Surfer's ear: external auditory exostoses are more prevalent in cold water surfers

OBJECTIVE

The study goal was to demonstrate the prevalence and severity of external auditory exostoses (EAEs) in a population of surfers and to examine the relationship between these lesions and the length of time surfed as well as water temperature in which the swimmers surfed. It was hypothesized that subjects who predominantly surfed in colder waters had more frequent and more severe exostoses.

METHODS

Two hundred two avid surfers (91% male and 9% female, median age 17 years) were included in the study. EAEs were graded based on the extent of external auditory canal patency; grades of normal (100% patency), mild (66% to 99% patency), and moderate-severe (<66% patency) were assigned. Otoscopic findings were correlated with data collected via questionnaires that detailed surfing habits.

RESULTS

There was a 38% overall prevalence of EAEs, with 69% of lesions graded as mild and 31% graded as moderate-severe. Professional surfers (odds ratio 3.8) and those subjects who surfed predominantly in colder waters (odds ratio 5.8) were found to be at a significantly increased risk for the development of EAEs. The number of years surfed was also found to be significant, increasing one's risk for developing an exostosis by 12% per year and for developing more severe lesions by 10% per year. Individuals who had moderate-severe EAEs were significantly more likely to be willing to surf in colder waters than were those who had mild EAEs (odds ratio 4.3).

CONCLUSIONS

EAEs are more prevalent in cold water surfers, and additional years surfing increase one's risk not only for developing an EAE but also for developing more severe lesions.

Para-aural abscessation following traumatic ear canal separation in a dog

Traumatic ear canal separation is rare in animals, with only eight dogs and one cat reported with the condition in the English language literature. Para-aural abscessation occurred in six of these nine animals. Diagnosis was made on otoscopic observation of a shortened, abruptly ending external ear canal that was free from advanced disease. Radiographs in those cases which have been described showed a disruption of the normal air opacity of the affected ear canal. Drainage, by creating a separate opening for the horizontal ear canal, or total ear canal ablation and lateral bulla osteotomy (TECA/LBO), have led to resolution of the clinical signs. This report adds a further case to the literature in which TECA/LBO was employed successfully.

Prevalence of external auditory canal exostoses in surfers

OBJECTIVE

To determine (1) the prevalence of external auditory exostoses in a population of surfers and (2) the relationship between the length of time spent surfing and the prevalence, severity, and location of the exostoses.

DESIGN

Cross-sectional epidemiological study.

SETTING

General community.

PATIENTS

Three hundred seven avid surfers (93.5% males and 6.5% females; age distributions: 11.2% were < or =20, 67.9% were 21 to 40, 17.5% were 41 to 50, and 3.3% were >50 years).

MAIN OUTCOME MEASURES

Questionnaires focusing on surfing habits (number of years, geographic region, and number of days per year of surfing) were correlated with otoscopic findings. A simple grading system was devised, based on the degree of external auditory canal stenosis. Grades of normal, mild, moderate, and severe corresponded to 100%, 99% to 66%, 65% to 33%, and less than 33% effective patent surface area, respectively.

RESULTS

There was a 73.5% overall prevalence of external auditory exostoses and a 19.2% overall prevalence of osteomas in the group studied. Of 441 ears with exostoses, 54.2% were mild, 23.6% were moderate, and 22.2% were severe. Of individuals who had surfed for 10 years or less, 44.7% had normal ear canals and only 6% had severely obstructed auditory canals. In comparison, in the group that had surfed for longer than 20 years, only 9.1% had normal auditory canals and 16.2% were severely affected. Of surfers with no exostoses, 61.1% had surfed for 10 years or less. In contrast, of surfers with severe exostoses, 82.4% had surfed for more than 10 years. Finally, the lesions seemed to affect all external auditory canal quadrants equally.

CONCLUSION

A positive association exists between the amount of time individuals spend surfing and the presence and severity of exostoses of the external auditory canal.

The leaking labyrinthine lesion resulting from direct force through the auditory canal: report of five cases

The leaking labyrinthine lesion is treated by conservative methods or surgical procedures. With respect to the stapes, the surgical treatment is controversial. Five cases of middle ear injuries accompanying oval window rupture are reported herein. In each case, direct force through the auditory canal damaged not only the ossicular chain but also the oval window. Initial symptoms were sudden hearing loss with significant conductive disturbance and various degrees of unsteadiness. Spontaneous horizontal nystagmus directed toward the uninvolved ear was observed in each case. Tympanic cavities were promptly explored under general anesthesia and oval window injuries were confirmed. In each case, the damaged stapes was temporally removed from the oval window. Perilymphatic leakage was recognized in each case. Two patients had subluxation of the stapes with a paucity leakage. Three had complete luxation of the stapes with a relatively huge oval window fistula. Disrupted oval windows were repaired with temporalis muscle fascial grafts that were inserted under the middle ear mucosae surrounding the oval windows. The stapes were replaced in the repaired oval windows, and the ossicular chains were reconstructed without artificial grafts. Vestibular dysfunctions disappeared within 7 days, and satisfactory audiologic results were obtained in each case.

Long-term morbidity from Pope Ear Wicks

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When not to syringe an ear

This article reviews the potential hazards of ear syringing and the Accident Compensation Corporation Medical Misadventure Unit's experience of alleged iatrogenic injury over a 17-month period. Syringing claims account for about 25% of the total claims received by the ACC ENT Medical Misadventure Committee. Forty-seven claims were accepted as either mishap or error, and 63 claims were declined. Perforation of the drum was by far the commonest injury resulting in significant disability. Severe iatrogenic otitis externa accounted for most of the remainder. Practice nurses had syringed the ears of approximately two-thirds of the claimants with significant disability. The contraindications to ear syringing are listed and discussed. The correct technique, with a few "do and don't" pointers, is briefly reviewed. Management of the unintentional injury is discussed.

The mysterious case of persistent malocclusion

We report an unusual case of malocclusion following a history of apparently blunt trauma. No maxillary or mandibular fractures were identified. The malocclusion persisted for several days. Finally computed tomography was performed, which revealed a foreign body in the infratemporal fossa. A 4-cm pencil was extracted from the patient's right temporomandibular joint.

Low velocity gunshot injuries to the temporal bone

OBJECTIVE

To review the presentation, symptoms and management associated with low velocity gunshot injuries to the temporal bone.

METHODS

A retrospective analysis of 26 patients treated for low velocity gunshot injuries to the temporal bone.

RESULTS

Initial presentation included otorrhoea (69 per cent), facial nerve injury (27 per cent), hearing loss (65 per cent), intracranial injuries (50 per cent), and cranial neuropathies (58 per cent). Nine patients (35 per cent) underwent angiography, which showed vascular injury in five of them. Four patients died.

CONCLUSIONS

Low velocity gunshot injuries can be devastating and may result in functional sequelae. Low velocity missiles crush and lacerate surrounding structures, while high velocity missiles cause extensive wound cavity formation. Early aggressive management for intracranial, vascular and facial nerve injury can improve outcome.

[Foreign bodies in the ear; report of 40 cases]

BACKGROUND

Foreign bodies in the external ear canal present a frequent situation in pediatric practice. It is generally benign, but infectious complications may occur.

POPULATION

Between January 1996 and March 1997, 35 children with a foreign body in the ear canal were treated in the ENT department of Robert-Debré hospital.

RESULTS

Age ranged from 15 months to 14 years, with a mean of 6.5 years. The sex ratio was 1.2 (19 boys/16 girls). Five children had bilateral foreign bodies. The most frequent foreign bodies were pearls (8/40) and cockroaches (7/40). Eleven children had complications: ear canal laceration in five cases, otitis externa in five cases, cervical adenitis in three cases, general septic syndrome with fever in one case, and drum perforation in one case.

CONCLUSION

The methods of extraction and the management of the complications are discussed.

Post-traumatic guitar-shaped deformity of the tympanic membrane

We report a unique case of post-traumatic guitar-shaped deformity of the tympanic membrane in an 8-year-old boy. After a traffic accident, he exhibited bleeding from the ear, incomplete facial palsy and a conductive hearing loss on the left side. Although his symptoms gradually improved, the deformity of the tympanic membrane and external auditory canal persisted. The tympanic membrane appeared to be duplicated. Careful examination using an otoscope was required for accurate diagnosis. Without knowledge of the deformity, the physician could easily misinterpret the appearance of the tympanic membrane. Formation of cholesteatoma was not observed and the normal migration of the epithelium in the external auditory canal seemed to be maintained. However, we were concerned that tubal dysfunction could eventually induce the retraction and atrophy of the tympanic membrane to ultimately form a cholesteatoma. We therefore recommend patients such as this to be evaluated periodically because of the risk of tubal dysfunction and cholesteatoma.

[A rare case of injury of the external auditory meatus]

The authors present difficulties in the diagnosis and the treatment of rare case of external ear injury. 41-year-old woman with acute inflammation of external ear was observed in our Department. The cause of this inflammation was a foreign body which obliterated the external auditory meatus.

An association between imaging and acute posttraumatic ear bleeding with trismus

OBJECTIVES

Computed tomography findings for each of 94 patients with unilateral ear bleeding and trismus correlated with either comminuted temporal bone fracture (26 cases) or bilateral temporomandibular joint fracture (68 cases).

STUDY DESIGN

Ninety-four patients with post-traumatic unilateral ear bleeding and 10 asymptomatic adults underwent coronal computed tomography examinations of their temporomandibular joints. Of these, 26 patients with intact temporomandibular joints underwent axial computed tomography of the temporal bones. For 23 of the 94 symptomatic patients, computed tomography was the final imaging procedure; for the other 71 symptomatic patients, it was the first imaging procedure. Quantifications of the radiation dose and the per-patient cost of imaging were performed. Measurement of the maximal mandibular movements in vertical and horizontal directions was performed clinically in the 10 asymptomatic adult control subjects and in the 94 patients with trismus and ear bleeding.

RESULTS

Ten control subjects had maximal opening values of 40 mm or more, and horizontal movement exceeded 24 mm. In 68 symptomatic patients, coronal computed tomography demonstrated bilateral fracture: there was bilateral high condylar fracture in 35 patients, and there was ipsilateral to the bleeding high condylar fracture with contralateral subcondylar fracture dislocation in 33 patients. Axial computed tomography scans in 26 symptomatic patients with intact temporomandibular joints demonstrated comminuted petrous bone fracture ipsilateral to the ear bleeding.

CONCLUSIONS

Patients with post-traumatic ear bleeding associated with trismus should first be evaluated by computed tomography. Any other initial procedure doubles the radiation dose as well as the cost of the imaging.

Traumatic separation of the annular cartilage from the external auditory meatus in a cat

A 13-year-old cat was evaluated because of anorexia and otic discharge of 1 week's duration. A left head tilt and left facial nerve deficit were evident. Pink fleshy tissue was seen in the area where the tympanic membrane was expected during otoscopic examination. The left ear canal was laterally displaced from the skull on a rostrocaudal (open mouth) radiographic view, suggesting ear canal separation. During surgery, the annular cartilage was found to be separated from the external auditory meatus, and total ear canal ablation was performed. Complications did not develop, and facial nerve function returned 6 weeks after surgery. In previous reports, traumatic ear canal separation was diagnosed after trapped otic secretions formed abscesses or para-aural fistulas.

Tetanus in Singapore: report of three cases

Three cases of tetanus in Singapore are presented. One local resident had cephalic tetanus most likely secondary to otitis media and the other two, residents from surrounding Asean countries, had generalised tetanus. The portal of entry was a puncture wound on the foot in one patient and the ear in another. No portal of entry was identified in one patient. All three patients required tracheostomy, ventilatory support and intensive care management for periods ranging from 11 to 22 days. One patient died from complications of nosocomial septicaemia and one patient required prolonged rehabilitation. There was a questionable history of tetanus immunization in the Singapore resident whereas the other two patients who were foreigners had never received any immunization. Tetanus is an uncommon but important disease in Singapore. In spite of the availability of intensive care management, it continues to be a disease with significant morbidity and mortality. Early recognition and treatment of the disease are critical factors in determining the prognosis. This is a disease that may be largely prevented by adequate immunization.

Neuro-otologic findings in the lightning-injured patient

Although lightning injuries are common, neuro-otologic sequelae are infrequently reported. The most common otologic injury encountered in the lightning strike victim is tympanic membrane rupture; the most common vestibular disturbance documented is transient vertigo. A variety of other clinical findings have been described in this population of patients. They include sensorineural hearing loss, conductive deafness, tinnitus, basilar skull fracture, avulsion of the mastoid bone, burns to the external auditory canal, and peripheral facial nerve palsy. The initial treatment of the lightning strike victim consists of basic life support measures. Once stabilized, the patient should undergo a complete otologic and vestibular evaluation. The majority of otolaryngologic problems encountered can be managed expectantly, with periodic re-evaluation. Tympanoplasty should be delayed for 6 to 12 months because of the frequent delay in spontaneous healing.

Traumatic ear canal separations and para-aural abscessation in three dogs

Three dogs were presented for para-aural abscessation. Ear canal separations were suspected preoperatively, based on histories of trauma, physical examination findings of minimally inflamed external ear canals with abrupt endings, and radiographic evidence of discontinuity of the ear canals. Concurrent otitis media, based on radiographic findings, was diagnosed in all three dogs. Disruptions of the external ear canals were confirmed at surgery, and the dogs each responded to total ear canal ablation and lateral bulla osteotomy.

The value of otoscopy

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