Recurrent Otitis Externa Research Articles

Complex trauma sequelae: Mycobacterium goodii and Priestia endophytica Hardware infection in a patient with Ehlers-Danlos syndrome

A 26-year-old man with Ehlers-Danlos syndrome, recurrent otitis externa, and chronic otitis media sustained a left lower extremity amputation and open femur fracture with internal hardware fixation after a motor vehicle collision in Arizona. He presented to the emergency department at our institution with severe left leg pain and purulent discharge despite receiving two unidentified antibiotics upon discharge. Evaluations revealed an abscess and malunion of the femur. Initial cultures yielded scant Priestia endophytica, leading to daptomycin treatment. His condition worsened until Gram-positive bacilli identified as Mycobacterium goodii, a rare nosocomial mycobacterial species, were found. Significant improvement occurred with appropriate antibiotics. This case highlights the challenges in diagnosing and managing M. goodii infections in immunocompromised patients with orthopedic complications and notes P. endophytica as a previously unreported, possibly opportunistic human pathogen.

Evaluation of plasma canine C-reactive protein concentrations in dogs with otitis media, healthy dogs and dogs with chronic otitis externa.

Otitis is characterised by inflammation of one or more of the structures of the ear. At present, to confirm or exclude otitis media (OM), it is most often necessary to perform a computed tomography (CT) scan or magnetic resonance imaging. Inflammation is an immune defence response found in many conditions that can be detected and tracked by measuring biological markers of inflammation as the Canine C-reactive protein (CRP). The objective of this study was to determine whether CRP measurement is useful as an adjunctive diagnostic tool in dogs with otitis and whether elevated concentrations correlated with disease severity/presence of OM. Twenty-four client-owned dogs were recruited over 1 year. The dogs were divided into three groups: chronic or recurrent otitis externa (CO), otitis media (OM) and H (healthy). The dogs with otitis underwent a CT scan of the head, measurement of the plasma CRP concentration and evaluation of a 0-3 Otitis Index Score 3 (OTIS3 score). No dog (0%) in group H had an increased CRP value, compared to 20% in the CO group (one of five dogs) and 23% in the OM group (3 of 13 dogs). Plasma CRP concentrations show a statistically significant positive relationship with the OTIS3 score (p = 0.04). Plasma CRP concentration is not reliable as a discriminatory tool in cases of otitis, although there is a trend for elevation in cases with more severe disease. However, a larger study may provide a statistically more reliable correlation between the severity of OM and CRP concentrations.

Impacted ear drop dispenser cap: A rare cause of recurrent otitis externa

: To report a case of an elderly male with aural foreign body presenting as recurrent otitis externa and to highlight the fact that aural foreign bodies may be an underlying cause in such recurrent cases.: Case report: Aural foreign body with recurrent otitis externa.: Tertiary care center.: Surgical removal of foreign body. : The granulations and recurrent otitis externa resolved after removal of foreign body.: Suspicion of an aural foreign body should be maintained in a child or even adult presenting with recurrent otitis externa.

Osteoma

Osteoma is a benign osteoblastic mesenchymal tumor consisting of differentiated mature bone tissue. Ear canal osteoma is an osteoma that occurs in the external acoustic canal. Osteoma of the ear canal is usually asymptomatic, but several symptoms that can accompany a total occlusion of the external acoustic canal are vertigo, tinnitus, which can also cause recurrent otitis externa, otorrhoea and otalgia. Mr. S came to the ENT Poly at Cut Meutia Hospital with complaints that his left ear felt blocked since 1 year ago. hearing loss in left ear. Left ear often bleeds when prying. Sometimes the patient feels pain in the left ear, and a clear, odorless discharge comes out of the left ear. The patient's left ear is often buzzing.
 On examination the local physical status found a solid mass, immobile, stalked, and unilateral and had closed all of the left external auditory canal. The tuning test found conductive deafness in the left ear. The patient was planned for CT-Scan Mastoid and osteoma excision surgery.

Managing recurrent otitis externa in dogs: what have we learned and what can we do better?

Recurrent otitis externa is a common problem in dogs. Topical treatment for each flare is successful in the short term, but repeated cycles of inflammation and infection lead to chronic inflammatory changes, pain and aversion, and antimicrobial resistance. These make the flares more frequent and harder to control. Eventually, the changes become irreversible and require a total ear canal ablation/lateral bulla osteotomy or ablative laser surgery. Most ear canal surgery is avoidable if recurrent otitis is properly managed at an earlier stage. This requires a different mindset and approach to these cases, taking advantage of recent research and clinical findings. Most importantly, clinicians must appreciate that all recurrent ear infections in dogs are secondary. To achieve a good long-term outcome, it is essential that all the underlying factors in each case are diagnosed and managed using the primary, secondary, predisposing, and perpetuating framework. This means that the primary condition must be diagnosed and managed, the secondary infection treated, predisposing risks identified and corrected, and the perpetuating factors reversed. Treatment is in 2 phases: induction to get the ears in remission and then long-term maintenance therapy to prevent relapses. Treatment should be appropriate to each dog but will typically involve ear cleaning, topical antimicrobial therapy, and topical or systemic glucocorticoids. Novel treatments for infection and inflammation will offer additional options in the future. Understanding the triggers for recurrent otitis in dogs will help clinicians plan effective management regimens that will make a huge difference to the quality of life of their patients and their owners.

Vertical canal auricular cartilage malformation in a Keetso cat with concurrent chronic otitis externa

AbstractA 7‐month‐old, male, neutered Keetso cat presented for assessment due to chronic recurrent otitis externa signs. Video otoscopic examination revealed corrugated stenosis of the vertical ear canal. A bilateral lateral wall resection was performed. Repeat examination 2 and 15 months after surgery showed no ongoing clinical signs. The Keetso cat is a new breed of cat with a small gene pool, with currently only two breeders worldwide. Significant features of the breed are polydactylism and externally curled pinnae (folded ears). The presence of cartilage malformation in the vertical ear canal may be associated with the chronic otitis externa and if occurring on a population level, presents a potential welfare concern for this breed.

Long-term complications of the transmeatal approach (Open Transcanal) in cochlear implants: A follow-up study

ObjectiveMultiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach. Transmeatal (open trnascanal) approach has not been adapted since first described in the clinical field. we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008. MethodsThis study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal (open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital (Riyadh, Saudi Arabia), which were conducted by the same surgeon. ResultsComplications were observed often with various combinations—recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16% (21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows: cholesteatoma in 5 (3.8%) patients, extrusion of the electrode in 5 (3.8%) patients, and tympanic membrane perforation or deep retractions in 5 (3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4 (3%) patients, recurrent otitis externa infections in 7 (5%) patients, and weakness of the posterior canal wall in 1 patient. ConclusionThe transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal

Darier’s disease presenting with otitis externa

Abstract Darier’s disease is an uncommon genetic disorder that causes dermatological manifestations such as crusted papules at seborrhoeic sites of the head, neck and trunk. Acantholysis and dyskeratosis are the characteristic histopathological picture. Darier’s disease is a genetically inherited disease that occurs with haploinsufficiency. Chronic otitis externa along with recurrent dermatological lesions should be investigated to rule out Darier’s disease, which will be helpful to provide appropriate treatment. We report the occurrence of Darier’s disease manifesting severe otitis externa in a 62-year-old male patient who presented with recurrent bilateral otitis externa with scaly and greasy lesions on the external auditory canal and pinna and was diagnosed to have bilateral otitis externa. At the age of 30 years, he was diagnosed with Darier’s disease on the basis of skin biopsy. This recurrent otitis externa with Darier’s disease should be known to the clinician for early diagnosis and prompt treatment.

Otological complications in inversa type recessive dystrophic epidermolysis bullosa.

The rare inversa subtype of recessive dystrophic epidermolysis bullosa (RDEB-I) is characterized by predominant intertriginous skin blistering and marked mucosal involvement. Specific recessive missense mutations in the collagen VII triple helix are implicated in the disease. To date, otological complications have been reported infrequently in this patient group. We conducted an observational, retrospective, double institution case record review of patients with RDEB-I who presented with otological complications between January 2000 and June 2020. Diagnosis was established on the basis of clinical features, family history and mutation analysis of the COL7A1 gene. In total, 11 (44%) of 25 patients with RDEB-I in our database (2 paediatric, 9 adult; mean age 40.9 years, range 8-72 years) experienced otological complications. Of these 11 patients, 10 (90.9%) had recurrent otitis externa, 7 (63.6%) had meatal stenosis and 7 (63.6%) had recurrent blistering of the external auditory canals. All 11 patients reported hearing difficulties, with conductive hearing loss confirmed by audiology testing in 6 (54.5%) of these. Of the 11 patients, 3 (27.3%) went on to have implantable hearing aids [2 bone-anchored hearing aids (BAHA) and 1 middle ear implant (MEI)] fitted with favourable outcome, while a fourth paediatric patient presented with a cholesteatoma that was surgically managed. We observed a higher prevalence of otological morbidity in RDEB-I than previously reported, and present the first case of cholesteatoma in epidermolysis bullosa (EB). Our data indicate that BAHA and MEI are safe and effective treatment options for hearing loss in EB. Clinicians should be vigilant in screening for ear symptoms in RDEB-I and consider early referral to an Ear, Nose and Throat specialist.

Collaborative Care Improves Treatment Outcomes for Dogs with Chronic Otitis Externa: A Collaborative Care Coalition Study.

The purpose of this retrospective study was to compare outcome measures in dogs treated by a primary care veterinarian (pcDVM) before referral and after seeking collaboration with a board-certified veterinary dermatologist (BCVD) for cases of severe recurrent chronic otitis externa. Medical records of 65 client-owned dogs were retrospectively reviewed, and data were obtained regarding treatment history, referral timeframe, recurrence rate, clinical signs, and resolution of signs. The median number of otitis recurrences while under the care of the pcDVM was 4 (range 1-40) versus collaborative BCVD care of 2 (P < .01). There was a longer median time to otitis recurrence with collaborative care (171 days) compared with dogs managed by the pcDVM before referral (21 days; P > .01). Proliferative changes in the ear canals improved in 41/45 (91%) of cases under BCVD care compared with 6/45 (13%) under care by the pcDVM (P < .01). Dogs with chronic otitis had better long-term outcomes when collaboration with a BCVD was pursued within 6 mo of treatment. Referral or consultation with a BCVD should be considered for cases of chronic canine otitis that are persistent or quickly recurrent (20-30 days) over a 6 mo period.

Transcanal Endoscopic Ear Surgery with Piezoelectric Device for External Auditory Canal Lesions

External auditory canal exostosis (EACE) is prone to occur in patients frequently exposed to cold water, which causes earwax impaction, recurrent otitis externa, and conductive hearing loss. The main treatment for symptomatic EACE is surgical excision. External auditory canal cholesteatoma (EACC) is a bone-destructive cystic mass caused by accumulation of plugs of desquamated keratin debris in the external auditory canal (EAC), which is also mainly treated with surgical removal. The main difficulties in the surgical removal of obstructive EACEs or EACCs are related to the adjacency of EAC skin, tympanic membrane, temporomandibular joint, and the blockage of the medial EAC landmarks during the operation. The piezoelectric device (PZD), which has long been used to cut bony structures in dental surgery, has clinical advantages here with regards to accurate exclusive bone cutting ability and minimal heat production. We report a series of cases that managed EAC lesions using PZD.

The MO-meatocanalplasty: long-term results in the narrow external auditory canal with recurrent otitis externa or the inability to wear a hearing aid.

The MO-meatocanalplasty is the oblique modification of the M-meatoplasty. The MO-meatocanalplasty was designed to address the superior quadrants of the meatus and the bony canal without the need for a retro-auricular incision. This retrospective analysis was performed to evaluate the long-term results of the MO-meatocanalplasty in patients with a narrow external auditory canal (EAC) with recurrent otitis externa or in patients unable to wear a hearing aid. Twenty-two ears in twenty consecutive patients who received a MO-meatocanalplasty for a narrow EAC with recurrent otitis externa or the inability to wear a hearing aid were analysed retrospectively. There were no patients included with any type of previous or planned second stage tympanoplasty procedures. A follow-up period of 3years was analysed for postoperative recurrent narrowing, the self-cleaning capacity of the EAC, the recurrence of otitis externa, the inability to wear a hearing aid, change in hearing level and for all types of aesthetical complaints. The MO-meatocanalplasty procedure was effective in 82% (n = 18). Postoperative recurrent narrowing was detected in 9% (n = 2). Insufficient self-cleaning capacity of the EAC was 9.1% (n = 2). The ability to wear a hearing aid was restored in all patients with the need for a hearing aid. No aesthetical complaints were reported. The MO-meatocanalplasty is an effective, safe and aesthetical accepted procedure to address the narrow meatus and external auditory canal. With this procedure, there is no need for a retro-auricular incision in order to create a well aerated, dry and self-cleaning EAC in patients with a narrow EAC with recurrent otitis externa or in patient with the inability to wear a hearing aid.

Importance of vitamin D among patients with recurrent acute otitis externa

Importance of vitamin D among patients with recurrent acute otitis externa

Diagnosis of Skull Base Osteomyelitis.

Skull base osteomyelitis (SBO) is an infection of the temporal, sphenoid, or occipital bone that can be a challenge to diagnose because of its nonspecific symptoms, long clinical course, and radiologic findings that mimic those of other entities. The authors review this unusual infection on the basis of six proven cases. The diagnosis of SBO should be made according to four points: a high index of clinical suspicion, radiologic evidence of infection, repeated biopsies that are negative for malignancy, and positive results of microbiologic tests. SBO typically manifests clinically in patients with diabetes and recurrent otitis externa; the infection usually extends inferiorly to the compact bone of the infratemporal fossa, affecting the lower cranial nerve foramina. Several image-based techniques should be used to diagnose SBO. CT is the best option for evaluating bone erosion and demineralization, MRI can help delineate the anatomic location and extent of disease, and nuclear imaging is useful for confirming bone infection with high sensitivity. However, the standard diagnostic procedure for SBO is for patients to undergo repeated biopsies to rule out malignancy, with histopathologic signs of infection and detection of microorganisms in the biopsied bone or soft tissue indicating SBO. The ability to diagnose SBO can be increased by identifying patients at risk, recognizing the most important causes and routes of infection, describing the main radiologic findings, and always considering the differential diagnosis. ©RSNA, 2021.

Darier´s disease as an unusual risk factor for otitis externa: a case report

Background: Darier´s disease is known for affecting seborrheic areas of the body, including the ear, but no previous case reports describe recurrent otitis externa as a manifestation of this rare disease.Case presentation: We describe the case of a 70-year-old woman presenting to the Otolaryngology department with bilateral otalgia and pruritus with a 4-day evolution. She complained of recurrent similar episodes for many years requiring treatment. Scaly, pruritic, greasy lesions of the pinna were present and bilateral otitis externa was diagnosed. Inframammary and lower leg involuting lesions were also present. She had been diagnosed with Darier´s disease by the age of 16 years reporting frequent flares. Targeted treatment resolved the otologic complaints after 1 week and Dermatology evaluation was advised to pursue systemic medical optimization.Conclusion: Patients showing chronic otitis externa along with concurrent dermatologic lesions should be referred to the Dermatology clinic so that diagnostic investigation and targeted therapies may be offered.

Recurrent otitis externa owing to allergic contact dermatitis to topical medications

Recurrent otitis externa owing to allergic contact dermatitis to topical medications

The importance of video otoscopy in the diagnosis and treatment of chronic otitis in dogs

Summary Chronic otitis is one of the most common reasons why dogs are presented to veterinary facilities in Lebanon. The chronicity of this disease is due to the failure to diagnose correctly the primary cause and the incapacity to treat it effectively. The objective of this study is to show the importance of the video otoscopy in the diagnosis and treatment of recurrent otitis externa and/or otitis media. A total of twenty cases (twelve dogs) with chronic otitis externa and/or media were used for this study. Video otoscopy was performed in all 20 cases where it was used for diagnosis in 13/20 cases and treatment in 17/20. Thirteen (65%) of the cases showed a change in the diagnosis after undergoing video otoscopy. Seventeen (85%) of the cases showed an improvement after using the video otoscopy for ear flushing and lavage, in conjunction with home therapy, for treatment purposes. Improvements were judged subjectively seven, fourteen, and twenty-one days after the otoscopic lavage took place. Three (15%) of the cases underwent a surgery due to the presence of polyps that were not removable with the video otoscope.

Short Communication: Otitis externa in a tertiary care hospital in Zagazig, Egypt: Isolated pathogens and their antibiotic sensitivity patterns

Introduction: Recurrent otitis externa is a worldwide problem. This study aims to identify the different aetiological organisms isolated from otitis externa and their sensitivity to different antibiotics. Methods: A total of 27 patients with clinical presentation of otitis externa for a period of three weeks or more were enrolled for the study. Two swab samples collected from each infected ear were cultured for bacterial and fungi, and growth identified using standard microbiological methods including analytical profile index (API) system. Antibiotic susceptibility of isolated bacteria was performed by the disk diffusion technique. Results: Thirty one organisms were isolated from the 27 patients; 12 (38.7%) fungi and 19 (61.3%) bacteria species. Aspergillus spp was the most frequently isolated organism (35.4%) while Pseudomonas aeruginosa was the most frequently isolated bacteria (19.3%), and was most sensitive to amikacin. Four of 11 patients with Aspergillus infection showed clinical resistance to econazole local treatment but had complete clinical response to itraconazole oral treatment. Conclusion: Otitis externa in Egypt is caused by antibiotic resistant bacteria or fungi, and the most causative organisms are Aspergillus spp and Ps. aeruginosa. Keywords: Otitis externa, antibiotic resistance, Pseudomonas aeruginosa, Egypt

Critically appraised topic on adverse food reactions of companion animals (7): signalment and cutaneous manifestations of dogs and cats with adverse food reactions

BackgroundOutside of pruritus, there is no clear consensus on the nature and prevalence of cutaneous manifestations of adverse food reactions (AFRs) in dogs and cats.ResultsWe searched two databases on August 7, 2018, for articles reporting detailed data on the signalment and clinical signs of at least one dog or cat with a cutaneous AFR (CAFR). We identified 233 and 407 citations from which were selected 32 articles reporting original information. Twenty-two articles included data on 825 dogs with CAFRs. The reported age of onset varied from less than one to 13 years of age; a beginning of signs by 6 or 12 months of age was noted in 22 to 38% of dogs, respectively. The female-to-male ratio also varied considerably. Four breeds (German shepherd dogs, West Highland white terriers, Labrador and golden retrievers) accounted for about 40% of affected dogs. Most dogs diagnosed with a CAFR were pruritic, most often in a generalized pattern, with the ears, feet, and abdomen also being frequently affected; the perineum was uncommonly targeted, however. Canine CAFRs presented mainly as recurrent bacterial skin infections, otitis externa and atopic dermatitis. Twelve articles reported novel information on 210 cats with this syndrome. There was no apparent breed and gender predisposition for feline CAFRs, but cats appeared to develop signs later than dogs with the same syndrome. Most cats with a CAFR were pruritic, especially on the head/face and neck, with the abdomen and ears also commonly involved. Symmetric self-induced alopecia, a head-and-neck self-traumatic dermatitis, miliary dermatitis and variants of eosinophilic diseases were the most common manifestations of feline CAFRs.ConclusionsCAFRs affect dogs and cats of any age, any breed, and both genders, with the proportion of juvenile dogs diagnosed about twice that of cats. There are no reliable breed predisposition data. Most patients are pruritic, with half the dogs having generalized pruritus and half the cats scratching their face/head or neck. Canine CAFRs most often manifest as bacterial skin infections, otitis externa or atopic dermatitis; cats with CAFRs will exhibit the expected clinical phenotypes associated with feline hypersensitivity dermatitides.

Schwannoma of the external auditory canal: An exceptional site

IntroductionSchwannomas are benign solitary neural tumours that are only exceptional located in the external auditory canal, as only a few cases have been reported in the literature. Case reportWe report a case of schwannoma of the external auditory canal in an 18-year-old man admitted for an isolated mass of the initial segment of the right external auditory canal visible to the naked eye, obstructing all of the external auditory meatus. Computed tomography of the temporal bone showed an isolated mass of the external auditory canal. Management of this patient consisted of biopsy-excision of the mass, histological examination of which confirmed a schwannoma of the external auditory canal. DiscussionAlthough rare, the possibility of a nerve tumour of the external auditory canal should always be considered. These tumours may be isolated or may occur in the context of von Recklinghausen's disease. The clinical presentation in the external auditory canal may correspond to recurrent otitis externa secondary to obstruction of the canal by the tumour, as in the case reported here. The definitive diagnosis must be based on the results of histological and immunohistochemical examination.