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The Journal of International Advanced... Jan 2022Τo investigate the differences in regard to the clinical, laboratory, and imaging findings as well as the treatment course between diabetic and non-diabetic,...
BACKGROUND
Τo investigate the differences in regard to the clinical, laboratory, and imaging findings as well as the treatment course between diabetic and non-diabetic, non-immunocompromised patients with malignant otitis externa.
METHODS
A total of 36 hospitalized patients diagnosed with malignant otitis externa between January 2011 and December 2020 were divided into 2 groups according to their medical history, blood glucose, and glycated hemoglobin levels.
RESULTS
Thirty-two patients were diabetic (group A) and 4 were non-diabetic, non-immunocompromised (group B). Otalgia was present in all patients (100%), followed by otorrhoea (67%) and edema (64%). Polyps were present in 18 patients (50%). Pseudomonas aeruginosa was isolated in 16 out of 25 positive cultures (64%). Four patients of group A and none of group B underwent surgery. Five patients of group A and none of group B had at least 1 cranial nerve involvement. The mean age was 77.22 ± 8.17 for group A and 47.25 ± 3.59 for group B (P < .001). No statistical significance was observed in regards to major symptoms, inflammatory markers (white blood cell, C-reactive protein, and erythrocyte sedimentation rate), positive imaging, and microbiological findings between the 2 groups. The average days of hospitalization were 42.41 ± 31.06 for group A and 10.25 ± 2.63 for group B (P < .049). Four diabetic patients died.
CONCLUSION
Non-diabetic, non-immunocompromised adult patients with malignant otitis externa had a better response to antibiotic therapy and a shorter length of hospitalization. A high clinical suspicion for malignant otitis externa should always raise in cases of otitis externa that fail to respond in a topic and/or oral antibiotic treatment for more than a week.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Humans; Otitis Externa; Pseudomonas aeruginosa
PubMed: 35193841
DOI: 10.5152/iao.2022.21313 -
Indian Journal of Otolaryngology and... Dec 2022Otitis externa is a common condition encountered in the ENT outdoors. For long, it was thought to be of fungal etiology but after World War II, bacterial pathogens were...
Otitis externa is a common condition encountered in the ENT outdoors. For long, it was thought to be of fungal etiology but after World War II, bacterial pathogens were found to be most commonly involved. has been described as the most common causative organism in the literature. This prospective study aimed to study the microbiological profile and antibiotic sensitivity of 100 patients of otitis externa. 100 diagnosed cases of otitis externa were included in the study after informed consent. Swabs were taken from the external acoustic canal maintaining asepsis. The swabs were analysed using microscopy, culture and sensitivity testing. The samples were cultured on blood agar, MacConkey agar and Sabourad's dextrose agar with antibiotics. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method. The most common bacteria identified was (36.36%), followed by (15.45%), (2.73%), (1.82%), and sp (1.82%). sp (19.09%) and (8.18%) were the fungal species identified. showed excellent sensitivity to imipenem, piperacillin and ofloxacin, while showed good sensitivity to vancomycin, ofloxacin and netilmycin. Topical fluoroquinolones can be used as empirical treatment in most cases of bacterial otitis externa. In resistant cases, culture and antibiotic sensitivity should be done to manage the infection.
PubMed: 36742823
DOI: 10.1007/s12070-020-02151-x -
Turkish Archives of Otorhinolaryngology Jun 2018The purpose of this study was to analyze previous treatments and outcomes in patients with malignant otitis externa (MOE) retrospectively. The efficacy of medical and...
OBJECTIVE
The purpose of this study was to analyze previous treatments and outcomes in patients with malignant otitis externa (MOE) retrospectively. The efficacy of medical and surgical treatments was also evaluated.
METHODS
This study included 25 patients diagnosed with MOE and treated at the Department of Otorhinolaryngology, Ege University School of Medicine between 2006 and 2017. The duration of hospitalization, Hemoglobin A1c (HbA1c) levels of the patients, erythrocyte sedimentation rate (ESR), source of the infection, complications, and previous medical and surgical treatments were also retrospectively assessed.
RESULTS
The mean age of the patients (7 females and 18 males) was 69.68±11.29 years. The mean length of hospital stay in patients with HbA1c levels ≤6 and in patients with HbA1c levels >6 was 26.86 and 33.39 days, respectively. The mean hospitalization time was significantly longer in patients with HbA1c levels >6 (p<0.05). Additionally, elderly patients (age>65 years) had a significantly longer hospital stay in our study (p<0.05). ESR was found to be 52.76±32.49 (9-108) mm/h at the first examination and 14.92±1.22 (4-32) mm/h at the time of discharge.
CONCLUSION
MOE is an aggressive disease that requires conservative management, and ESR proved to be a good indicator of treatment response. Long-term antibiotherapy are recommended for treatment.
PubMed: 30197809
DOI: 10.5152/tao.2018.3075 -
International Journal of Emergency... Oct 2020This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea...
CASE PRESENTATION
This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule.
DIAGNOSIS
The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.
PubMed: 33115411
DOI: 10.1186/s12245-020-00310-z -
American Family Physician Nov 2006Otitis externa can take an acute or a chronic form, with the acute form affecting four in 1,000 persons annually and the chronic form affecting 3 to 5 percent of the... (Review)
Review
Otitis externa can take an acute or a chronic form, with the acute form affecting four in 1,000 persons annually and the chronic form affecting 3 to 5 percent of the population. Acute disease commonly results from bacterial (90 percent of cases) or fungal (10 percent of cases) overgrowth in an ear canal subjected to excess moisture or to local trauma. Chronic disease often is part of a more generalized dermatologic or allergic problem. Symptoms of early acute and most chronic disease include pruritus and local discomfort. If left untreated, acute disease can be followed by canal edema, discharge, and pain, and eventually by extra-canal manifestations. Topical application of an acidifying solution is usually adequate in treating early disease. An antimicrobial-containing ototopical is the preferred treatment for later-stage acute disease, and oral antibiotic therapy is reserved for advanced disease or those who are immunocompromised. Preventive measures reduce recurrences and typically involve minimizing ear canal moisture, trauma, or exposure to materials that incite local irritation or contact dermatitis.
Topics: Acetic Acid; Administration, Topical; Analgesics; Anti-Infective Agents; Benzethonium; Diagnosis, Differential; Drug Combinations; Drug Hypersensitivity; Exudates and Transudates; Humans; Otitis Externa; Propylene Glycols; Steroids
PubMed: 17111889
DOI: No ID Found -
PloS One 2021Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key...
OBJECTIVE
Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE.
STUDY DESIGN
COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition.
SETTING
Stakeholders from the United Kingdom.
SUBJECTS AND METHODS
Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition.
RESULTS
Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'.
CONCLUSION
The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.
Topics: Activities of Daily Living; Delphi Technique; Ear, External; Humans; Otitis Externa; Outcome Assessment, Health Care; Pain; Quality of Life; Treatment Outcome
PubMed: 33989313
DOI: 10.1371/journal.pone.0251395 -
Surgery (Oxford, Oxfordshire) Oct 2018Infections of the ear, nose and throat are common. The majority of these infections are managed by the primary care physicians and they settle with conservative and... (Review)
Review
Infections of the ear, nose and throat are common. The majority of these infections are managed by the primary care physicians and they settle with conservative and medical management. However, a small group can progress to become troublesome and develop complications to the extent that they may require surgical intervention. Some of the infections can lead to life-threatening complications therefore awareness and correct diagnosis along with appropriate management is paramount. Foreign bodies in the ear, nose and throat are commonly encountered. The location and type of foreign body can have an implication on the urgency of action and the possible complications. In this article the common ENT infections and foreign bodies and their management are discussed.
PubMed: 32336859
DOI: 10.1016/j.mpsur.2018.08.008 -
Disease Models & Mechanisms Mar 2022In mice, rats, dogs and humans, the growth and function of sebaceous glands and eyelid Meibomian glands depend on the ectodysplasin signalling pathway. Mutation of genes...
In mice, rats, dogs and humans, the growth and function of sebaceous glands and eyelid Meibomian glands depend on the ectodysplasin signalling pathway. Mutation of genes encoding the ligand EDA, its transmembrane receptor EDAR and the intracellular signal transducer EDARADD leads to hypohidrotic ectodermal dysplasia, characterised by impaired development of teeth and hair, as well as cutaneous glands. The rodent ear canal has a large auditory sebaceous gland, the Zymbal's gland, the function of which in the health of the ear canal has not been determined. We report that EDA-deficient mice, EDAR-deficient mice and EDARADD-deficient rats have Zymbal's gland hypoplasia. EdaTa mice have 25% prevalence of otitis externa at postnatal day 21 and treatment with agonist anti-EDAR antibodies rescues Zymbal's glands. The aetiopathogenesis of otitis externa involves infection with Gram-positive cocci, and dosing pregnant and lactating EdaTa females and pups with enrofloxacin reduces the prevalence of otitis externa. We infer that the deficit of sebum is the principal factor in predisposition to bacterial infection, and the EdaTa mouse is a potentially useful microbial challenge model for human acute otitis externa.
Topics: Animals; Ear Canal; Ectodermal Dysplasia 1, Anhidrotic; Ectodysplasins; Female; Lactation; Mice; Otitis Externa
PubMed: 35107126
DOI: 10.1242/dmm.049034 -
Journal of Fungi (Basel, Switzerland) Jun 2023is an emerging global public health threat and is resistant to most antifungal agents. Though fungi are significant pathogens for animals, the role of in animal health...
is an emerging global public health threat and is resistant to most antifungal agents. Though fungi are significant pathogens for animals, the role of in animal health remains unexplored. Here, we analysed the microbial cultures of skin and ear swabs of 87 dogs in Delhi and performed fungal meta-barcode sequencing of ear and skin samples of 7 dogs with confirmed otitis externa (OE). Overall, 4.5% of dogs (4/87) with chronic skin infections contained evidence of in their ear canal ( = 3) and on their skin surface ( = 1). Of the three OE dogs with infection/colonisation, a diversity of fungi was observed, and their meta-barcode ITS sequence reads for ranged from 0.06% to 0.67%. Whole-genome sequencing of six strains obtained in culture from two dogs showed relatedness with Clade I clinical strains. The report highlights the isolation of from an animal source; however, the routes of transmission of this yeast to dogs and the clinical significance of transmission between dogs and humans remain to be investigated.
PubMed: 37504709
DOI: 10.3390/jof9070720 -
Indian Journal of Otolaryngology and... Dec 2022Malignant otitis externa (MOE) is a rare and fatal condition affecting temporal bone. It is also known as skull base osteomyelitis and is a rapidly progressive...
Malignant otitis externa (MOE) is a rare and fatal condition affecting temporal bone. It is also known as skull base osteomyelitis and is a rapidly progressive condition. This retrospective study evaluates the clinical, haematological, microbiological profile and management of malignant otitis externa in a tertiary care hospital and literature review. A retrospective review of 79 patients diagnosed with Malignant Otitis Externa from January 2015 to June 2021 was analyzed. History and Clinical findings, Imaging, Bacteriology, Random blood sugar on admission, Erythrocyte Sedimentation rate, HbA1C level, Biopsy of the granulation tissue from Externa auditory canal, cranial nerve involvement, duration of hospital stay, and treatment outcomes were analyzed. Out of 79 patients, otorrhea, otalgia, EAC oedema, and granulation were the most common findings. Facial nerve paralysis was found in 20 patients (25.3%) and multiple cranial nerve paralysis in 5 patients (6.3%). Uncontrolled diabetes mellitus and older age have increased duration of hospital stay, while cranial nerve paralysis did not affect this duration. Six different microorganisms were isolated. Pseudomonas aeruginosa was the most common organism cultured. Ciprofloxacin resistance was detected in 79% of cases. Amikacin, Cefaperazone-Sulbactam, and Piperacillin were the most sensitive antibiotics for gram negative organisms in our study. This study reviews the current microbiological profile and shows the need for higher-end antibiotics to treat MOE in present times. Early diagnosis, aggressive control of diabetes mellitus, and long duration culture-sensitive antibiotic therapy with regular monitoring are essential to reducing morbidity and mortality due to MOE.
PubMed: 36742648
DOI: 10.1007/s12070-021-03068-9