Otitis

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
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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.

Benign necrotizing otitis externa

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

Location of the ventilation tube

May 31, 2009     Michael M. Paparella, MD
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Otogenic cerebellar abscess: A case report

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

An estimate of the number of mastoidectomy procedures performed annually in the United States

April 30, 2008     Lesley C. French, MD, Mary S. Dietrich, PhD, and Robert F. Labadie, MD, PhD
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Abstract

We conducted a study to estimate the number of mastoidectomy procedures performed annually in the United States. Our results are based on state-specific healthcare utilization data and Medicare-funded procedural data from 2002. The utilization data were obtained from the State Ambulatory Surgery Database, which is made available through the Healthcare Cost and Utilization Project. Statistical Package for the Social Sciences (SPSS) statistical software was used to quantify the number of mastoidectomy procedures performed during 2002 in Maryland, New Jersey, New York, and Florida. Information was also obtained from the Federated Ambulatory Surgery Association on the number of Medicare-funded mastoidectomy procedures performed in 2002. State and U.S. population statistics were obtained from the U.S. Census Bureau. These data were extrapolated to obtain a nationwide estimate of the number of mastoidectomies performed annually in the U.S. With 99% confidence, we determined that 0.73 to 0.94 mastoidectomy procedures were performed per 10,000 population in Maryland and 2.55 to 2.74/10,000 in New York. Estimates for both New Jersey and Florida fell in between. Medicare patients underwent between 1.68 and 1.79 procedures per 10,000 population. Based on these data, we estimate that between 30,000 and 60,000 mastoidectomies are performed each year in the U.S., although we suspect that our range may be an underestimation of the actual number because of some limitations inherent in the data collection process. Although mastoidectomy is a common outpatient procedure, to the best of our knowledge, no report on the annual frequency of mastoidectomy procedures in the U.S. has ever been published in the English-language literature. We hope that our report will serve to motivate further research into technological and surgical advancements surrounding this procedure.

Multiple simultaneous complications of acute otitis media in a child diagnosed with chronic granulomatous disease: A case report

April 30, 2008     Robert Wilson, MD, Tarika Bhuta, MD, and Richard Haydon, MD
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Abstract

While the prevalence of acute otitis media complications in pediatric patients has decreased over the past 30 years because of effective antibiotic therapy, the incidence has begun to rise again recently, possibly because of increased antibiotic resistance. Patients who simultaneously manifest multiple complications may require a more thorough evaluation, including an immunologic work-up. The presented case should encourage physicians to investigate the possibility of an underlying immunodeficiency when treating patients with multiple simultaneous complications of acute otitis media.

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