Otitis Externa Research Articles

Long-lasting otic solution containing mometasone furoate can influence intradermal testing in dogs with healthy ears and otitis externa.

Topical therapy is preferred for otitis externa (OE) in dogs. Otic products commonly contain glucocorticoids that can be systemically absorbed and possibly interfere with diagnostic tests such as intradermal testing (IDT). To determine the effect of a long-lasting otic solution containing mometasone furoate (MF) on IDT immediate reactions and to determine withdrawal time before IDT. Seventeen dogs with healthy ears (Group 1) and 12 with OE (Group 2). Intradermal injections of histamine, anticanine-immunoglobulin (Ig)E and saline were subjectively and objectively evaluated before treatment and weekly for 6 weeks, after a single application of a long-lasting otic solution containing MF. Statistically significant reductions in the mean subjective histamine scores after application of MF were observed at Weeks 1 (p = 0.012) and 2 (p = 0.028) in Group 1, and Weeks 1 (p = 0.00066), 2 (p = 0.02) and 4 (p = 0.034) in Group 2. Mean histamine objective scores were significantly reduced in Weeks 1 (p = 0.042), 2 (p = 0.0009), 3 (p = 0.001) and 5 (p = 0.018) in Group 1 only. The mean subjective anticanine-IgE scores were significantly reduced in Week 1 in both groups (p = 0.003, p = 0.0066), respectively. There were no significant changes in the mean anticanine-IgE objective score in either group. Application of a long-lasting otic solution containing MF can interfere with IDT immediate reactions in healthy and OE dogs. Based on the subjective evaluation, IDT can be performed ≥2 weeks after application of the otic solution in healthy dogs, and ≥4 weeks in dogs with OE.

Role of Tympanometric Ear Canal Volumes in Determining Outcome of Myringoplasty in Chronic Suppurative Otitis Media Patients.

Middle ear aeration is a predictive indicator of myringoplasty's successful outcome and tympanometric ear canal volume is a novel investigation that can estimate the volume of middle ear cleft and mastoid air cells. Our aim of this study is to determine the role of tympanometric ear canal volume on myringoplasty outcome in Chronic Suppurative Otitis Media Patients. Prospective analysis involving 50 patients of CSOM was performed on patients undergoing myringoplasty from April 2022 to December 2023. Smokers, Patients with squamosal COM, Bilateral COM, Otitis Externa, and Revision surgery were excluded from the study. The successful outcome of surgery was defined as no tympanic membrane perforation on postoperative follow-up. Analysis was carried out using SPSS. V. 25 and P-value less than 0.05 was considered significant. A total of 50 patients were included in the study with a mean age of 24.4 ± 8.965 and male predominance. Overall graft uptake was 64%. Graft uptake had no significant statistical correlation with age, gender, type, location, or size of perforation. However, there is a significant effect of tympanometric ear canal volume of pathological ear and interaural tympanometric ear canal volume difference on graft uptake with p-values of 0.023 and 0.033 respectively. Tympanometric ear canal volume can predict middle ear aeration and the higher the interaural tympanometric canal difference more are the chances of successful graft uptake.

New Insights into Molecular Characterization, Antimicrobial Resistance and Virulence Factors of Methicillin-Sensitive Coagulase-Positive Staphylococcus spp. from Dogs with Pyoderma and Otitis Externa

The first Tunisian national molecular survey of coagulase-positive staphylococci (CoPS) isolated from dogs with pyoderma and otitis externa was conducted to evaluate the prevalence of CoPS and identify its phenotypic and genotypic diversities. A total of 99 out of the 195 samples collected from 39 sick dogs were identified across multiple sites as methicillin-susceptible CoPS belonging to the species S. pseudintermedius (64.4%), S. aureus (20.2%), S. coagulans (10.1%), and S. hyicus (5%). Fifteen sampled dogs carried more than one Staphylococcus species. Their antibiotic resistance and virulence factors were determined using conventional and molecular methods. Of the S. pseudintermedius isolates found, 17.4% were multidrug-resistant, whereas high rates of virulence genes were observed among the S. aureus isolates. On polystyrene surfaces, 75% of S. aureus isolates were biofilm producers, of which 15% were classified as strong producers. The capsular polysaccharide cap8 genotype was predominant among them. A MultiLocus Sequence Typing (MLST) analysis clustered the S.aureus isolates into five distinct sequence types (STs), with four assigned for the first time. Our findings highlight the spread of CoPS among diseased dogs and, especially, the emergence of S. hyicus, S. coagulans, multidrug-resistant S. pseudintermedius and S. aureus isolates with high genetic variability. The precise characterization of these strains, as well as their continuous monitoring, is necessary for the implementation of preventive strategies given the significant public health risk.

Multiple associated fibroepithelial polyps (acrochordonous plaques) in the external ear canal of three French bulldogs with chronic otitis

AbstractMultiple closely associated fibroepithelial polyps, also known as acrochordonous plaques, are benign proliferative lesions, described so far only on the dorsal neck and the head of bulldogs and pugs, and on the lumbo‐sacral region of a dobermann. Here, we report for the first time the presence of multiple closely associated fibroepithelial polyps in the external ear canal of three French bulldogs with chronic otitis. In all the cases, lesions presented as a plaque composed of domed shaped, villous or filiform proliferations. The diagnosis was obtained combining video‐otoscopic and histopathological findings. In only one case, these lesions were considered critical for the persistence of the otitis externa, and surgical treatment was recommended. Multiple closely associated fibroepithelial polyps should be set among the differential diagnoses of plaque‐like lesions with an irregular surface in the external ear canal of French bulldogs.

Incidence and Characteristics of Pediatric Patients with Acute Otitis Hospitalized in a Romanian Infectious Diseases Hospital.

Otic involvement is common in children during acute infectious diseases, and is an important cause of morbidity and health service utilization. We performed a retrospective analysis of pediatric cases hospitalized in the largest infectious disease hospital in Romania between 2018 and 2023, with the aim of quantifying the incidence and impact of acute otitis (AO) according to pediatric age subgroups. A total of 1118 cases diagnosed with AO were eligible and included in the analysis. Acute congestive otitis media was the most common subtype, identified in 53.3% of cases, followed by acute purulent otitis media (APOM) in 26.7% of children. The majority of AO cases (69.9%) were diagnosed in the pre-pandemic period (2018-2019), and infants (10.6%), toddlers (49.4%), and preschoolers (29.2%) were the most affected age groups. A viral infection associated with the AO episode was documented in 49.6% of cases. Influenza viruses were most commonly reported (20.5%), followed by SARS-CoV-2 (5.8%), and adenovirus (4.9%). A total of 38 cases of AO were identified in children with measles. In 15.9% of APOM cases, Streptococcus pneumoniae was isolated by culture from otic secretions. The duration of hospitalization was longer in children with APOM and acute otitis externa compared to the other subtypes of AO (p < 0.001). Our study highlights the importance of ENT (ear, nose, and throat) monitoring in children hospitalized for acute infectious diseases, as the majority of AO cases occur in the context of a viral infection. These findings emphasize the necessity for tailored assessment and intervention in suspected cases of AO, especially in young children under 5 years of age.

Brainstem auditory evoked responses in horses with hearing loss and during general anesthesia

The brainstem auditory evoked response (BAER) is a diagnostic approach to examine the hearing system of horses objectively. The aim of this BAER examination was the diagnosis of conductive or sensorineural hearing loss or deafness in horses with external otitis, head trauma, headshaking, tinnitus or skittish horses with eye disease. Brainstem dysfunction is induced by intracranial hypotension. BAER was used in horses with colic surgery which had a low arterial blood pressure during general anesthesia. The endoscopic finding of the guttural pouch was the ipsilateral mild to severe hypertrophy of the tympanostylohyoideum in horses with external otitis or head trauma. The otoscopic examination of standing sedated horses was done before BAER. The cartilagineous and osseous part of the external ear canal in horses with external otitis were obstructed with exsudate and tympanic membranes were not visible. Horses with right sided external otitis: right moderate to severe conductive hearing loss (significantly prolonged latencies of I, III, V and interpeak latencies I-III, I-V, III-V; thresholds of hearing levels 60 to 80 dB right); horses with left sided external otitis: left severe conductive hearing loss (no correct identification of BAER peaks, latencies not measurable, 80 dB); horse with left sided head trauma: severe left sided conductive hearing loss (blood in the left external ear canal, no visible tympanic membrane, no correct identification of BAER peaks, latencies not measurable, 80 dB); horses with head shaking: mild sensorineural hearing loss on both sides (on both sides osseous parts II/III with keratin scales of the junction, visible tympanic membranes, significantly prolonged V, I-III, I-V, 40 dB); moderate to severe skittish horses with chronic eye disease (mostly left sided equine recurrent uveitis): moderate sensorineural hearing loss on both sides (normal otoscopical findings, significantly prolonged latencies and interpeak latencies left; I-V, III-V right, 60 dB, pathological involvement in the auditory pathway of the brainstem between the cochlear nucleus and colliculus caudalis); horse with a tinnitus on both sides: mild sensorineural hearing loss on both sides (normal otoscopical findings, prolonged V, I-III, I-V, III-V, 40 dB, pathology of auditory nerve, cochlear nucleus and above the level of this nucleus); American paint horses: sensorineurale deafness on both sides (normal otoscopical findings, absent BAER peaks, isoelectric lines and 80 dB on both sides). The prolonged latencies of I, III and V including interpeak latencies I-III only left and I-V and III-V on both sides in horses with laparotomy during general anesthesia were associated with low arterial blood pressure (62 mmHg, median). These findings could demonstrate a hypotension in the brainstem too. The BAER could be a technical tool during general anesthesia for normalizing the arterial blood pressure and brainstem function to prevent imbalance of body movements after general anesthesia.

Applying two approaches to detect unmeasured confounding due to time-varying variables in a self-controlled risk interval design evaluating COVID-19 vaccine safety signals, using myocarditis as a case example.

We test the robustness of the self-controlled risk interval (SCRI) design in a setting where time between doses may introduce time-varying confounding, using both negative control outcomes (NCOs) and quantitative bias analysis (QBA). All vaccinated cases identified from 5 European databases between 1 September 2020 and end of data availability were included. Exposures were doses 1-3 of the Pfizer, Moderna, AstraZeneca, and Janssen COVID-19 vaccines; outcomes were myocarditis and otitis externa (NCO). The SCRI used a 60-day control window and dose-specific 28-day risk windows, stratified by vaccine brand and adjusted for calendar time. The QBA included two scenarios: (i) baseline probability of the confounder was higher in the control window and (ii) vice versa. The NCO was not associated with any of the COVID-19 vaccine types or doses except Moderna dose 1 (IRR = 1.09, 95%CI 1.01-1.09). The QBA suggested even the strongest literature-reported confounder (COVID-19; RRmyocarditis = 18.3) could only explain away part of the observed effect from IRR = 3 to IRR = 1.40. The SCRI seems robust to unmeasured confounding in the COVID-19 setting, although a strong unmeasured confounder could bias the observed effect upward. Replication of our findings for other safety signals would strengthen this conclusion.

Risk of emergency hospital admission related to adverse events after antibiotic treatment in adults with a common infection: impact of COVID-19 and derivation and validation of risk prediction models

BackgroundWith the global challenge of antimicrobial resistance intensified during the COVID-19 pandemic, evaluating adverse events (AEs) post-antibiotic treatment for common infections is crucial. This study aims to examines the changes in incidence rates of AEs during the COVID-19 pandemic and predict AE risk following antibiotic prescriptions for common infections, considering their previous antibiotic exposure and other long-term clinical conditions.MethodsWith the approval of NHS England, we used OpenSAFELY platform and analysed electronic health records from patients aged 18–110, prescribed antibiotics for urinary tract infection (UTI), lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI), sinusitis, otitis externa, and otitis media between January 2019 and June 2023. We evaluated the temporal trends in the incidence rate of AEs for each infection, analysing monthly changes over time. The survival probability of emergency AE hospitalisation was estimated in each COVID-19 period (period 1: 1 January 2019 to 25 March 2020, period 2: 26 March 2020 to 8 March 2021, period 3: 9 March 2021 to 30 June 2023) using the Kaplan–Meier approach. Prognostic models, using Cox proportional hazards regression, were developed and validated to predict AE risk within 30 days post-prescription using the records in Period 1.ResultsOut of 9.4 million patients who received antibiotics, 0.6% of UTI, 0.3% of URTI, and 0.5% of LRTI patients experienced AEs. UTI and LRTI patients demonstrated a higher risk of AEs, with a noted increase in AE incidence during the COVID-19 pandemic. Higher comorbidity and recent antibiotic use emerged as significant AE predictors. The developed models exhibited good calibration and discrimination, especially for UTIs and LRTIs, with a C-statistic above 0.70.ConclusionsThe study reveals a variable incidence of AEs post-antibiotic treatment for common infections, with UTI and LRTI patients facing higher risks. AE risks varied between infections and COVID-19 periods. These findings underscore the necessity for cautious antibiotic prescribing and call for further exploration into the intricate dynamics between antibiotic use, AEs, and the pandemic.

Efficacy and Safety of Brodalumab, an Anti-interleukin-17 Receptor A Monoclonal Antibody, for Palmoplantar Pustulosis: 16-Week Results of a Randomized Clinical Trial.

Palmoplantar pustulosis (PPP), a refractory skin disease characterized by repeated eruptions of sterile pustules and vesicles on palms and/or soles, involves interleukin-17 pathway activation. Brodalumab, a fully human anti-interleukin-17 receptor A monoclonal antibody, is being investigated for use in PPP treatment. The aim was to assess the efficacy and safety of brodalumab in Japanese PPP patients with moderate or severe pustules/vesicles. A phase 3, randomized, double-blind, placebo-controlled trial was conducted between July 2019 and August 2022, at 41 centers in Japan. Patients aged 18-70 years with a diagnosis of PPP for ≥24 weeks, a PPP Area Severity Index (PPPASI) score of ≥12, a PPPASI subscore of pustules/vesicles of ≥2, and inadequate response to therapy were included. Participants were randomized 1:1 to receive brodalumab 210 mg or placebo, subcutaneously (SC) at baseline, weeks 1 and 2, and every 2 weeks (Q2W) thereafter until week 16. Changes from baseline to week 16 in the PPPASI total score (primary endpoint) and other secondary skin-related endpoints and safety endpoints were assessed. Of the 126 randomized patients, 50 of 63 in the brodalumab group and 62 of 63 in the placebo group completed the 16-week period. Reasons for discontinuation were adverse event (n = 6), withdrawal by patient/parent/guardian (n = 3), progressive disease (n = 3), and lost to follow-up (n = 1) in the brodalumab group and Good Clinical Practice deviation (n = 1) in the placebo group. Change from baseline in the PPPASI total score at week 16 was significantly higher (p = 0.0049) with brodalumab (least-squares mean [95% confidence interval {CI}] 13.73 [10.91-16.56]) versus placebo (8.45 [5.76-11.13]; difference [95% CI] 5.29 [1.64-8.94]). At week 16, brodalumab showed a trend of rapid improvement versus placebo for PPPASI-50/75/90 response (≥50%/75%/90% improvement from baseline) and Physician's Global Assessment 0/1 score: 54% versus 24.2%, 36.0% versus 8.1%, 16.0% versus 0.0%, and 32.0% versus 9.7%, respectively. Infection was the dominant treatment-emergent adverse event (TEAE); the commonly reported TEAEs were otitis externa (25.4%/1.6%), folliculitis (15.9%/3.2%), nasopharyngitis (14.3%/4.8%), and eczema (14.3%/12.9%) in the brodalumab/placebo groups, respectively. The severity of most TEAEs reported was Grade 1 or 2 and less frequently Grade ≥3. Brodalumab SC 210 mg Q2W demonstrated efficacy in Japanese PPP patients. The most common TEAEs were mild infectious events. NCT04061252 (Date of Trial Registration: August 19, 2019).

A Comparative Study on the Management of Acute Otitis Externa Using Hydroxylated Polyvinyl Acetate Ichthammol Glycerine Wick Versus Cotton Ichthammol Glycerine Wick.

Acute otitis externa is a localized inflammation of the skin of the external auditory meatus. It is characterized by pain, edema, erythema, and itchy discomfort. Treatment includes topical and oral antibiotics, analgesics, steroids, and anti-inflammatory medication for the ear. Aural medicated wicks are used to reduce edema and pain. To compare the clinical outcome of hydroxylated polyvinyl acetate ichthammol glycerine wick versus cotton ichthammol glycerine wick used in the treatment of acute otitis externa. It is a six-month observational study with 120 patients. The patients in this study were grouped into two groups with hydroxylated polyvinyl acetate and cotton wick, respectively. Pain was assessed using the VAS score before and after three days of treatment of acute otitis externa. Group B (patient treated with cotton ichthammol glycerine wick) had significant improvement in the pain score on days 2 and 3 compared to group A, with a significant p-value of <0.001. During the second visit (on day 2), the cotton ear wick was significantly better in terms of otalgia when compared with the hydroxylated polyvinyl acetate. The cotton wick group showed better and faster recovery in terms of pain and edema compared to the polyvinyl alcohol (PVA) groups.

185 Examining the Efficiency of Diagnosing and Managing Necrotising Otitis Externa (NOE) Using a Departmental Management Algorithm

185 Examining the Efficiency of Diagnosing and Managing Necrotising Otitis Externa (NOE) Using a Departmental Management Algorithm

Younger Children with Respiratory Tract Infections Are More Exposed to Off-Label Treatments: An Exploratory Retrospective Study in a Pediatric Emergency Setting.

We performed a retrospective data analysis. All patients aged 0-18 referred to PED from 1 September to 1 October 2022, were included. Further analysis was performed when respiratory tract infections were diagnosed. gender, age, triage group, chronic diseases, vital signs, and PED-prescribed treatment (medications, dosages, methods of administration). Statistical analysis used SPSS 28.0, with significance at p < 0.05. Data from 473 patients were analyzed, median age 3.5 years. Chronic diseases were present in 17.1% of children. 387 medications were prescribed, 47.5% being off-label. Off-label treatment was common for external otitis, acute laryngitis, and acute bronchitis (p < 0.001). There was incorrect administration of tobramycin with dexamethasone for otitis (n = 16, 100%) and inappropriate use of salbutamol inhalations by age (34.8%, n = 16). Some medications were given orally instead of injections (ondansetron n = 5, 62.5%; dexamethasone n = 82, 98.7%) or intranasally instead of intravenously (IV) (midazolam n = 7, 87.5%). IV adrenalin was prescribed for inhalations (n = 46). Younger children were more likely to receive off-label treatment (p < 0.001). Our study highlights the widespread issue of off-label and unlicensed drug prescribing in pediatric emergency care. Further research is necessary, because this reliance on off-label prescribing raises concerns about patient safety and compliance, especially given the limited clinical trials and therapeutic options available.

Otitis media/interna and encephalitozoonosis are the most common causes of head tilt in pet rabbits in the UK: 73 cases (2009‒2020).

There are limited studies that identify diseases associated with head tilt in pet rabbits. This was an observational, retrospective, single-centre study of rabbits with head tilt presented between 2009 and 2020. Descriptive statistics were performed for all cases, whereas univariate and multivariate analyses were only performed for the 36 cases with a final diagnosis. Seventy-three rabbits met the inclusion criteria. The final diagnoses included Encephalitozoon cuniculi meningoencephalomyelitis (EC) (15/36; 41.7%), otitis media/interna (OMI) (8/36; 22.2%) and concurrent EC and OMI (13/38; 36.1%). Subacute-to-chronic onset was more common in rabbits with OMI than in those with EC (p = 0.018). Previous middle ear surgery (p = 0.046) and a diagnosis of otitis externa (p = 0.004) significantly increased the risk of OMI. Meloxicam was associated with improvement of clinical signs(p = 0.007). Upright ears (p = 0.013), recumbency (p = 0.037) and impaired mentation (p = 0.001) were associated with a higher risk of death/euthanasia. The proportions of residual head tilt (66.7%) and relapse of vestibular signs (42.1%) were high. This was a retrospective study with cases varying in their investigation and conclusive final diagnoses. OMI and EC were the most common aetiologies of head tilt in pet rabbits in the UK. Meloxicam might be associated with a favourable outcome in affected rabbits. Paired EC serology and a CT scan of the head should be the baseline investigation for head tilt in rabbits.

Clinical outcomes in OPAT patients treated with ceftriaxone 4 g and ceftazidime 6 g extended interval dosing regimens.

New dosing regimens for ceftriaxone 4 g/24 hours and ceftazidime 3 g/12 hours are convenient for patients receiving OPAT. To date, these have not been clinically validated. To assess the tolerability, toxicity and effectiveness of once daily ceftriaxone (4 g) and 12 hourly ceftazidime regimens (3 g twice a day) in the OPAT setting. From April 2018 until March 2023; demographic, clinical, microbiological and outcome data were collected on all adult patients discharged to a community-based OPAT team in East London. There were 487 OPAT episodes. Fifty-three (10.9%) patients received ceftriaxone 4 g once a day and 20 (4.1%) ceftazidime 3 g twice a day. In the ceftriaxone group, the commonest conditions treated were orthopaedic, neurosurgical or diabetic foot infections. OPAT was used to expedite the discharge of 45 (84.9%) patients, the remainder were admission avoidance episodes. The commonest isolate causing infection was MSSA 23 (43.4%). There were no tolerability or toxicity episodes recorded. All patients were cured and bed days saved were 1266.In the smaller twice-daily ceftazidime cohort, seven (35%) patients were treated for necrotizing otitis externa, six (30%) for bronchiectasis and six (30%) for urinary tract infections. The commonest cause of infection was P. aeruginosa, 18 (90%). One case of nephrotoxicity was recorded. All patients were cured and bed days saved were 896. Regimens of ceftriaxone 4 g once a day and ceftazidime 3 g twice a day were well tolerated and highly effective. If widely adopted, these regimens will save OPAT and nursing time and enable more patients to be treated.

Pattern of Diseases Presenting in ENT Outpatient Department in a Postgraduate Teaching Hospital in S.I.T.E. Area Karachi

Ear, Nose and Throat (ENT) diseases are one of the public health problems and affect a huge number of the patient around the globe. Objective: To determine the pattern of ENT disorders or diseases in those patients who were attended outpatient department of ORL in a postgraduate teaching hospital of Karachi. Methods: Patients presenting at ENT OPD were selected randomly for the study. Data about ENT problems and information were collected through well structured questionnaire. After data collection, it was entered and analyzes by using software SPSS-23. Variables were age, sex, residence, socioeconomic status and different ENT diseases including wax, otitis media, allergic rhinitis, pharyngitis, tonsillitis, Deviated Nasal Septum (DNS) etc. Results: Male patients were 585 (46.8%) while female patients were 665 (53.2%) out of 1250 patients. Most of the patients were from industrial areas 775 (62%) and 475 (38%) were from city areas. 355 (28%) were suffering from wax followed by acute otitis media 300 (24%), acute tonsillitis and deviated nasal septum each in 225 (18%), otitis externa 150 (12%) and acute pharyngitis 145 (11%). In our study, a huge number of 72% of cases had ear disorders. 43.2% of patients had nasal issues, while 45.2% were related to laryngopharyngeal issues. Conclusions: Majority of the patients attending outpatient ENT department were related to ear wax followed by acute otitis media, acute tonsillitis, DNS, otitis externa, acute pharyngitis and many patients have multiple diseases.

A rare cause of malignant otitis externa and skull base osteomyelitis.

An elderly male with type 2 diabetes presented with a 2-month history of otalgia and severe headaches. He was diagnosed with malignant otitis externa (MOE) and was commenced on empirical treatment with oral ciprofloxacin. Pseudomonas is the most common cause of MOE. A baseline CT scan was undertaken that demonstrated skull base osteomyelitis (SBO) due to findings of bone erosion at the mastoid tip and an infiltrating soft tissue mass eroding the clivus. Eight weeks later, he returned with worsening and bilateral symptoms of otitis externa, hearing loss, temporomandibular pain and dysfunction. Worsening and now bilateral malignant otitis externa were confirmed with an MRI scan that also demonstrated a small fluid collection in his left temporal region. The collection was aspirated and grew scedosporium apiospermum. He was diagnosed with fungal SBO and was commenced on treatment with the antifungal voriconazole, with significant improvement in symptoms and radiological findings. Fungal osteomyelitis is more likely in immunosuppressed patients, particularly those with type 2 diabetes. Fungal aetiology should be suspected in patients with progressive symptoms, despite treatment. A microbiology diagnosis of fungal SBO or MOE can be challenging to obtain and can lead to diagnostic delay. A sampling of the external auditory canal can aid in diagnosing MOE; however, scedosporium may also be isolated as a commensal organism. Aspirations from accessible fluid collections, infratemporal fossa needle sample and bone biopsy can provide material for diagnosis. Scedosporium is a rare cause of disease in humans, however, fungal infections are increasing in humans, due to an increase in susceptible populations. Scedosporium apiospermum is a rare cause of SBO and should be considered in patients not responding to standard treatment.

Phenotypic and genotypic characterization of Staphylococcus aureus strains isolated from otitis externa: Emergence of CC30-spa t019-SCCmec IV carrying PVL as major genotype

The increasing emergence of Staphylococcus aureus as the primary causative agent of otitis externa has been noted; however, detailed information regarding the molecular characteristics of these strains in Iran remains scarce. The current study aims to investigate both genotypic and phenotypic attributes of S. aureus strains implicated in ear infections. In the present work, we analyzed 60 S. aureus strains isolated from cases of otitis externa over a period of 45 months. The resistance patterns were determined using disk diffusion and microbroth dilution methods. All S. aureus isolates were confirmed by the nucA polymerase chain reaction assay, and their biofilm production was assessed by a microtiter plate assay. Molecular characterization of the isolates was performed using the staphylococcal cassette chromosome mec, multilocus sequence typing, and staphylococcus protein A typing methods. Overall, the results indicated that 44 out of 60 S. aureus isolates (73.3 %) were methicillin-resistant Staphylococcus aureus. Resistance to mupirocin and vancomycin was observed in 13.3 % and 1.7 % of the tested isolates, respectively. Furthermore, out of the 60 S. aureus isolates, 56 strains (93.4 %) were classified as positive biofilm strains at different levels. Twelve distinct clonal lineages were identified. The vast majority of S. aureus isolates belonged to CC30/ST30-MRSA IV/t019 (41.7 %). Among the 31 strong biofilm producers, the majority (64.5 %) belonged to CC30/ST30-MRSA IV/t019 clone. Biofilm negative isolates belonged to CC22/ST22 (2 isolates), CC8/ST585 (one isolate), and CC8/ST8 (one isolate). Our result revealed that about three-quarters of PVL-positive strains belonged to CC30/ST30. Our data confirmed the presence of MSSA strains among CC30/ST30 and CC22/ST22 isolates. The mupirocin resistant isolates (n = 8) belonged to CC8/ST585-MRSA III/t713 (37.5 %), CC8/ST239-MRSA III/t030 (25 %), CC8/ST8-MRSA IV/t008 (12.5 %), CC8/ST239-MRSA III/t037 (12.5 %), and CC22/ST22-MRSA IV/t790 (12.5 %) lineages. The VRSA strain belonged to the CC8/ST8-MRSA IV/t008 lineage, carrying the vanA determinant. iMLSB phenotypes (n = 14) were distributed across different lineages, including CC30/ST30-MRSA IV/t019 (21.5 %), CC30/ST30-MSSA/t021 (21.5 %), CC22/ST22-MSSA/t005 (14.3 %), CC8/ST239-MRSA III/t030 (14.3 %), CC22/ST22-MSSA/t1869 (7.1 %), CC22/ST22-MRSA IV/t790 (7.1 %), CC8/ST239-MRSA III/t037 (7.1 %), and CC1/ST772-MRSA IV/t10795 (7.1 %). These findings highlight significant genotypic diversity and high biofilm formation among our isolates. The frequent occurrence of the CC/ST30 clone in S. aureus strains isolated from otitis externa reflects the emergence of these lineages as a predominant clone in Iran, posing a significant public health concern.

Karakteristik Pasien Otitis Eksterna di Poli THT-KL Rumah Sakit Universitas Mataram Periode Oktober 2022 – Oktober 2023

Background: Otitis externa (OE) is one of the most common diseases encountered in otorhinolaryngology practice. OE is an inflammation of the external acoustic canal (CAE). Around 10% of people experience OE at some stage of their lives. OE is related to several factors, one of which is excessive ear cleaning with cotton buds. Some people are still unfamiliar with the dangers of ear cleaning. Therefore, understanding OE is very important. This study aims to improve public understanding of OE by knowing the characteristics of OE patients in the ENT clinic of Mataram University Hospital. Methods: This study is a retrospective descriptive-analytic study. Data were obtained from the medical records of ENT clinic patients at the University of Mataram Hospital from October 2022 to October 2023. Samples were taken using the total sampling method. Data were analyzed using quantitative descriptive statistics. Results: A total of 164 samples were analyzed and it was found that most OE patients were female (61.0%). Most OE patients were in the age group under 50 years (79.9%) with a mean age of 33.93 ± 17.64 years. The most common clinical symptom complained by OE patients was ear pain (73.8%), followed by itching (48.8%), discharge (36.6%), buzzing (17.7%), decreased hearing (15.9%), and ear fullness (14.6%). The location of complaints was mostly felt in the left ear (43.9%). Conclusion: OE cases in the ENT clinic of Mataram University Hospital are most often found in the female population, the age group is under 50 years, and the most clinical symptoms are ear pain, with the most complaints felt in the left ear.

Complications of External Otitis in Horses

The physiological removal of foreign bodies in the horse’s external ear canal is best achieved by head-shaking. However, external otitis in the horse induces moderate to severe pain: therefore, the horse does not shake his head. The causes of external otitis are dust, water in the external ear canal, keratin, and ceruminous debris. The clinical symptoms are ear discharge, skittishness, facial nerve paresis, and/or head tilt. After the horse has been sedated, the most important diagnostic procedure is the endoscopy of the cartilaginous and osseous part of the external ear canal, including the evaluation of the transparency of the tympanic membrane. The clinical complications of external otitis are hearing loss, facial nerve paresis, head tilt, hypertrophy of the tympanostylohyoideum, and corneal ulcers. The most important treatment is soaking up the exudate in the osseous part of the external ear canal using small cotton balls which are held by the foreign body forceps of the endoscope. Based on the results of the culture of exudate and the antibiogram, an antibacterial drug must be administered orally for 3 to 4 weeks. At this time, an endoscopy of the external ear canals and guttural pouches also has to be done. Based on the outcome of the endoscopy, endoscopic and clinical investigations have to be performed six months later as well. Only 7/19 horses had a normal osseous part of the external ear canal with a transparent tympanic membrane, including normal hearing measured by the brainstem auditory-evoked response after one month of treatment.

Hyperbaric oxygen therapy in malignant otitis externa: a retrospective analysis.

Malignant otitis externa (MOE) is a rare form of invasive osteomyelitis of the external ear canal. It is typically caused by Pseudomonas aeruginosa in immunocompromised patients. The diagnosis is clinical, and the initial treatment involves systemic antibiotics or antifungal therapy. Surgery is usually only considered when medical treatment has failed. Although hyperbaric oxygen therapy (HBOT) is recommended for refractory osteomyelitis, there are no specific guidelines for MOE. This is a retrospective study that evaluates clinical data, treatment, and results obtained in patients diagnosed with MOE treated with HBOT at the Pedro Hispano Hospital between 2007 and 2022. During the study period, fifteen patients diagnosed with MOE were admitted for treatment with HBOT. All patients received antibiotic and/or antifungal therapy, and three required surgical intervention before starting HBOT. The pathology was successfully managed on all patients. HBOT may be an effective adjuvant treatment option in patients with MOE but it lacks robust scientific evidence. However, its therapeutic value should not be underestimated due to the good results and few adverse effects reported in recent retrospective studies and case reports.