Otitis

Tuberculous otitis media

September 20, 2011     Min-Tsan Shu, MD, Cheng-Chien Yang, MD, and Kang-Chao Wu, MD
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Lateral sinus thrombosis in children: A review

June 13, 2011     Borlingegowda Viswanatha, MS, DLO
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Abstract

A retrospective study was undertaken to review the clinical presentation, evaluation, management, and outcome of otogenic lateral sinus thrombosis (LST) in children. All pediatric patients with LST seen in our department between 1999 and 2007 were included; there were 9 cases involving 6 boys and 3 girls whose ages ranged from 8 to 12 years. They had all been treated with antibiotics elsewhere prior to admission, and the duration of symptoms before admission ranged from 5 to 18 days. The most common presenting symptoms were ear discharge, headache, otalgia, and fever. Radiologic evaluation included computed tomography and magnetic resonance imaging. All patients underwent radical mastoidectomy with incision of the lateral sinus and removal of its content. There were no deaths. Pseudomonas and Proteus spp were the most commonly identified organisms. Otogenic LST still poses a serious threat that warrants immediate attention and care. It is often associated with other intracranial complications, such as cerebellar abscess. Computed tomography and magnetic resonance imaging play an important role in the management of this disease. Early and aggressive surgical intervention of this otogenic complication can potentially minimize mortality.

The pH of commonly used topical ear drops in the treatment of otitis externa

March 31, 2011     Chee-Yean Eng, MRCS, DOHNS and Amged S. El-Hawrani, FRCS(ORL-HNS)
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Abstract

Healthy ear canal skin has an acidic pH. Evidence suggests that reacidification of the ear canal may lead to resolution of otitis externa. The pH of 15 commonly prescribed topical ear drop preparations used in the treatment of otitis externa was measured using a Jenway 3020 pH meter with temperature compensation at 37.5°C. The pH values ranged from 2.89 to 7.83. Two-thirds of preparations tested were of acidic pH. The remaining one-third were alkaline. Reacidification of the ear canal may help in the treatment of otitis externa.

Otitic hydrocephalus: A report of 2 cases

June 30, 2010     Borlingegowda Viswanatha, MS, DLO
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Abstract

Otitic hydrocephalus is a rare intracranial complication of otitis media. It is characterized by elevated cerebrospinal fluid (CSF) pressure with normal CSF biochemistry and without any focal neurologic abnormality other than those related to the increased intracranial pressure. The pathophysiology of this rare condition is unknown. The incidence of intracranial complications was reduced dramatically with the introduction of newer antibiotics, but complicated cases still occur. Serious consequences can ensue if complications are not identified and treated properly. The author reviews the literature on otitic hydrocephalus and describes 2 new cases.

Amyloidosis of the external auditory canal

April 30, 2010     James J. Klemens, MD, Wendy Recant, MD, Joseph M. Baron, MD, and Miriam I. Saadia-Redleaf, MD
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Abstract

We present a case of bilateral otitis externa that did not respond to local treatment. Cutaneous biopsies revealed bilateral amyloid depositions secondary to multiple myeloma. Persistent, identical bilateral canal lesions may be the only manifestation of treatable systemic disease and should be biopsied, even though their bilaterality argues against malignancy.

Review of inactive ingredients in antibiotic ear drops

December 1, 2009     G. Michael Wall, PhD, Onkar Singh, PhD, Leslie Lemke, PhD, DABT, and Peter Roland, MD
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Abstract

The authors review the relevant chemical and biological characteristics of inactive ingredients in antibiotic ear drop drug products. Although many of the older aminoglycoside-containing otic products are still used today, only some fluoroquinolone-containing ear drops, approved in the last decade, have been proven safe and effective according to current rigorous scientific standards, including ototoxicity testing of the formulations. Preservatives, antioxidants, surfactants, buffers, suspending and emulsifying agents, osmotic agents, viscosity modifiers, solvents, and penetration enhancers are reviewed with regard to their functional role in formulations, as well as their potential for ototoxicity.

Necrotizing otitis externa: A new trend? Report of 6 atypical cases

December 1, 2009     Fergal Glynn, MRCSI and Rory McConn Walsh, MD, FRCS (ORL-HNS)
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Abstract

Necrotizing otitis externa (OE) is traditionally seen in elderly diabetics and immunocompromised patients. During a 7-year period at our institution, we treated 6 patients with necrotizing OE who were not diabetic, who were not immunocompromised, and who were relatively young (age range: 27 to 65 yr; mean: 42.8). The necrotizing OE in these patients was less aggressive but just as severe as its usual presentation in older diabetic or immunocompromised patients. All 6 patients had evidence of bony erosion on computed tomography of the temporal bones, although 4 had negative findings on technetium-99m scintigraphy. Four of the 6 patients required mastoid exploration and fascia lata grafting, and the other 2 chose to undergo extensive daily microdebridements and intravenous antibiotics followed by 6 weeks of oral antibiotics. We recommend that a diagnosis of necrotizing OE be kept in mind when evaluating any patient who presents with severe otalgia, particularly in the presence of Pseudomonas aeruginosa infection of the external auditory canal, edema, granulation tissue, and bony erosion.

Bilateral atticoantral chronic suppurative otitis media presenting as bilateral cutaneous mastoid fistulas

September 30, 2009     Kemmannu Vikram Bhat, MS, DNB, PhD, Shankarappa Gangadharaiah Udayashankar, MS, DLO, and Belur Keshavamurthy Venkatesha, MS, DNB; Praveen Kumar, MS
article

Abstract

Postauricular cutaneous mastoid fistula secondary to chronic suppurative otitis media (CSOM) is an unusual complication. Bilateral manifestation along with primary acquired cholesteatoma and atelectasis of the pars tensa as an end-stage complication in the natural course of atticoantral CSOM is rare. This kind of complication has a very morbid effect on the ear, and it poses a therapeutic challenge in terms of eradicating disease and restoring function. In this article, we describe the unusual course of an atticoantral CSOM that (1) began as a primary acquired cholesteatoma simultaneously in both ears, (2) proceeded to automastoidectomy and a severe mixed hearing loss bilaterally, and (3) ended with the development of bilateral cutaneous mastoid fistulas that served to arrest the further progression of the disease process on its own. This case serves as a good demonstration of how a ventilating mastoid fistula can change the natural course of atticoantral CSOM and abort the occurrence of deadly complications.

Location of the ventilation tube

May 31, 2009     Michael M. Paparella, MD
article

Benign necrotizing otitis externa

May 31, 2009     Alexandros Tsikoudas, FRCS(Ed), DLO and Brian Clive Davis, FRCS(Ed)
article

Abstract

Benign necrotizing otitis externa (BNOE) is a rare condition of the external acoustic meatus characterized by ulceration of the floor of the deep meatus overlying an area of bony necrosis. Recognition of this condition as different from malignant necrotizing otitis externa (MNOE) and carcinoma of the external ear is important because its treatment is very different. The best choice of treatment for BNOE is not clear because both long-term medical therapy and surgery have been advocated as first-line treatments. We describe a case involving a 50-year-old man and present what we believe to be the first published photographs of the surgical management of BNOE.

Otogenic cerebellar abscess: A case report

March 31, 2009     Gresham T. Richter, MD, Jason A. Smith, MD, and John L. Dornhoffer, MD
article

Abstract

This case report describes the gradual deterioration of a healthy, highly functioning man who initially presented with a draining right ear. The patient's indolent neurologic decline and referral to an otologist ultimately led to the diagnosis and treatment of an otogenic cerebellar abscess, an increasingly rare intracranial complication of otitis media. We report this case to illustrate that severe complications of chronic otitis media still occur in the United States, to stress the importance of clinical suspicion in the postantibiotic era, and to review the literature regarding the most appropriate time to perform the otologic portion of the surgery.

The prevalence of hearing loss among schoolchildren with chronic suppurative otitis media in Nigeria, and its effect on academic performance

December 1, 2008     Fatai Olatoke, MBBS, Foluwasayo Emmanuel Ologe, MBBS, Clement C. Nwawolo, MBBS, and Mohammed Jimoh Saka, MBBS
article

Abstract

We conducted a cross-sectional study to determine the prevalence of hearing loss among 1,500 Nigerian schoolchildren aged 9 to 15 years who had chronic suppurative otitis media (CSOM). We also attempted to ascertain the effect that this hearing loss had on their academic performance. The study population was drawn from three schools in different socioeconomic tiers—low (n = 300), medium (n = 400), and high (n = 800). Overall, CSOM was present in 35 of these children (2.3%)—12 from the low-status school (4.0%), 11 from the middle-status school (2.8%), and 12 from the high-status school (1.5%); the overall difference in prevalence among the three schools was statistically significant (χ2 = 6.40; degrees of freedom [df] = 2; p = 0.04). In all, 52 ears were affected by CSOM; of these, 18 (34.6%) had a pure-tone average (PTA) within normal limits, 20 (38.5%) had a mild conductive hearing loss, and 14 (26.9%) had a moderate loss. All but 2 of 160 control ears (1.2%) had hearing thresholds within normal limits. The difference in PTAs across groups was statistically significant (χ2 = 114.89; df = 2; p< 0.001). As for academic performance, cumulative average test scores were significantly lower in the CSOM patients than in the controls—χ2 = 14.57; df = 3; p = 0.002. At the higher end of the academic scale, scores of 66% and higher were obtained by 40.0% of patients and 51.3% of controls, and scores of 50 to 65% were achieved by 20.0% of patients and 37.5% of controls. At the lower end, scores of 40 to 49% were obtained by 31.4% of patients and 6.3% of controls, and scores of 39% and lower were obtained by 8.6% and 5.0%, respectively. We conclude that hearing loss was a significant sequela of CSOM in our study population and that it had an adverse effect on their academic performance. Children in the low socioeconomic group appeared to be more vulnerable.

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