[Otitis externa, a self-inflicted disease?]

Otitis externa, an inflammation of the external auditory canal is the most frequent cause of ENT consultation all over the world. It can be caused by viral, bacterial or fungal infections. In most of the cases it is provoked by anatomical causes and, even more frequently inadvertently, by the patient himself. Typically, otitis externa is an isolated episode of short duration, easily treated with topical medication. It evolves rarely to the atypical forms of chronic otitis externa and malignant otitis externa. It is important to search for an allergy, eczema or immunodepression in cases of chronic otitis externa and for diabetes in cases of malignant otitis externa.

Requirement for additional treatment for dogs with atopic dermatitis undergoing allergen-specific immunotherapy

Allergen-specific immunotherapy (ASIT) is one of the main treatments for atopic dermatitis in dogs, but it often requires additional treatments such as antibacterial and antifungal therapy for secondary bacterial and yeast infections, or antipruritic drugs to control the clinical signs or treat the adverse effects of the immunotherapy. Twenty-seven dogs enrolled in a study of ASIT were clinically assessed four times over a period of nine months; their requirement for treatment for secondary bacterial and yeast infections, for the administration of glucocorticoids as additional antipruritic therapy, and for the treatment of any adverse effects of the ASIT were evaluated. Twenty (74 per cent) of the dogs were treated for superficial bacterial pyoderma, 18 (66.6 per cent) required treatment for Malassezia species dermatitis on one or more occasions, eight (29.6 per cent) required treatment for otitis externa due to Malassezia species or bacteria, and eight required glucocorticoids to control their clinical signs. Five (18.5 per cent) of the dogs experienced adverse effects due to the ASIT and two required treatment with antihistamines (H1 receptor antagonists) in order to continue with the ASIT.

[Allergies in ENT]

Allergy is quite frequent and ENT syptoms are usually the visible part of a general disease. Questioning remains the most important part of the enquiry for clinical examination is usually poor if notdesapointing. Biological testings detailed in this paper may be of some help; In Africa, test-treatements using cheap and unharmfull drugs give often the best evidence of allergy. Seldom, ENT allergy may be or become life-threatening. Its detection and appropiate actions are briefly mentioned.

[Malignant external otitis]

Malignant external otitis or skull base osteomyelitis and osteoradionecrosis of the skull base and the skull are potentially life-threatening conditions. The standard methods of treatment involve the use of antibiotics, local treatment and, where necessary, surgical excision of necrotic tissue. These approaches do not provide a complete cure in many cases. Severe functional deficits and even death can occur in advanced stages. We conducted a long-term retrospective follow-up study and report on a multimodal approach that we have been using with great success since 1987. The four cornerstones of this treatment are surgical debridement, combinations of antibiotics, specific immunoglobulins, and adjunctive hyperbaric oxygen therapy. This multimodal treatment approach has proved to be highly effective in improving the survival and quality of life of the patients concerned. These excellent outcomes justify the high costs that this therapy admittedly involves.

Tick bites in the external auditory canal

We report a case of Ixodes ovatus tick in the external auditory canal. Chief complaints of earfullness and pruritus appeared after the contact with dog. Using a removal method consisting of excising the abdomen of the tick and suctioning its body fluids, followed by removal of the tick body 3 days later, the patient was successfully treated without the development of complications.

Ear problems in swimmers

Acute diffuse otitis externa (swimmer's ear), otomycosis, exostoses, traumatic eardrum perforation, middle ear infection, and barotraumas of the inner ear are common problems in swimmers and people engaged in aqua activities. The most common ear problem in swimmers is acute diffuse otitis externa, with Pseudomonas aeruginosa being the most common pathogen. The symptoms are itching, otalgia, otorrhea, and conductive hearing loss. The treatment includes frequent cleansing of the ear canal, pain control, oral or topical medications, acidification of the ear canal, and control of predisposing factors. Swimming in polluted waters and ear-canal cleaning with cotton-tip applicators should be avoided. Exostoses are usually seen in people who swim in cold water and present with symptoms of accumulated debris, otorrhea and conductive hearing loss. The treatment for exostoses is transmeatal surgical removal of the tumors. Traumatic eardrum perforations may occur during water skiing or scuba diving and present with symptoms of hearing loss, otalgia, otorrhea, tinnitus and vertigo. Tympanoplasty might be needed if the perforations do not heal spontaneously. Patients with chronic otitis media with active drainage should avoid swimming, while patients who have undergone mastoidectomy and who have no cavity problems may swim. For children with ventilation tubes, surface swimming is safe in a clean, chlorinated swimming pool. Sudden sensorineural hearing loss and some degree of vertigo may occur after diving because of rupture of the round or oval window membrane.

Health issues for surfers

Surfers are prone to acute injuries as well as conditions resulting from chronic environmental exposure. Sprains, lacerations, strains, and fractures are the most common types of trauma. Injury from the rider's own surfboard may be the prevailing mechanism. Minor wound infections can be treated on an outpatient basis with ciprofloxacin or trimethoprim-sulfamethoxazole. Jellyfish stings are common and may be treated with heat application. Other treatment regimens have had mixed results. Seabather's eruption is a pruritic skin reaction caused by exposure to nematocyst-containing coelenterate larvae. Additional surfing hazards include stingrays, coral reefs, and, occasionally, sharks. Otologic sequelae of surfing include auditory exostoses, tympanic membrane rupture, and otitis externa. Sun exposure and skin cancer risk are inherent dangers of this sport.

[Main symptom otorrhea: diagnosis and therapy]

Otorrhea is an ambiguous symptom that underlies diverse clinical pictures. Fundamentally, the treatment of uncomplicated acute otitis externa and media can be carried out by the family physician. An ENT specialist should be definitely consulted in cases of complications or development of a chronic condition.

Prospective phase II trial of concomitant boost radiotherapy for stage II nasopharyngeal carcinoma: an evaluation of response and toxicity

INTRODUCTION

Stage II nasopharyngeal carcinoma (NPC) treated with conventionally fractionated radiotherapy results in loco-regional control of around 80%. This report aims to document the outcome of Stage II NPC patients treated with external beam radiotherapy delivered using an accelerated concomitant boost (C-Boost) schedule.

METHODS AND MATERIALS

Twenty-five 1997 AJCC Stage II NPC patients were enrolled and analyzed in this preliminary report. The primary tumor and clinically involved nodes received a total dose of 72 Gy in 42 fractions. C-Boost for gross disease consisted of 18 Gy in 12 fractions commencing on day 19 and was delivered at least 6 hours after the first dose. Patients were assessed for response, survival, and toxicity.

RESULTS

With a median follow-up of 24 months, only one patient had pathologically confirmed local recurrence, necessitating IMRT. Two developed distant metastases for which they received chemotherapy. One died from systemic disease after refusing treatment for persistent neck lymphadenopathy. Two-year loco-regional control rates, overall survival and disease-free survival rates were 96%, 96%, and 88%, respectively. All patients experienced some degree of acute and/or late toxicity. However, the toxicity profile was comparable to that seen following standard fractionation. Acute or late toxicities directly attributable to C-Boost were not observed.

CONCLUSION

This C-Boost radiotherapy regimen administers a substantially higher biologically effective dose compared with conventional radiation schedules. Preliminary locoregional control and survival rates are promising with no significant acute and/or late toxicities.