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Emergency Medicine Practice Apr 2024Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the...
Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the most common diseases, such as acute otitis media and otitis externa. For more severe disease processes, such as necrotizing otitis externa, acute mastoiditis, and perichondritis, early recognition and timely management are paramount in reducing morbidity and mortality. A systematic approach to the evaluation of these patients is key to establishing an accurate diagnosis, identifying patients who are at high risk for dangerous etiologies or complications, and providing optimal patient care. This issue summarizes the most recent guidelines and presents a systematic, evidence-based approach to the emergency department evaluation and management of patients with otalgia.
Topics: Humans; Earache; Otitis Externa; Otitis Media; Emergency Service, Hospital; Acute Disease
PubMed: 38507217
DOI: No ID Found -
European Archives of... May 2024Necrotizing otitis externa (OEN) is an aggressive and morbid infection of the external acoustic meatus. What are the risk factors for OEN extension?
PURPOSE
Necrotizing otitis externa (OEN) is an aggressive and morbid infection of the external acoustic meatus. What are the risk factors for OEN extension?
METHODS
French monocentric retrospective study (2004-2021), including patients with OEN defined by the association of an inflamed EAM, a positive nuclear imaging, the presence of a bacteriological sample and the failure of a well-followed local and/or general antibiotic treatment. OEN was extensive if it was associated with vascular or neurological deficits, if nuclear imaging fixation and/or bone lysis extended beyond the tympanic bone.
RESULTS
Our population (n = 39) was male (74%), type 2 diabetic (72%), aged 75.2 years and pseudomonas aeruginosa was found in 88% of cases. Complications for 43% of patients were extensive fixation on nuclear imaging, for 21% of them the presence of extensive bone lysis, for 13% the appearance of facial palsy, for 5.3% the presence hypoglossal nerve palsy and for 2.5% the presence of thrombophlebitis or other nerves palsies. 59% of our population had extensive OEN. The diagnosis of the extensive OEN was made 22 days later (p = 0.04). The clinical presentation was falsely reassuring due to easier identification of the tympanic membrane (70% vs 46%, p = 0.17) but associated with periauricular oedema (42% vs 0%), bone exposure (16% vs 0%) and a temporomandibular joint pain (41% vs 12%).
CONCLUSION
Delayed treatment of OEN, identification of clinical bone lysis, especially when the tympanic membrane is easily visualized, and the presence of unbalanced diabetes are potential risk factors for extension of OEN.
Topics: Humans; Male; Otitis Externa; Retrospective Studies; Ear Canal; Pseudomonas Infections; Anti-Bacterial Agents; Risk Factors
PubMed: 38499694
DOI: 10.1007/s00405-024-08549-5 -
International Journal of Surgery Case... Apr 2024Acquired external auditory canal (EAC) atresia is a very rare condition, especially due to direct trauma. The challenge lies in the difficulty of treatment and the...
INTRODUCTION
Acquired external auditory canal (EAC) atresia is a very rare condition, especially due to direct trauma. The challenge lies in the difficulty of treatment and the tendency to recur even after a long period. Here we present a case report of treatment of recurrent EAC atresia resulting from a dog bite using a silicone stent prosthesis.
CASE PRESENTATION
A 4-year-old, bitten by a dog, suffered severe head injuries, including scalp avulsion and left auricle avulsion. Initial treatment included wound closure, antibiotics, and vaccines. However, complications arose, leading to left EAC atresia and hearing loss. Surgical interventions, including canaloplasty and skin grafting, were conducted, with recurrence prompting second surgery with using a silicon prosthetic post-surgery. Follow-up for up to 14 months showed no evidence of recurrence of atresia, with complete improvement in hearing.
DISCUSSION
Acquired stenosis of the External Auditory Canal (EAC) can result from various factors, predominantly otitis externa and traumatic incidents, including previous surgeries. Though direct trauma is rare, it can lead to stenosis. Surgical intervention is often necessary for post-traumatic cases, involving removal of obstructions, canal widening, and reconstruction. Management depends on maturity of stenosis, with non-surgical methods for soft stenoses and surgical procedures for mature ones, often supplemented by postoperative stents to preventing restenosis.
CONCLUSION
Acquired external auditory canal atresia remains a rare, difficult-to-treat entity with a high rate of recurrence. The use of a silicone prosthesis stent after surgery can be considered an effective method in preventing recurrence.
PubMed: 38493613
DOI: 10.1016/j.ijscr.2024.109540 -
Animals : An Open Access Journal From... Feb 2024A retrospective study of microbiological laboratory results from 2020 to 2022, obtained from a veterinary diagnostic laboratory of the island of Gran Canaria, Spain,...
Microbiological Survey and Evaluation of Antimicrobial Susceptibility Patterns of Microorganisms Obtained from Suspect Cases of Canine Otitis Externa in Gran Canaria, Spain.
A retrospective study of microbiological laboratory results from 2020 to 2022, obtained from a veterinary diagnostic laboratory of the island of Gran Canaria, Spain, focused on canine otitis cases, was performed. The objective of this study was to analyze the pathogen distribution, antimicrobial susceptibility, prevalence of multidrug resistant phenotypes and the role of coinfections in otitis cases in order to provide up-to-date evidence that could support effective control strategies for this prevalent pathology. A total of 604 submissions were processed for the diagnosis of canine external otitis. Of the samples analyzed, 472 were positive for bacterial or fungal growth (78.1%; 95% CI: 74.8-81.4%). A total of 558 microbiological diagnoses were obtained, divided in 421 bacterial (75.4%; 95% CI: 71.8-79.0%) and 137 fungal (24.6%; 95% CI: 20.9-28.1%) identifications. , and were the most prevalent microorganisms detected in clinical cases of otitis. High level antimicrobial resistance was found for (30.7%), (29.4%), (25.1%) and (19%). Multidrug-resistant phenotypes were observed in 47% of the bacteria isolated. In addition, a 26.4% prevalence of methicillin-resistant was detected. The high prevalence of antimicrobial resistant phenotypes in these bacteria highlights the current necessity for constant up-to-date prevalence and antimicrobial susceptibility data that can support evidence-based strategies to effectively tackle this animal and public health concern.
PubMed: 38473127
DOI: 10.3390/ani14050742 -
Frontiers in Veterinary Science 2024The development of a non-invasive method to analyze cytokine expression in the skin will provide further understanding of inflammatory skin disorders. This study aimed...
The development of a non-invasive method to analyze cytokine expression in the skin will provide further understanding of inflammatory skin disorders. This study aimed to evaluate cytokine expression in the skin through cerumen swabbing in dogs with otitis externa (OE) and to investigate whether increased cytokine expression in infected OE reflects the inflammatory status of the ear canal. Three groups consisting of control dogs ( = 24), dogs with ceruminous OE ( = 25), and dogs with suppurative bacterial OE ( = 15) were included in the study. The concentrations of keratinocyte-derived cytokines including Interleukin (IL)-8/chemokine ligand (CXCL)8, IL-10, IL-6, Tumor necrosis factor (TNF)-α, and IL-1ß in the cerumen of the ear canal of the included patients were analyzed using commercial ELISA kits. Additionally, correlations between cytokine levels and cytology scores (of yeasts, cocci/rod-shaped bacteria, and inflammatory cells) were assessed. IL-8/CXCL8 concentrations were significantly higher in dogs with ceruminous OE and dogs with suppurative bacterial OE than in control dogs. Furthermore, IL-8/CXCL8 concentrations positively correlated with scores in dogs with ceruminous OE ( = 0.630) and with bacterial scores in dogs with suppurative OE ( = 0.601). In addition, increased expression of IL-6 and IL-1ß were detected in dogs with suppurative bacterial OE compared to those with OE and control dogs, and showed positive correlation with inflammatory cell scores IL-6 = 0.520, IL-1ß; = 0.680). Therefore, keratinocyte-derived cytokines could be evaluated using non-invasive methods such as cerumen swabbing in dogs with OE.
PubMed: 38464701
DOI: 10.3389/fvets.2024.1355569 -
The Veterinary Record May 2024A single-dose, in-clinic, veterinary professional-administered treatment for canine otitis externa was developed to improve compliance and canine welfare.
BACKGROUND
A single-dose, in-clinic, veterinary professional-administered treatment for canine otitis externa was developed to improve compliance and canine welfare.
METHODS
This multicentre, controlled, examiner-masked, randomised field trial was conducted in 316 dogs over 42 days. Dogs were treated once, on day 0, with the investigational product containing gentamicin, posaconazole and mometasone furoate (Mometamax Ultra [MU]) or twice (days 0 and 7) with a control product containing florfenicol, terbinafine and betamethasone acetate (CP). The primary endpoint was a composite otitis index score of 4 or less (of 12) on day 14 and 3 or less (of 12) on day 28.
RESULTS
On day 28, treatment success was recorded in 128 of 143 MU-treated dogs (89.5%), significantly non-inferior to 116 of 133 (87.2%) CP-treated dogs (Farrington-Manning test, Z = 4.1351, p < 0.0001). For mixed cultures of Staphylococcus pseudintermedius and Malassezia pachydermatis, there was 100% treatment success in MU-treated dogs (n = 33), significantly non-inferior to 90.2% (37 of 41) in CP-treated dogs (Farrington-Manning test, Z = 3.1954, p = 0.0007).
LIMITATIONS
Efficacy in chronic otitis externa cases was not investigated. Cytology was not used to aid in diagnosis or for identification of secondary pathogens.
CONCLUSION
This unique combination, single-dose product is safe and effective in dogs with otitis externa. It offers enhanced compliance, canine welfare and quality of life by eliminating the owner burden of treating this painful condition.
Topics: Animals; Dogs; Dog Diseases; Otitis Externa; Mometasone Furoate; Treatment Outcome; Female; Male; Triazoles; Gentamicins; Anti-Bacterial Agents; Drug Therapy, Combination; Antifungal Agents; Suspensions
PubMed: 38462781
DOI: 10.1002/vetr.3955 -
Ugeskrift For Laeger Feb 2024External otitis (EO) is a common and often painful infection in the ear canal. This review provides an overview of the typical presentation, causes, complications, and... (Review)
Review
External otitis (EO) is a common and often painful infection in the ear canal. This review provides an overview of the typical presentation, causes, complications, and treatment of EO. The condition is influenced by factors like pH levels, inflammation, and bacterial or fungal invasion. Most common bacteria involved are Pseudomonas aeruginosa and Staphylococcus aureus, and most common fungi are Aspergillus and Candida species. EO can lead to serious complications, such as necrotising EO, which requires prompt medical attention. Treatment involves local care, ear drops, and, in severe cases, systemic antibiotics.
Topics: Humans; Otitis Externa; Inflammation; Anti-Bacterial Agents; Candida; Staphylococcal Infections
PubMed: 38445328
DOI: 10.61409/V05230339 -
Veterinary Journal (London, England :... Apr 2024Malassezia are members of the mycobiome of dogs and cats. In the presence of an underlying disease, these yeasts can proliferate, attach to the skin or mucosa to induce... (Review)
Review
Malassezia are members of the mycobiome of dogs and cats. In the presence of an underlying disease, these yeasts can proliferate, attach to the skin or mucosa to induce a secondary Malassezia dermatitis, otitis externa or paronychia. Since allergic dermatitis is one of the most common underlying causes, diagnostic investigation for allergy is often indicated. Cats may suffer from various other underlying problems, especially where Malassezia dermatitis is generalised. Malassezia dermatitis in dogs and cats is chronic, relapsing and pruritic. Direct cytology from dermatological lesions and the ear canal, showing "peanut-shaped" budding yeasts, facilitates a rapid and reliable diagnosis. Topical treatment includes antiseptic and antifungal azole-based products. Systemic treatment with oral antifungals is indicated only in severe or refractory disease. Identification and treatment of the underlying cause is essential for an optimal response. In this evidence-based narrative review, we discuss the clinical presentation of Malassezia dermatitis in dogs and cats, underlying comorbidities, and diagnostic considerations. Treatment is discussed in light of emerging evidence of antifungal resistance and the authors' clinical experience.
Topics: Animals; Cats; Dogs; Malassezia; Dermatomycoses; Cat Diseases; Antifungal Agents; Dog Diseases; Neoplasm Recurrence, Local; Dermatitis
PubMed: 38431127
DOI: 10.1016/j.tvjl.2024.106084 -
The Laryngoscope Feb 2024Endoscopic ear surgery is no longer a promising technique, but a well-established one. This study aims to compare endoscopic and microscopic tympanoplasty based on... (Review)
Review
OBJECTIVE
Endoscopic ear surgery is no longer a promising technique, but a well-established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature evidence, in terms of their efficacy and safety characteristics.
DATA SOURCES
We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty.
REVIEW METHODS
Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS-I and RoB-II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group.
RESULTS
Thirty-three studies, with 2646 patients in total, were included in the meta-analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:-0.23; 95% CI: -0.61, 0.14, I = 33.42%), and air-bone gap improvement (pooled mean difference:-0.05; 95% CI:-0.23, 0.13, I = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: -1.72; 95% CI: -3.39, -0.04, I = 0%), dysgeusia (OR: -1.47; 95% CI: -2.47, -0.47, I = 0%), otitis externa development (OR: -1.96; 95% CI: -3.23, -0.69, I = 0%), auricular numbness (OR: -2.56; 95% CI: -3.93, -1.19, I = 0%), as well as surgical duration (OR: -1.86; 95% CI: -2.70, -1.02, I = 43.95%), when compared to the postauricular microscopic approach.
CONCLUSION
Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach.
LEVEL OF EVIDENCE
NA Laryngoscope, 2024.
PubMed: 38415937
DOI: 10.1002/lary.31365 -
Antibiotics (Basel, Switzerland) Jan 2024() with multi-drug resistance (MDR) is a major cause of serious healthcare-associated infections, leading to high morbidity and mortality. This opportunistic pathogen... (Review)
Review
() with multi-drug resistance (MDR) is a major cause of serious healthcare-associated infections, leading to high morbidity and mortality. This opportunistic pathogen is responsible for various infectious diseases, such as those seen in cystic fibrosis, ventilator-associated pneumonia, urinary tract infection, otitis externa, and burn and wound injuries. Due to its relatively large genome, has great diversity and can use various molecular mechanisms for antimicrobial resistance. For example, outer membrane permeability can contribute to antimicrobial resistance and is determined by lipopolysaccharide (LPS) and porin proteins. Recent findings on the regulatory interaction between peptidoglycan and LPS synthesis provide additional clues against pathogenic . This review focuses on recent advances in antimicrobial agents and inhibitors targeting LPS and porin proteins. In addition, we explore current and emerging treatment strategies for MDR , including phages, vaccines, nanoparticles, and their combinatorial therapies. Novel strategies and their corresponding therapeutic agents are urgently needed for combating MDR pathogens.
PubMed: 38391505
DOI: 10.3390/antibiotics13020119