mimicking REM sleep. These patients also emply a whole arsenal of grossly exaggerated Freudian "defense mechanisms" to account for their paralysis. To explain this, I propose that in normal individuals the left hemisphere ordinarily deals with small, local anomalies by trying to impose consistency but, when the anomaly exceeds threshold, an interaction with the right hemisphere forces a "paradigm shift". A failure of this process, in patients with right hemisphere damage, might partially account for anosognosia. Finally, I present a new conceptual framework that may help link several psychological and neurological phenomena such as Freudian defense mechanisms, vestibular stimulation, anosognosia, memory repression, visual illusions, anterograde amnesia, REM sleep, dreaming, and humor.

The use of acetone to dissolve a styrofoam impaction of the ear

Foreign bodies in the ear occasionally thwart conventional means of removal. Styrofoam can be particularly problematic because it can be compressed and become tightly impacted in an ear canal. Furthermore, Styrofoam is friable and tends to fragment with usual removal methods. We report the case of a 6-year-old girl who was referred from another tertiary care hospital after failed efforts to remove a painfully impacted piece of Styrofoam from her left ear canal. Instillation of the organic solvent acetone into the ear canal was well tolerated and caused rapid and near-complete dissolution of the Styrofoam impaction. This is the first reported case of organic solvent dissolution of an otic foreign body. Ototoxic considerations are discussed as is a method for safe acetone instillation that minimizes the amount of acetone introduced into the ear canal.

Effect of cotton-tipped swab use on ear-wax occlusion.

We studied parents' and patients' approach to earwax (cerumen) removal, patients' level of cerumen occlusion, and the association between the use of cotton-tipped swabs (CTS) and cerumen occlusion. Six hundred fifty-one consecutive patients from the general pediatric practice of the Cleveland Clinic aged 2 weeks to 20 years (57% males) answered a questionnaire with their parents' help. Of the 651, 401 (62%) had used CTS during the 2 months before the study. Examiners unaware of the questionnaire results found that 46 (7%) of both right and left ear canals were at least 75% occluded by cerumen. Cerumen occlusion of at least 75% was associated with CTS use on the left side (P = .02), but not on the right side (P = .27). We conclude that cotton-tipped swab use may be associated with cerumen accumulation.

イヤモールド中耳異物例

A foreign body was found in the left middle ear of a 64-year-old woman during tympanoplasty- I surgery. No abnormalities were found in the external canal or inner ear. Element analysis by X-ray microanalyzer and infrared spectrum revealed that the foreign body consisted of polymethyl metacrylate beads (a resin) surrounded with a little fibrous tissue. Molding material had been instilled into the left external ear canal 4 months earlier when she was fitted for a hearing aid because of moderate bilateral deafness. The molding material had exactly the same element composition as the foreign body. So it appeared that the plastic material had flowed into the middle ear through a small hole in the ear drum to form the foreign body of resin. The resin had probably caused marked unilateral otorrhea and severe hearing loss in the left ear. In the making of hearing aid molds, medical care and consultation by specialists is as necessary as when contact lenses are prescribed.

Lnfrared, Thermistor, and Glass-Mercury Thermometry for Measurement of Body Temperature in Children With Cancer

Body temperature is often the sole determinant of whether or not the neutropenic cancer patient is admitted to the hospital for empiric antibiotic therapy. Recently developed infrared tympanic thermometers offer rapid readings, but their accuracy has not been established. We studied two infrared thermometers (FirstTemp and Thermoscan) and a thermistor (IVAC) in children with cancer. Mean infrared measurements did not differ significantly between right and left ear canals, and the mean IVAC temperature did not differ significantly from the left to the right axilla (P greater than 0.05, paired t test). IVAC predictive mode mean temperature was 0.2 degrees C lower than monitor mode mean temperature in the axilla (P less than 0.0001), but 0.1 degree C higher than monitor mode orally (P less than 0.0001). Aiming the infrared instrument at the tympanic membrane using an ear tug resulted in a 0.2 degree C higher mean temperature than casual placement in the ear canal (P less than 0.0001). After compensation for the mean difference in reference oral glass-mercury versus test instrument temperatures, the FirstTemp, Thermoscan, and oral and axillary predictive mode IVAC measurements yielded sensitivities for the detection of fever of 84%, 84%, 82%, and 86%; specificities of 100%, 99%, 100%, and 100%; positive predictive values of 100%, 93%, 100%, and 100%; and negative predictive values of 95%, 98%, 98%, and 98%, respectively. We conclude that each of these instruments detects fever with comparable reliability. Infrared instruments are especially attractive alternatives due to their time efficiency.

First Reported Case of Human Aural Myiasis Caused by the Flesh Fly Parasarcophaga crassipalpis (Diptera: Sarcophagidae)

Comparatively few specific reports of human myiasis have been published and in most records there is a lack of preserved material retained for verification of identifications. However, the author believes that this is the first record of human myiasis involving Parasarcophaga crassipalpis (Macquart), 1839. Myiasis is the invasion of a living human or other vertebrate by dipteran larvae (maggots). Comprehensive accounts of human myiasis have been published (James, 1947, U.S. Department of Agriculture Miscellaneous Publication 631, 175 p.; Zumpt, 1965, Myiasis in man and animals in the Old World, Butterworths, London, 1,267 p.). In addition, Lee (1968, Medical Journal of Australia 1: 170-173) lists 6 Australian cases, 1 of which was aural myiasis, involving Sarcophagidae. A further case of aural myiasis in Australia has been recorded by Morris and Weinstein (1986, Medical Journal of Australia 145: 634-635). Smart (1936, Proceedings of the Royal Entomological Society of London (A) 11: 1) comments on a case of aural myiasis in Essex attributed to Lucilia sericata Mg., and Burgess (1966, Transactions of the Royal Society of Tropical Medicine and Hygiene 60:432-433) reports a case of human myiasis in London caused by Sarcophaga barbata Thomson. In this record, the patient was a 16-yr-old, mentally retarded, nonresponsive, caucasian male at a public institution in Adelaide, South Australia. Some blood was noted in the left external ear canal when the ear was routinely cleaned by medical staff in late January 1986. Two weeks later, on 4 February 1986, dark blood was seen discharging from that ear. Using a torch, the duty doctor detected movement in the left ear canal. That evening at 1845 hr, a single maggot emerged from the ear without assistance. No other maggots were found and there was no evidence of tissue damage in the external canal. The preserved 14 mm long maggot was sent to the author for identification. It was a thirdstage Sarcophagidae larva. Diagnostic characters including stout mouth hooks, pharyngeal sclerite with windows in both cornua, and anterior spiracles with 11-12 rays compared favourably with illustrations and descriptions given by Greene (1925, Proceedings of the U.S. National Museum 66: 1-35), Smith (1933, Proceedings of the Entomological Society of Washington 35: 159-164), Sanjean (1957, Memoirs of the Cornell University Agricultural Experiment Station 349: 1-115), Ishijima (1967, Japanese Journal of Sanitary Zoology 18: 47-100), and Cantrell (1981, Journal of the Australian Entomological Society 20: 237248), of the cosmopolitan fly Parasarcophaga crassipalpis (Macquart). Synonyms include Sarcophaga securifera Villeneuve, Parasarcophaga securifera (Villeneuve), Sarcophaga dalmatina Schiner, Parasarcophaga (Jantia) securifera Rohdendorf, and Sarcophaga crassipalpis Macquart (James, 1947, loc. cit.; Zumpt, 1965, loc. cit.). Smith (1933, loc. cit.) found that larvae of Parasarcophaga crassipalpis leave their food resource in search of a pupation site when between 9 mm and 21 mm long and this occurs on average about 5-6 days after deposition. The maggot in this case falls within the size range of a fully-fed larva. However, it is impossible to say whether it left its host for pupation or as a result of the disturbance caused by medical staff. Sarcophagids are medium-sized to large, slender flies. Three broad longitudinal stripes of brown-black to deep black are conspicuous on the mesonotum and the abdomen has a checkerboard pattern. There are hundreds of species, they are difficult to identify, and Brown and Shipp (1978, Systematic Entomology 3: 179-188) suggest that a restructuring of the group may be warranted.

Pseudomonas aeruginosa Otitis Externa in an Infant Associated With a Contaminated Infant Bath Sponge

Pseudomonas is a Gram-negative bacterium frequently recovered from environmental sources, particularly an aquatic environment. Epidemics of skin rash,1 otitis externa,2 isolated cases of urinary tract infections,3 and pneumonia4 have been associated with whirlpools contaminated by Pseudomonas aeruginosa. This report describes P aeruginosa otitis externa in an infant associated with a contaminated infant bath sponge. CASE REPORT K.E., a 3-month-old, first born, healthy girl was seen for drainage from the left ear. She was listless and febrile and had a moderate amount of whitish drainage from the left ear canal. There was no discharge from the right ear canal, but on examination there was right otitis media.

Otite externa maligna por Pseudomonas aeruginosa: relato de três casos

The cases of three patients aged over sixty, diabetic for a long time and having clinical, otological, neurological and microbiological findings of malignant external otitis by Pseudomonas aeruginosa are registered. The first patient, a 62 years old woman, had important neurological alterations, such as proven P. aeruginosa meningitis and involvement of the 6th, 7th, 8th, 9th and 10th left cranial nerves. Although mortality and morbidity rates of cases with these characteristics are reported to be high, this patient survived. The second was a 64 years old male with the classical complaints of this condition consisting of persistent and intensive ear pain, serous purulent discharge and an emerging tumourous lesion in the left external ear canal. Good results were obtained with the surgical treatment administered along with an antimicrobial plan which remained incomplete because the patient has requested his discharge from the hospital. In less than one month, he was again hospitalized already presenting neurological manifestations (paralysis of the 6th cranial nerve) following a fatal course in a few days. The third was also a male patient, 70 years old, whose initial complaints occurred after a month a butterfly penetrated his right ear during his sleep. In spite of the presence of neurological troubles (facial paralysis and stupor) he survived with a prolonged antibiotic therapy. After a literature revision on this pathology, considerations are made concerning its pathogeny, clinical findings, diagnosis, therapy and prognosis.

A Case of First Branchial Cleft Anomaly Associated with Bony External Auditory Canal

First branchial cleft anomalies are rare disorders. A case of a first branchial anomaly with an unusual fistulous tract is presented.The patient was a 6-year-old boy who complained of white gelatinous discharge from his left ear canal and recurrent abscess in the left submandibular region. Otoscopic examination revealed deformity of the tympanic membrane and a downward excavation of the bony external auditory canal at its deepest potion. Hearing was normal and there was no deformity in his left auricle or other parts of the body. The fistulous tract was extirpated. The tract extended upwards from the submandibular wound, passing medially through to the deep parotid gland lobe and opening into the bony external auditory canal. The tract was found to be lined with keratinized squamous epithelium with adnexal structures and accompanied by cartilage at the junction of the auditory canal.In the past literature we could not find a case that had a fistulous opening at the bony external auditory canal and a deformity of the tympanic membrane.We observed collected human fetuses (the fourth to eighth weeks) in order to study these anomalies from the embryological standpoint. We found by chance two other developmental stage fetuses both of which showed duplicated external auditory canal and pinna. After careful comparison with these fetuses, we concluded that the first branchial cleft anomaly with the fistulous tract running through from the submandibular area to the external auditory canal were not derived from these duplication anomalies of the external ear. This type of first branchial cleft anomaly was considered to be closely associated with Reichert's cartilage. In our case we supposed there would be interaction between Reichert's cartilage and the tympanic ring during the latter half of the fetal period.The deformity of the tympanic membrane was believed to be caused by incomplete closure of the foramen of Huschke.

EAR ANOMALIES IN AN INFANT WITH POTTER??S SYNDROME

Microdissection and scanning electron microscopy were used to study temporal bone specimens from a newborn infant with Potter's syndrome. The 34-year-old mother of the infant had juvenile-onset rheumatoid arthritis and she took prostaglandin inhibitors (aspirin, indomethacin, and Clinoril) during pregnancy. Autopsy findings included bilateral renal dysgenesis, pulmonary hypoplasia, abnormal facies with low-set ears, and bilateral cataracts. The infant's left external ear canal was stenotic and the left tympanic anulus was narrowed. Otherwise, both middle ears, as well as the sensory structures of the cochleae and semicircular canals, were normal. The saccular and utricular muculae on the right were entirely devoid of otoconia, although they were covered by gelatinous otoconial membranes which appeared normal. On the left, the maculae were covered by thin layers of flat, lenticular crystals 2 to 10 mu in diameter. X-ray powder diffraction analysis showed these aberrant otoconia to be composed of calcium carbonate in the form of vaterite. No abnormalities of the neuroepithelia or macular nerve supply were found in either ear.

Vector analysis of auditory brain stem responses (BSR) in human beings.

The purpose of the present study is to clarify the origins of BSRs. We recorded BSR by three ortho-diagonal leads (X-axis: right ear canal to left ear canal, Y-axis: vertex to submental position, Z-axis; forehead to inion). We studied the waveforms on each of the three planes: frontal, sagittal, and horizontal and analysed their vectors on the basis of Lissajous'figures. Lissajous'figures revealed the following: (1) The vector of wave I is almost horizontal and is directed towards the non-stimulated side. (2) Wave II seems to be derived from the cochlear nuclei and double firings of the auditory nerves. (3) Wave III represents the activities of the circuits of the auditory pathways in the brain stem. (4) The vector of Wave V is the largest of the five responses, and is directed towards the fronto-parietal region, tilting slightly to the non-stimulated side.