[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.

Severe otitis due to Vibrio fluvialis in a patient with AIDs: first report in the world

A case of waterborne otitis in a patient with AIDS was reported, who got infected with Yibrio fluvialis by swimming in a pool of sea water. This is the first case reported in Cuba and as far as we know in the world. We describe the clinical features associated with this an unusual case and discuss its significance.

The Bone-Anchored Hearing Aid

OBJECTIVES

To assess the impact of a bone-anchored hearing aid (BAHA) on the quality of life (QOL) of adults and to test the hypothesis that a BAHA improves QOL because otorrhea and/or skin irritations decrease.

DESIGN

Prospective postal-based questionnaire study using validated health-related QOL instruments, combined with hearing-aid-related questions.

PATIENTS AND METHODS

The study included 56 consecutive adult patients with acquired conductive or mixed hearing loss who were scheduled for BAHA implantation at the University Medical Centre Nijmegen, Nijmegen, the Netherlands. All 56 patients completed the 36-Item Short-Form Health Survey (SF-36), the EuroQol-5D (EQ-5D), and the Hearing Handicap and Disability Inventory (HHDI); 36 patients had been using an air-conduction hearing aid (ACHA) and 20 patients a conventional bone-conduction hearing aid (CBHA). Questionnaires were filled out before surgery and after 6 months of experience with the BAHA.

RESULTS

In the SF-36 group, there was significant improvement in the scores of the mental health domain (P =.02). When the SF-36 patients were classified according to previous hearing aid, there was no statistically significant change in the scores in any of the domains. In the EQ-5D group and in its ACHA and CBHA subgroups, there were no important differences in the results before and after the patients received their BAHAs. In the HHDI group, the handicap and disability scales showed significant improvement (P<.01) irrespective of the type of previously worn hearing aid.

CONCLUSIONS

Overall, generic health-related QOL was not influenced significantly by the use of a BAHA according to the SF-36 and the EQ-5D. The more disease-specific scales (HHDI) did show improved QOL with a BAHA.

Cotton-tip applicators as a leading cause of otitis externa

OBJECTIVE

Otitis externa (OE), also known as "swimmer's ear", is an inflammation or infection of the external auditory canal. Many risk factors have been identified, mainly excessive moisture in the canal from swimming.

STUDY DESIGN/METHODS

To study the leading risk factors of otitis externa. Eighty-seven children aged 3.5-12 years (mean 68+/-6.5 months) who were diagnosed with otitis externa from December 1999 to March 2001 were studied for age, sex, cerumen cleaning habits, signs and symptoms. Findings were compared to an age-matched control group of 90 children without otitis externa.

RESULTS

Sixty-one children (70.1%) in the study group had their ears cleaned with a cotton-tip applicator (Q-tip) during the 10 days preceding the diagnosis of otitis externa. In the control group, only 31 (34%) used applicators routinely during the 10 days prior to diagnosis (P<0.001). Other risk factors for otitis externa were swimming in a pool (34%), wax removal (5.8%) and ventilation tubes (1.1%).

CONCLUSIONS

Use of a cotton-tip applicator to clean the ear seems to be the leading cause of otitis externa in children and should be avoided.

Causes of otitis externa

Dogs with long-standing, chronic, recurrent otitis externa often represent one of the most frustrating types of problems in daily clinical practice. The important aspect of this discussion is that the clinician may be presented with a patient in which the primary chief complaint is otitis externa but a wide variety of disease processes may be causing the problem, including various combinations of the primary, predisposing, and perpetuating causes as discussed previously. The use of a thorough history and general and dermatologic physical examinations often leads the clinician to establish a systematic approach to identify the specific underlying problems. Until this is accomplished, the recurrent nature of the otitis externa will remain as a persistent problem.

Poor-quality water in swimming pools associated with a substantial risk of otitis externa due to Pseudomonas aeruginosa

There are many large and small public outdoor and indoor swimming pools in Tehran that hundreds of people use, especially on hot summer days. The bacteriological quality of the water of some of these pools was assayed over a period of about one year (2001-2002). To assess if these swimming pools were a health risk to users, eleven public swimming pools, in the east and northeast of the city, were examined, and the exposed people were monitored. Samples of swimming-pool waters were examined for colony counts, Escherichia coli and coliforms. In addition, Pseudomonas aeruginosa was isolated from nine (81.8%) of those pools. P. aeruginosa grew in seven (63.6%) of the swimming-pool water samples. In two (18.2%) other samples, in addition to P. aeruginosa, high rates of total bacterial count, total coliforms and faecal coliform counts were also found. At the same time, users of the swimming pools were asked to complete a questionnaire. Ear swabs were collected from 179 users with a history of ear problems during the previous two weeks. An adequate control group was chosen randomly from those who never used the investigated pools. P. aeruginosa was isolated from the ear swabs of 142 (79.3%) of the cases, as well as from 4% of the controls. Results were matched for age, sex, duration of time spent in the pools, place of occurrence and other useful information. Investigation of the contaminated swimming pools revealed that chlorination was often inadequate, especially when high numbers of people led to overuse of the pools. Although the results of this research showed that otitis externa was strongly associated with the swimming pools, due to P. aeruginosa, an extensive follow-up study is needed to determine the other possible health risks associated with public pools.

An unusual case of external ear inflammation caused by sarcoidosis

Inflammation of the pinna can occur in conjunction with polychondritis and otitis externa. We describe a case of pinneal inflammation that proved to be sarcoidosis, and we discuss the otolaryngologic manifestations of sarcoidosis.

[Chronic recurrent otitis externa. Excessive ear hygienic care can have sequelae]

Numerous factors may be involved in the development of chronic recurrent otitis externa: altered pH of the cerumen, increased susceptibility to contact allergens (e.g. nickel ear-rings) in atopic patients, the use of instruments for cleaning out the auditory canal, the presence of a foreign body, congential narowing of the auditory canal, or systemic diseases (in particular diabetes mellitus). For diagnostic purposes, the use of the otoscope is mandatory, and swabs to determine the presence of bacteria or fungi are to be recommended. Treatment is dictated by the clinical picture presenting, and may comprise the local application of antibiotic cortisone containing or antimycotic preparations and temponade of the auditory canal (acute inflammatory phase) or pH-stabilizing lotions (chronic dry inflammatory phase) with the aim of ameliorating the frequently highly troublesome pruritus.

External auditory canal pH in chronic otitis externa

Several risk factors have been postulated to play a part in the progression of acute into chronic otitis externa, including changes towards alkalinity of the skin pH of the external auditory canal. These changes have been previously reported to occur in the acute stage, and their persistence may predispose to a chronic status of this condition. This prospective control study was designed to look at this possible relationship in more depth, by comparing the external auditory canal pH of individuals with chronic otitis externa, but with no current exacerbation, with an age-/sex-matched control group. Analysis of the data revealed a significantly higher external auditory canal pH in the chronic otitis externa group (P < 0.004) when compared with the controls, with no concomitant difference in body skin pH. Within this chronic otitis externa cohort, a statistically significant correlation was found between external auditory canal pH and the severity of the condition, as assessed using a multiparameter scoring system (r = 0.562; P < 0.02). Importantly, the pH was not related to the length of time since the last exacerbation. There was a significant age relationship present within our sample. Younger patients displayed more severe chronic otitis externa(r = -0.813; P < 0.001), with correspondingly higher external auditory canal pH values (r = -0.550; P < 0.02). The results suggest that alkaline ear canal skin is a local risk factor for the progression into chronic otitis externa, occurring, in this study, with greater severity in younger individuals.

CT and MRI in malignant external otitis: a report of four cases

Malignant external otitis (MEO) is a severe infection of the external auditory canal and skull base which most often affects elderly patients with diabetes mellitus. Early diagnosis and aggressive treatment are important in terms of reducing risks of dissemination. We report four cases of MEO in patients with diabetes mellitus who were observed with computed tomography (CT) and/or magnetic resonance imaging (MRI). MRI was superior to CT in patients with MEO in terms of estimating the anatomic extent of the disease, but it cannot be used for monitoring therapy.

Inflammatory polyps of the middle ear in 5 dogs

OBJECTIVE

To describe inflammatory polyps of the middle ear in 5 dogs.

STUDY DESIGN

Case series.

ANIMALS

Five dogs with ear disease.

METHODS

Medical records (1995-2001) were reviewed to identify dogs with inflammatory polyps of the middle ear. Signalment, clinical signs, ancillary diagnostic procedures, treatment, postoperative complications, and outcome were recorded. Owners and referring veterinarians were contacted to document outcome.

RESULTS

Dogs with inflammatory polyps of the middle ear were male and aged 4 to 13 years. Two dogs had bilateral polyps, whereas 3 had unilateral polyps. The most common clinical presentation was otitis externa and media, with radiographic evidence of otitis media. Polyps were treated by ventral bulla osteotomy (VBO) in 1 dog and total ear canal ablation with lateral bulla osteotomy (TECA-LBO) in 4 dogs. Polyps consisted of a fibrovascular stroma infiltrated with neutrophils, macrophages, lymphocytes, and plasma cells. The overlying epithelium was frequently ulcerated. Immediate postoperative complications included a seroma after VBO (1 dog) and transient unilateral facial nerve paralysis after bilateral TECA-LBO (1 dog). No recurrence occurred within 9 to 69 months.

CONCLUSIONS

Unilateral or bilateral, inflammatory polyps can occur in the middle ear of dogs in association with otitis externa and media. No recurrence occurred after surgical removal of the polyps.

CLINICAL RELEVANCE

Inflammatory polyps of the middle ear in dogs can be a cause of otitis externa/media. Surgical removal of aural polyps has a good prognosis.

Idiopathic inflammatory medial meatal fibrotizing otitis

BACKGROUND

Idiopathic inflammatory medial meatal fibrotizing otitis (IMFO) is rare. Only a few cases with unknown cause have been reported.

OBJECTIVE

To report 3 cases of IMFO as a specific diagnostic entity.

PATIENTS AND METHODS

Two adults and 1 child with bilateral IMFO were observed for several years at the Department of Otorhinolaryngology of Helsinki University Hospital, Helsinki, Finland.

RESULTS

Only the osseous part of the external ear canals was affected by IMFO. The skin and skin organs over the lateral cartilage of the ear canals remained rigorously and constantly uninflamed through the active, relentless progression of the disease over several years, resulting in the formation of a fibrous plug of the medial meatal canal. The middle ears and mastoid air cells were not affected during the active inflammatory phase.

CONCLUSION

IMFO has its own specific pathophysiologic characteristics, and perhaps also etiopathologic characteristics, which are still unknown.

Allergic otitis externa

Chronic otitis externa is a common condition, which is usually successfully treated by topical medications and aural toilet. In cases that persist despite conventional treatment, a diagnosis of allergic otitis externa should be considered. Sensitization to otic medications (secondary contact otitis) is not uncommon. Topical aminoglycosides are the most common sensitizers although many components of topical preparations can cause sensitization. Patients who may have developed allergic otitis externa should undergo patch testing. Otolaryngologists should consider using topical antibiotics with a low allergenic potential and avoiding neomycin when treating patients with otitis externa. Primary contact otitis may occur to metals used in earrings and also to hearing aid moulds. Treatment of both primary and secondary contact otitis consists of identifying the allergen, avoiding further contact and use of simple preparations avoiding common sensitizers.