Earache

Ear health and quality of life in pet rabbits of differing ear conformations: A UK survey of owner-reported signalment risk factors and effects on rabbit welfare and behaviour

The impacts of ear disease on animal welfare and behaviour are little documented. Ear disease may be common in rabbits, but difficult to recognise, and lop-ears have previously been indicated as a risk factor for ear disease. We aimed to better understand the range of ear conditions in pet rabbits, signalment risk factors, and impacts on welfare and behaviour. Through an online questionnaire, we investigated owner-reported signalment, veterinary diagnosis of ear conditions, impaired hearing, and ear pain for UK pet rabbits. Relationships between ear condition measures and ear conformation, quality of life, and behaviour were analysed using logistic regression. Of 551 valid responses, 28.5% of rabbits reportedly had experienced ear conditions; 21.2% diagnosed or mentioned by vets, with otitis and excess cerumen most common. Approximately 25% of lop-eared rabbits had ear conditions indicated by a vet versus 10% of erect-eared rabbits. Lop-eared, half-lop, and older rabbits were most at risk (P<0.050). Rabbits reported as showing ear pain responses had reduced owner-reported quality of life compared with other rabbits (P<0.050). Rabbits with ear problems were less likely to be responsive to relevant sounds, and performed binky behaviour (joy jumps) less frequently, than rabbits without such issues. Understanding prevalence and risk factors for ear conditions is critical to improving welfare standards across this widely owned pet species. The findings suggest that improved recognition and treatment of ear conditions, and avoiding breeding from rabbits with early signs, or a family history, of ear disease are necessary to help combat this animal welfare issue.

Epidemiology of otologic diagnoses in United States emergency departments

OBJECTIVES/HYPOTHESIS

Otologic complaints may place a significant burden on emergency departments (EDs) in the United States; however, few studies have comprehensively examined this discrete patient population. We aimed to identify utilization of EDs by patients with primary otologic complaints.

STUDY DESIGN

Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011.

METHODS

The NEDS database was queried for patient encounters with a primary otologic diagnosis based on International Classification of Diseases, Ninth Revision codes (380-389). Weighted estimates for demographics, diagnostic characteristics, socioeconomic status, and trends over time were extracted. Predictors of mortality and admission were determined by multivariable logistic regression.

RESULTS

A weighted total of 8,611,282 visits between 2009 and 2011 were attributed to otologic diagnoses, representing 2.21% of all ED visits. Stratified by patient age, otologic diagnoses encompassed 1.01% and 6.79% of all adult and pediatric ED visits, respectively. The majority of patients were treated and released (98.17%). The average age of patients presenting with an otologic complaint was 17.9 years (standard error = 0.23). Overall, 62.7% of patients who presented with an otologic complaint were 0 to 17 years old. The most common diagnoses among all age groups included otitis media not otherwise specified (NOS) (60.6%), infected otitis externa NOS (11.8%), and otalgia NOS (6.8%).

CONCLUSIONS

We provide a comprehensive overview of otologic complaints that are an overlooked diagnostic category in public health research. NEDS data demonstrate a significant number of visits related to otologic complaints, especially in the pediatric population, that are nonemergent.

LEVEL OF EVIDENCE

4

The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study

BACKGROUND

Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States.

METHODS

Prospective cohort studies were conducted at four freshwater and five marine sites in the United States and Puerto Rico. Beach visitors were enrolled on summer weekends and holidays. Ten to twelve days after the beach visit, respondents answered questions about health symptoms, including earaches or ear infections experienced since the beach visit. Economic and physical burdens were also obtained. Fixed slope, random intercept (beach site) multivariate logistic regression models were used to estimate the relationship between head immersion swimming exposure and earaches. Model results were used to calculate excess risk for earaches attributable to swimming.

RESULTS

The overall incidence of self-reported earache was 1.6% in the 10-12 days after the beach visit. Earaches were more frequent in head immersion swimmers compared to non-swimmers for all beach sites and age groups. Earaches were unassociated with water sample measures of fecal contamination and turbidity. After adjustment for covariates, we calculated 7.12 excess earaches among head immersion swimmers per 1,000 swimming events. Twenty-four percent of those with earache reported missing their regular activities; 28% visited a doctor; 4% visited the emergency room; and 31% and 40% used prescription and non-prescription medications, respectively.

CONCLUSIONS

There are at least 128 million swimming events in natural waters annually. Such frequent exposures could result in 900,000 excess earaches, 260,000 visits to the doctor, 39,900 visits to the emergency room, nearly $4 million dollars in out-of-pocket expenditures on prescription and over-the-counter medications, and close to 75,000 hours of clinician time. More accurate estimates of swimming exposure are needed to improve population burden and associated cost estimates.