Skin diseases of the Chinese Shar-Pei

This article deals with the unique skin disorders seen only in the Shar-Pei. The difference between skin diseases in Shar-Pei and other breeds is described. Prevention and treatment are discussed. Suggestions are given to alter the breed's anatomy slightly to decrease the genetic predisposition to certain dermatoses.

An unusual case of Candida tropicalis sepsis in a patient submitted to allogeneic bone marrow transplantation

We describe an exceptional case of Candida tropicalis sepsis in a patient submitted to allogeneic BMT; the diagnosis was made on a peripheral blood smear, when the pt was neutropenic and only mildly febrile. The combination of GM-CSF to accelerate hematological recovery and the possibility of administering large doses of a liposomal form of Amphotericin B were the contributing factors to the resolution of the infection.

Another hazard of ear syringing: malignant external otitis

A case of malignant external otitis is presented. This occurred in a healthy 72-year-old non-diabetic, non-immuno-compromised man after ear syringing. The infection was treated with oral ciprofloxacin for eight weeks with complete resolution.

Otolaryngic manifestations of myiasis

Although rare in North America and Europe, myiasis is seen occasionally in tropical and undeveloped countries. This disorder results from the penetration of a fly larva into a part of the human body, and it causes various symptoms in the host. The exposed areas of the skin are the ones predominantly affected and the eyes, ears, nose, and paranasal sinuses are less commonly affected. We review our experience with 12 patients with myiasis of the ears, nose, and paranasal sinuses.

Management of radiation-induced otitis externa

Four cases of otitis externa secondary to radiotherapy are described. This fairly common complication of irradiation to the head and neck, may impede a satisfactory completion of the therapy. Water precautions and regular otoscopic examination of the ears should be encouraged as prevention or early recognition of the condition is essential for the well being of the patient. The treatment of established otitis externa consists of frequent aural toilet and the application of weak antiseptic solutions. However, complete resolution will not occur until the cutaneous reaction has fully settled.

Otogenic Münchausen syndrome

Münchausen syndrome is uncommon in otolaryngology. Self-induced otitis externa has rarely been reported, and nothing is known concerning the true incidence of feigned vertigo. We present a patient who has been hospitalized several times and who has undergone ear surgery and treatment at different institutions along the eastern seaboard. She has suffered complications of therapy, including a profound sensorineural hearing loss, and was referred to us for surgical treatment of bizarre intractable otitis externa. The infection failed to respond to medical treatment and was ultimately found to be self-inflicted. Despite psychotherapy, the patient continues to seek further treatment at still other hospitals. This entity must be considered whenever a thorough evaluation fails to yield a reasonable organic diagnosis.

Borderline cases of malignant external otitis

The cases of four healthy people are presented; each suspected of having contracted malignant external otitis (MEO). In all four patients, the classic symptoms of MEO were present. In two cases, cautrimoxazole was administered orally; the other two patients did not receive any oral antibiotics. In each case, the disease took a benign course. It was concluded that MEO may occur in a wider, healthy population who overcome it quite easily, without recourse to antibiotics.

Invasive external otitis caused by Aspergillus

Invasive external otitis occurs almost exclusively in patients with longstanding diabetes. Except for occasional cases, the etiologic agent has been Pseudomonas aeruginosa. We report a case caused by Aspergillus species in a diabetic patient with acute leukemia. Persistent infection was documented by culture and histology after a course of intravenous amphotericin B (total dose, 2 g). Clinical resolution occurred in association with a 3-month course of oral itraconazole. Four previously reported cases of invasive aspergillus otitis are reviewed.

[Pathology of the external ear. A year's review]

The purpose of this paper is to study the incidence of external ear pathology in our ENT Service in the period between November 1987 and November 1988. During this period 238 cases of this pathology were diagnosed.

A clinical comparison of hydrocortisone butyrate with oxytetracycline/hydrocortisone acetate-polymyxin B in the local treatment of acute external otitis

In a single blind, randomized study, 46 patients with acute external otitis were treated with either oxytetracycline/hydrocortisone with polymyxin B (TPB) or hydrocortisone-17-alpha-butyrate eardrops for 7 days. Pseudomonas pyocyanea, Staphylococcus epidermidis and Staph. aureus were the microorganisms most frequently found in the ear canal. Fungi were not found in any culture. The overall cure rate was 80%. No significant difference in therapeutic efficacy was noted between the preparations except regarding Staph. aureus, which was cultured from 17% of the patients. Although the butyrate solution did not contain any antibiotic supplement, it seemed to be more effective than TPB in treating the staphylococcal infections. These findings suggest that such other factors as the hydrogen ion concentration, the steroid potency or the vehicle per se are of importance for the successful treatment of acute external otitis.

Wegener's granulomatosis with otological disorders as primary symptoms

Otological symptoms as initial manifestations of Wegener's granulomatosis have been observed in 3 patients. In one of them, symptoms consisted of a bilateral sensorineural hearing loss, improved by corticoid therapy. No other organ system was involved and laboratory tests remained within normal limits for 2 years after the onset of otological signs. In the other 2 patients, Wegener's granulomatosis manifested mainly as serous otitis media. Otologic involvement underscores the role of the otolaryngologist in the early diagnosis and treatment of this disease.

Use of ceftazidime for malignant external otitis

During the past 2 years we have used ceftazidime (Fortaz), a third-generation cephalosporin, in the treatment of eight patients with progressive necrotizing "malignant" external otitis. Ceftazidime is very active against Pseudomonas species and provides penetration into the CSF. Our results suggest that this medication has several advantages over the previously recommended combinations of aminoglycosides and semisynthetic penicillins, including improved cure rate, lower toxicity, and simpler administration schedules. We review our experience with ceftazidime in the treatment of eight patients.

Hearing aids worn with tympanic membrane perforation: complications and solutions

Hearing aids are sometimes recommended in ears with tympanic membrane perforation. Presented are six illustrative cases that represent various degrees of perforation, ear-mold styles, and wearing habits. The degrees of perforation represented include total, 50%, 20%, myringotomy tube, and modified mastoid cavity (canal up). Patients wearing earmolds with total perforation experience nearly constant irritation, infection, itching, or drainage. Rare periods of success are achieved in such cases by strict adherence to hygiene and ventilation guidelines. Lesser degrees of perforation usually experience significantly fewer problems if such guidelines are followed. Ear ventilation is found to be the primary success factor, whether achieved by periods of non-use or earmold venting. Since the potential for serious complications always exists, such fittings require patient education and regular otologic follow-up.

Otologic manifestations of Langerhans' cell histiocytosis

Eighteen of 62 children diagnosed with Langerhans' cell histiocytosis at the Children's Hospital of Pittsburgh (Pa) between 1970 and 1986 demonstrated ear and temporal bone involvement. In six children, such otologic disease was their sole presenting manifestation. Common signs and symptoms included aural discharge, postauricular swelling, and conductive hearing loss. The otologic findings in these children, if not investigated properly, could easily be attributed to acute or chronic infectious ear disease. Computed tomography with contrast enhancement proved to be particularly valuable as a diagnostic study because of its clear delineation of both osseous and soft-tissue temporal bone involvement. Computed tomographic findings could also be used to enhance local treatment by guiding surgical biopsy and curettage procedures or defining low-dose radiation therapy portals. Eleven of these 18 children with otologic Langerhans' cell histiocytosis additionally required chemotherapy due to the systemic nature of their disease.

Treatment of Pseudomonas aeruginosa auricular perichondritis with oral ciprofloxacin

Pseudomonas aeruginosa auricular perichondritis can be a serious and expensive postoperative infection requiring prolonged hospitalization and intravenous administration of antibiotics. Oral antimicrobial agents have not been effective in the treatment of serious P. aeruginosa infections. Recently completed clinical trials have shown that oral ciprofloxacin, one of the new fluoroquinolone antimicrobials, is effective in the treatment of certain P. aeruginosa infections. We report two cases of P. aeruginosa auricular perichondritis successfully treated as outpatients with oral ciprofloxacin. This article also reviews the salient features of the new fluoroquinolones and their impact on antimicrobial therapy of serious skin and skin-structure infections.

Osteomyelitis of the skull base

Osteomyelitis of the temporal bone often begins with minor trauma and results in a persistent external otitis. I report my experience with ten patients managed with combined medical and surgical therapy, and discuss the progression of the disease process and how it affects the duration of antibiotic therapy and the indications for planned surgical debridement. Early recognition of osteomyelitis of the temporal bone, combined with the aggressive use of long-term antibiotic therapy, in addition to planned surgical debridement, will reduce morbidity and potential mortality.

Histopathology of the soft parts in 50 patients with malignant external otitis

Reports concerning the lesions of the skin coverage of the external ear canal in malignant external otitis (M.E.O.) are very few. To evaluate this problem, we studied the skin lesions of 45 skin biopsies from 40 M.E.O. patients, 23 from regions covering the osseous part of the ear structure, seven from the cartilaginous part of the external canal and 15 from both parts. The epidermis was normal in nine, thickened in 16, with acanthotic thickening and pseudoepitheliomatous hyperplasia in 20. In the dermis the amount of collagen was normal, but it was infiltrated by the inflammatory process. Acute inflammation was observed in 16 biopsies, subacute in 23, chronic in six. A mixture of acute and chronic changes was present in 18 biopsies. No major abnormalities of the vasculature could be detected. The distinguishing pathological feature of M.E.O. concerns the typical topographic distribution of the inflammation in the osseous part of the external ear canal.

Malignant otitis externa due to Staphylococcus infection

A case of malignant otitis externa occurring in a fit 25-year-old non-diabetic male is reported. The clinical and histological findings support this diagnosis but neither identification nor culture of Pseudomonas aeruginosa was made and the condition was bilateral. The only pathogen identified was Staphylococcus aureus which has been reported in only two previous cases.

Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy

Malignant external otitis is an infection of the external ear canal, mastoid, and base of the skull caused by Pseudomonas aeruginosa. The condition occurs primarily in elderly patients with diabetes mellitus. Current theories on pathogenesis and anatomic correlations are reviewed. Severe, unrelenting otalgia and persistent otorrhea are the symptomatic hallmarks of the disease, whereas an elevated erythrocyte sedimentation rate is the only distinctive laboratory abnormality. Iatrogenic causes such as administration of broad-spectrum antibiotics and aural irrigation may play a predisposing role in high-risk populations. The disease can result in cranial polyneuropathies (with facial nerve [VII] paralysis being the most common) and death. The mainstay of treatment is administration of antipseudomonal antibiotics for four to eight weeks. Recurrence is common, and mortality remains at about 20 percent despite antibiotic therapy. Given the increasing longevity of diabetic patients, the frequency of this disease is increasing. Internists, family practitioners, and ambulatory care physicians must now be cognizant of the presenting symptoms, while infectious disease specialists and otolaryngologists need to be appraised of strides in diagnosis and therapy. The role of surgery should be minimized. Use of new diagnostic radiologic modalities and new antipseudomonal antibiotics discussed in this review should lead to improved outcome.

Evaluation of the patient with otitis externa

This article considers the history, physical examination, cytologic evaluation of smears and fungal and bacterial culture and sensitivity testing, clinical interpretation of information obtained from a biopsy of the external ear canal, and ancillary aids for the evaluation of the patient with otitis externa.

Pathologic changes in otitis externa

Otitic lesions must be evaluated in the context of the whole animal. Accurate historical and clinical assessments are important aids to the pathologist attempting to reach an accurate diagnosis. Primary lesions of the pinna, with or without involvement of the external ear canal, may be an extension of a more generalized dermatologic problem or may specifically involve the ear because of its unique gross and histologic characteristics.