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Albulayhid NA, Al-Jabr KH, Almazroua MM, Aldossari MH, Alsannat IA, Alotaibi AM, Almalki YF, Alotaibi FT, Alselmi FA, Alsharif MHK. Knowledge and Attitude Toward Otitis Externa: A Saudi Arabian Perspective. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1628-S1632. [PMID: 38882757 PMCID: PMC11174189 DOI: 10.4103/jpbs.jpbs_1167_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 06/18/2024] Open
Abstract
Objectives This study intended to assess the level of awareness and attitude toward otitis externa (OE) and specific limitations that counter the attempts to uplift the understanding and notion related to OE among the general population of Saudi Arabia. Methods A cross-sectional quantitative study using a questionnaire was done via Google Forms between May 2023 and July 2023. The scoring method was used to determine the participant's awareness or attitude; participants who scored >50% were considered aware or to have a good attitude. Results Approximately 52.2% had a good attitude toward the OE, and majority were willing to visit healthcare professionals (81%) to provide care and receive proper education during office visits (80.1%). Of all the participants, 69%, 33.4%, and 30.8% suggested that a lack of awareness, cost, and health insurance, respectively, might prevent patients from seeking a healthcare professional. Only 10.9% of participants demonstrated good awareness (score >13) of outer ear inflammation. Conclusion The findings indicate a poor level of awareness regarding OE, and a positive attitude toward seeking healthcare, with the majority recommending professional visits and relying on healthcare professionals for information.
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Affiliation(s)
- Naif A Albulayhid
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Khalid H Al-Jabr
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mohammed M Almazroua
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mubarak H Aldossari
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Ibrahim A Alsannat
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Abdulwhab M Alotaibi
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Yazeed F Almalki
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Faihan T Alotaibi
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Faris A Alselmi
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mohammed H Karrar Alsharif
- Department of Basic Medical Science, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
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Dey D. How to avoid pitfalls when referring patients to otolaryngology. JAAPA 2023; 36:1-4. [PMID: 37668487 DOI: 10.1097/01.jaa.0000937320.81549.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
ABSTRACT Delayed, faulty, incomplete, or misdiagnosed referrals to otolaryngology (also called ear, nose, and throat, or ENT) can result in physical and monetary harm to the patient and time spent by clinicians in reordering the appropriate diagnostic tests. This article describes how to refer patients to ENT in the most time- and cost-effective ways, and addresses initial management in primary care.
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Affiliation(s)
- Dennis Dey
- Dennis Dey practices in otolaryngology at Baptist St. Anthony Panhandle ENT of Amarillo, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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Shawish AM, Hobani AH, Zaalah LA, Hakami RA, Alharbi GH, Alhazmi RM, Hakami BH, Matari MH, Majrashi KA, Mawkili AA. The Awareness Among Parents About Cotton Earbud (Q-tips) Use in Children in the Jazan Region, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e43734. [PMID: 37727172 PMCID: PMC10505834 DOI: 10.7759/cureus.43734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Background and objective The waxy substance secreted in the ear canal of mammals, including humans, is known as ear wax; it is also known by the medical term cerumen. It protects against germs, fungi, and water, helps with cleansing and lubrication, hydrates, and protects the skin of the human ear canal. The purpose of using cotton earbuds (Q-tips) is to clean the ear auricle (external part), relieve itching, and remove any excess water among other things; however, many people have been mistakenly using them for cleaning deeper spots in the ear, leading to some serious complications. Cotton earbud misuse has been documented to be the most common cause of accidental penetrating trauma of the eardrum among children. In this study, we aimed to determine the level of awareness of parents about the use of Q-tips among children and its consequences in the Jazan region, Saudi Arabia. Methods This was a cross-sectional study involving 391 participants conducted from February 2023 to April 2023 in the Jazan region. While all parents in the Jazan region were eligible to be included in the study, only those who responded to our survey questionnaire were recruited. Since our research focused on parents, participants who were aged less than 18 years and those who had never married were excluded. A validated questionnaire tested for reliability was used in the study. The association between the level of awareness about Q-tips use and the sociodemographic characteristics of the parents was evaluated using the chi-squared test. A p-value ≤0.05 was considered statistically significant. Results Out of the 391 individuals included in the survey, two-thirds (67.5%) were male and 32.5% were female, and most of them were married (89.8%). Regarding the knowledge of cotton bud use among the participants, we found that 12.3% agreed and 34% strongly agreed that cotton buds should be used to clean the ears. Furthermore, 74.9% of the participants knew that cotton buds could cause ear infections, 80.8% knew that cotton buds could cause eardrum perforation, and 79.3% knew that cotton buds could push ear wax deeper into the ear. We found that 152 (57.6%) of the male and 91 (71.7%) of the female participants used cotton buds on their own (p=0.011). Moreover, 176 (66.7%) of the male participants thought that cotton buds can damage their child's ear while 69 (54.3%) of the female participants thought the same (p=0.048). When the participants were asked if they thought that the use of cotton buds caused complications, 155 (58.7%) of the males and 55 (43.3%) of the females said yes (p=0.015). Conclusions The parents in the Jazan region had a relatively good level of knowledge about ear cleaning using cotton buds among children. Nevertheless, we found a poor level of awareness about using cotton buds as the primary tool for cleaning the ears. Of note, 62.7% of the respondents knew that cotton buds could damage the ear, and 55% of the respondents thought that the use of cotton buds causes complications. However, 62.1% of the respondents still reported using it, and 50.1% of the respondents erroneously believed that it is beneficial to clean the ears with cotton buds. Otolaryngologists have always warned the public regarding the use of Q-tips and the complications they can cause. However, people are still ignorant as well as careless about these facts.
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Gelardi M, Giancaspro R, Landi M, Santoiemma L, Balestra M, Cassano M, Rizzo R. Perspectives of Italian Physicians and Patients in the Treatment of Otitis Externa: A Real-Life Study. J Pers Med 2023; 13:1083. [PMID: 37511695 PMCID: PMC10381888 DOI: 10.3390/jpm13071083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Otitis externa (OE) is a common inflammatory disease of the external ear canal. Given the numerous manifestations of OE, the high rate of recurrence of the disease, as well as the emergence of resistance to antibiotics, therapeutic strategies are numerous and still not well standardized. The aim of this study was to investigate the patient journey of Italian patients suffering from OE, paying greater attention to new therapeutic options. (2) Methods: We conducted a national survey to evaluate the characteristics of patients affected by OE and to analyze the most-prescribed treatments. (3) Results: OE is a common, often relapsing disease that has several clinical manifestations. Prior to observation, the combination of corticosteroids and topical antibiotics was the most common therapeutic strategy. At the time of observation, new liposomal ozone-based preparations were the most-prescribed treatment. (4) Conclusions: This multi-center study investigated key aspects of the OE patient journey, highlighting the growing problem of antibiotic resistance. Restoring a correct ear microbiome is the therapeutic goal. In this context, new liposomal ozone-based drugs represent a promising therapeutic strategy.
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Affiliation(s)
- Matteo Gelardi
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Rossana Giancaspro
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Massimo Landi
- Paediatric National Healthcare System, 10135 Torino, Italy
| | - Luigi Santoiemma
- General Practitioner, Local Health Department Bari, 70026 Modugno, Italy
| | | | - Michele Cassano
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Roberta Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44121 Ferrara, Italy
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Lathi OP, Sharma A, Maheshwari M. Surveillance of Antimicrobial Susceptibility Pattern of Chronic Suppurative Otitis Media in Tertiary Care Hospital of Southern Rajasthan. Indian J Otolaryngol Head Neck Surg 2023; 75:588-595. [PMID: 37206713 PMCID: PMC10188809 DOI: 10.1007/s12070-023-03648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 02/26/2023] [Indexed: 03/18/2023] Open
Abstract
The main aim of this work is to identify aerobic bacteriology and antibiotic sensitivity pattern of chronic suppurative otitis media in tertiary care hospital of southern Rajasthan. Two hundred and fifty clinically diagnosed cases of chronic suppurative otitis media of all age groups and both the sexes with the ear discharged of more than 6 weeks duration formed the subject of the study group. The specific identification of bacterial pathogens is done based on microscopic morphology, staining characteristics, cultural and biochemical properties using standard laboratory procedures. Antimicrobial susceptibility of the bacterial isolates to the commonly used antibiotics according to CLSI guideline is done by Kirby-Bauer disc diffusion method. Out of 250 cases, 226 (90.4%) were found to be smear positive and culture positive, 17 (6.8%) were found smear positive and culture negative, 7 (2.8%) were smear negative and culture negative. Pseudomonas spp was found the most common organism isolated was. Out of 244 isolates, 174 (71.3%) were found to be sensitive to Amikacin. In our study, Pseudomonas spp. 98% isolates were found to be most sensitive to Meropenem and 84.2% isolates were found to be most resistance to Ceftazidime. This study is useful to prevents the administration of unwanted antibiotics and in development of empirical policy. This may be helpful to medical practitioner for the prescribing antibiotics in the treatment of CSOM.
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Affiliation(s)
- Om Prakash Lathi
- Department of Microbiology, R. N. T. Medical College, Udaipur, Rajasthan 313001 India
| | - Anshu Sharma
- Department of Microbiology, R. N. T. Medical College, Udaipur, Rajasthan 313001 India
| | - Monika Maheshwari
- Geetanjali Institute of Pharmacy, Geetanjali University, Manwakhera NH-8 Bypass, Udaipur, Rajasthan 313002 India
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Mukdad L, Shapiro NL. Establishing Healthy Lifestyle Choices Early: How to Counsel Children and Their Parents. Otolaryngol Clin North Am 2022; 55:1111-1124. [PMID: 36088165 DOI: 10.1016/j.otc.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Promoting childhood and adolescent health and long-term well-being requires an emphasis on preventative care and anticipatory guidance. In this review, the authors will focus on pertinent ear, nose, and throat preventative health in children, providing clinicians with relevant and succinct information to counsel children and their parents on the following essential subjects: foreign body aspiration and ingestion, upper respiratory infection prevention, noise exposure risks, aural hygiene, risks of primary and secondhand smoke exposure, and sleep hygiene.
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Affiliation(s)
- Laith Mukdad
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095, USA
| | - Nina L Shapiro
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095, USA.
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Helbing AHB, Straughan AJ, Pasick LJ, Benito DA, Zapanta PE. I'm All Ears: A Population-Based Analysis of Consumer Product Foreign Bodies of the Ear. Ann Otol Rhinol Laryngol 2021; 131:829-833. [PMID: 34514851 DOI: 10.1177/00034894211045638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the nationwide incidence of ear foreign body (FB) presentations to the emergency department (ED) and analyze the most common FB consumer products encountered. METHODS The National Electronic Injury Surveillance System (NEISS) was evaluated for ED visits that included "ear foreign bodies" from 2010 through 2019. The most frequent foreign bodies were identified and organized by demographics. RESULTS A total of 20,545 ear FB cases were found, with an estimated 608,860 ED visits nationwide. Female patients (56%) were more likely to have jewelry and first aid equipment FBs. Males between the ages of 5 and 15 years were significantly (P < 0.05) more likely to have paper products, pens/pencils, and desk supplies in their ears. CONCLUSION Ear FBs represent a substantial proportion of healthcare expenditures. Although children are the most commonly affected individuals, all ages require further education and preventive measures.
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Affiliation(s)
- Alexandra H B Helbing
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Alexander J Straughan
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Luke J Pasick
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel A Benito
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Philip E Zapanta
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Bhardwaj S, Bhatia S, Singh S, Franco Jr F. Growing emergence of drug-resistant Pseudomonas aeruginosa and attenuation of its virulence using quorum sensing inhibitors: A critical review. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2021; 24:699-719. [PMID: 34630947 PMCID: PMC8487598 DOI: 10.22038/ijbms.2021.49151.11254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022]
Abstract
A perilous increase in the number of bacterial infections has led to developing throngs of antibiotics for increasing the quality and expectancy of life. Pseudomonas aeruginosa is becoming resistant to all known conventional antimicrobial agents thereby posing a deadly threat to the human population. Nowadays, targeting virulence traits of infectious agents is an alternative approach to antimicrobials that is gaining much popularity to fight antimicrobial resistance. Quorum sensing (QS) involves interspecies communication via a chemical signaling pathway. Under this mechanism, cells work in a concerted manner, communicate with each other with the help of signaling molecules called auto-inducers (AI). The virulence of these strains is driven by genes, whose expression is regulated by AI, which in turn acts as transcriptional activators. Moreover, the problem of antibiotic-resistance in case of infections caused by P. aeruginosa becomes more alarming among immune-compromised patients, where the infectious agents easily take over the cellular machinery of the host while hidden in the QS mediated biofilms. Inhibition of the QS circuit of P. aeruginosa by targeting various signaling pathways such as LasR, RhlR, Pqs, and QScR transcriptional proteins will help in blocking downstream signal transducers which could result in reducing the bacterial virulence. The anti-virulence agent does not pose an immediate selective pressure on growing bacterium and thus reduces the pathogenicity without harming the target species. Here, we review exclusively, the growing emergence of multi-drug resistant (MDR) P. aeruginosa and the critical literature survey of QS inhibitors with their potential application of blocking P. aeruginosa infections.
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Affiliation(s)
- Snigdha Bhardwaj
- Department of Pharmaceutical Science, SHALOM Institute of Health and Allied Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, Prayagraj, India
| | - Sonam Bhatia
- Department of Pharmaceutical Science, SHALOM Institute of Health and Allied Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, Prayagraj, India
| | - Shaminder Singh
- Regional Centre for Biotechnology, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurugram Expressway, Faridabad - 121 001, Haryana, India
| | - Francisco Franco Jr
- Department of Chemistry, De La Salle University, Manila, Metro Manila, Philippines
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Herane-Vives A, Ortega L, Sandoval R, Young AH, Cleare A, Espinoza S, Hayes A, Benöhr J. Measuring Earwax Cortisol Concentration using a non-stressful sampling method. Heliyon 2020; 6:e05124. [PMID: 33195832 PMCID: PMC7644886 DOI: 10.1016/j.heliyon.2020.e05124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND "Short-term" samples are not the most appropriate for reflecting chronic cortisol concentration. Although hair is used for reflecting the systemic level of this hormone, its use as a "long-term" measure appears clinically problematic. Local and systemic stress and non-stress related factors may release cortisol that is accumulated in hair. Non-stressful earwax sampling methods may provide a more accurate specimen to measure chronic cortisol concentration. METHODS Earwax from both ears of 37 controls were extracted using a clinical procedure commonly associated with local pain. One month later, earwax from the left ear side was extracted using the same procedure, and earwax from the right ear side was more comfortably obtained, using a novel earwax self-sampling device. Participants also provided one centimetre of hair that represented the retrospective month of cortisol output, and one serum sample that reflected the effect of systemic stressors on cortisol levels. Earwax (ECC), Hair (HCC) and Serum (SCC) Cortisol Concentration were correlated and compared. Confounders' effect on cortisol levels were studied. RESULTS The highest levels of cortisol concentration were found in serum, and the lowest in hair (p < 0.01). Left-ECC was larger than Right-ECC (p = 0.03). Right-ECC was the only sample unaffected by confounders (all p > 0.05). A Pearson correlation showed that Right-ECC and HCC samples were moderately correlated between them (r = 0.39; p = 0.03). CONCLUSIONS The self-sampling device did not increase cortisol locally. It provided the cortisol level that was least likely to be affected by confounding factors over the previous month. ECC using the novel device might constitute another accurate, but more suitable and affordable specimen for measuring chronic cortisol concentration.
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Affiliation(s)
- Andres Herane-Vives
- Institute of Cognitive Neuroscience, University College London, UK
- Affective Disorders Research Group, Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lorena Ortega
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
| | - Rodrigo Sandoval
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
| | - Allan H. Young
- Affective Disorders Research Group, Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anthony Cleare
- Affective Disorders Research Group, Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Susana Espinoza
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
| | - Alexander Hayes
- Affective Disorders Research Group, Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jan Benöhr
- Benöhr Design Creatives, München, Germany
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Charlton A, Janjua N, Rejali D. Cotton bud in external ear canal causing necrotising otitis externa and subdural abscess. BMJ Case Rep 2019; 12:12/3/e227971. [PMID: 30846453 DOI: 10.1136/bcr-2018-227971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Necrotising otitis externa (NOE) is an infection originating in the soft tissues of the external auditory canal (EAC) spreading to the surrounding bone and rarely causing intracranial complications. It is usually caused by Pseudomonas aeruginosa and has historically occurred in elderly patients with diabetes or immunodeficiency. EAC foreign body is a risk factor for otitis externa but has not been described in NOE. A healthy 31-year-old man presented with new-onset seizures and worsening left-sided otalgia and otorrhoea. Brain imaging revealed left temporal subdural abscesses superior to the petrous bone. A retained cotton bud was identified in the left EAC, along with osseocartilaginous junction and mastoid granulation tissue. The foreign body was removed; a cortical mastoidectomy performed and intravenous antibiotic administered. At 10 weeks, the patient remained well, with no neurological deficit and no residual ear symptoms, and CT demonstrated complete resolution of the intracranial abscesses.
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Affiliation(s)
- Alexander Charlton
- Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Noor Janjua
- Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Darius Rejali
- Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Abstract
Ear injuries caused by cotton buds are commonly seen in ear, nose and throat (ENT) practice. We asked 1000 patients attending an ENT referral clinic whether they used cotton buds to clean the ear canal. Of the 325 who responded, 171 said they did. The frequency of use was no higher in those with ear complaints than in those with nose and other complaints. 15–20% of respondents disagreed with the statements that cotton buds can cause infections, wax impaction or perforations. On the evidence of this survey, manufacturers’ warnings need to be fortified.
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Affiliation(s)
- Jonathan C Hobson
- Royal National Throat Nose & Ear Hospital, 330 Gray's Inn Road, London WC1X 8DA, UK.
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Ameen ZS, Chounthirath T, Smith GA, Jatana KR. Pediatric Cotton-Tip Applicator-Related Ear Injury Treated in United States Emergency Departments, 1990-2010. J Pediatr 2017; 186:124-130. [PMID: 28473166 DOI: 10.1016/j.jpeds.2017.03.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/14/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the characteristics of children with cotton-tip applicator (CTA)-related ear injuries. STUDY DESIGN Data on CTA-related ear injuries among children presenting to US emergency departments (EDs) from 1990 through 2010 were obtained from the National Electronic Injury Surveillance System. RESULTS Between 1990 and 2010, an estimated 263 338 children aged <18 years were treated for CTA-related ear injuries in US hospital EDs. There was a nonsignificant increase in the annual number of injuries from 1990 through 2001 (78.2%) and a significant decrease from 2001 through 2010 (26.0%). Younger children sustained the highest rate of injury (32.2 per 100 000 for age 0-3 years). Ear cleaning was the most frequently documented circumstance at the time of injury (73.2%), and patients themselves were most commonly handling the CTA (76.9%). Foreign body sensation (39.2%) and bleeding (34.8%) were commonly documented reasons for visiting the ED. The presence of a foreign body (29.7%) and tympanic membrane perforation (25.3%) were common diagnoses. CONCLUSION Most CTA-related injuries occurred with children themselves handling CTAs while cleaning their ears. Foreign body and tympanic membrane perforation were the most common associated diagnoses. Despite warnings against the use of CTAs in the ear canal and use of CTAs by children, these injuries continued to occur. Additional injury prevention strategies through further parent/caregiver and child education are warranted.
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Affiliation(s)
- Zeenath S Ameen
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
| | - Thiphalak Chounthirath
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
| | - Kris R Jatana
- The Ohio State University College of Medicine, Columbus, OH; Department of Pediatric Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital and Wexner Medical Center at The Ohio State University, Columbus, OH.
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Wingelaar TT, van Ooij PJA, van Hulst RA. Otitis externa in military divers: more frequent and less harmful than reported. Diving Hyperb Med 2017; 47:4-8. [PMID: 28357818 PMCID: PMC6147244 DOI: 10.28920/dhm47.1.4-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Although otitis externa (OE) is a common disease, data related to (military) divers are limited. This study aimed to determine the incidence of OE in military divers during their initial training. We also wished to consider seasonal influences on incidence and whether early detection increases completion of the diving course. METHODS From January 2011 to October 2016 the Royal Netherlands Navy Diving School trained 189 divers. Up to December 2015 we used the training records for the analyses. From January 2016 onward all divers were prospectively screened. Pearson's chi-squared 2 and Fisher's exact tests were used to analyse the data. RESULTS In the 162 included divers, 30 cases of OE were identified. The incidence in 2016 was significantly higher than in 2011-2015 (17/35 (49%) versus 13/127 (10%), P < 0.001). Almost all cases developed after three weeks of diving. No influence of season was found (P = 0.354). Early diagnosis and treatment of OE does not seem to affect completion of diving courses (P = 0.28). Only in three cases did a diver have to discontinue the course due to OE. DISCUSSION This study suggests that OE is more frequent among military divers than earlier reported, most likely caused by prolonged water exposure. Diving activities can often be continued with standard topical treatment.
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Affiliation(s)
- Thijs T Wingelaar
- Royal Netherlands Navy Diving Medical Center, Rijkszee en marinehaven, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam
| | | | - Rob A van Hulst
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam
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Kiakojuri K, Mahdavi Omran S, Jalili B, Hajiahmadi M, Bagheri M, Ferdousi Shahandashti E, Rajabnia R. Bacterial Otitis Externa in Patients Attending an ENT Clinic in Babol, North of Iran. Jundishapur J Microbiol 2016; 9:e23093. [PMID: 27127584 PMCID: PMC4841979 DOI: 10.5812/jjm.23093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Acute otitis externa, an inflammatory condition of the external auditory canal, is a common clinical problem in general medicine. Objectives This study aimed to determine the etiology of otitis externa in patients from the Mazandaran province, north of Iran, which has a humid climate, as humidity can affect the prevalence of pathogenic microorganisms. Patients and Methods This cross-sectional study involved 116 patients with otitis externa. Two sets of samples were collected from their ears; one set was used for slide preparations, and the other for microbial culturing. After culturing, the microorganisms were identified by conventional methods. Results Patients between 35 and 44 years of age were most frequently affected (25.00%) by otitis externa (average age, 43.87 ± 18.08 years). Moreover, women (54.31%) were more frequently affected than men (45.69%). Upon direct investigation, Gram-positive bacilli were the most commonly identified microorganisms (22.41%). Furthermore, Bacillus spp. and coagulase-negative staphylococci (22.41% and 19.83%, respectively), were the organisms most frequently identified from cultures of otitis externa samples. Conclusions Direct examination and culture showed that a mixed infection of fungi and bacteria is the most common cause of otitis externa. The present study revealed that Bacilli spp. were the most abundant bacteria isolated from patients with otitis externa. Thus, it is recommended that both organisms should be considered as etiologic agents in protocols for treatment of otitis externa.
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Affiliation(s)
- Keyvan Kiakojuri
- Department of ENT, Faculty of Medicine, Roohani Hospital, Babol University of Medical Sciences, Babol, IR Iran
| | - Saeid Mahdavi Omran
- Department of Medical Parasitology and Mycology, Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, IR Iran
| | - Bahareh Jalili
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Babol University of Medical Sciences, Babol, IR Iran
| | - Mahmood Hajiahmadi
- Department of Biostatistics, Faculty of Medicine, Babol University of Medical Sciences, Babol, IR Iran
| | - Meghdad Bagheri
- Department of Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, IR Iran
| | | | - Ramazan Rajabnia
- Department of Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, IR Iran
- Corresponding author: Ramazan Rajabnia, Department of Microbiology, Faculty of Medicine, Babol University of Medical Sciences, P. O. Box: 4717647745, Babol, IR Iran. Tel: +98-9112179434, Fax: +98-1132199936, E-mail:
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Eichhorn L, Leyk D. Diving medicine in clinical practice. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:147-57; quiz 158. [PMID: 25797514 DOI: 10.3238/arztebl.2015.0147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/30/2014] [Accepted: 10/30/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diving is a popular sport, and some recreational divers have medical risk factors. Their health can be endangered by high extracorporeal (ambient) pressure and its many systemic effects. METHODS We review relevant publications on free (breath-hold) diving, scuba diving, medical evaluation for diving, barotrauma, decompression sickness, and diving with medical risk factors, which were retrieved by a selective search of PubMed. RESULTS Free diving or scuba diving, even at seemingly innocuous depths, puts considerable stress on the cardio - vascular system, ears, and lungs. Unexpected events while diving, diminished functional reserve, and pre-existing medical illnesses increase the risk of a diving accident. An international survey revealed that minor incidents occur in 1.3% of all dives, and decompression accidents in 2 of every 10 000 dives. A properly conducted medical examination to determine diving fitness, followed by appropriate counseling, can make a life-threatening diving accident less likely. CONCLUSION To be able to certify diving fitness and give competent medical advice about diving, physicians must be well informed about the physical and physiological changes of diving and the associated risks to health, and they need to know how to perform a medical evaluation of prospective divers. In Germany, any licensed physician may judge a person fit to dive. It is recommended that this be done in adherence to the relevant evaluation standards and recommendations of the medical specialty associations. Randomized controlled trials on the effect of preventive behavior would be desirable, as would a central registry of diving accidents.
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Affiliation(s)
- Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Central Institute of the German Armed Forces' Medical Service, Department IV-Military Ergonomics and Exercise Physiology-Koblenz, Research Group Epidemiology of Performance, Institute for Physiology and Anatomy, German Sport University Cologne
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Kohli C, Kadirvelu U, Garg S, Sharma N. Burden of ear morbidities among children in primary care setting in Delhi. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2016. [DOI: 10.1016/j.cegh.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Urkin J, Bar-David Y, Holdstein Y. Cleaning Earwax Impaction: Clinical Tips for the Primary Care Clinician. Clin Pediatr (Phila) 2015; 54:1311-4. [PMID: 26156979 DOI: 10.1177/0009922815594761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jacob Urkin
- Ben-Gurion University of the Negev, Beer-Sheva, Israel Soroka University Medical Center, Beer-Sheva, Israel
| | - Yair Bar-David
- Ben-Gurion University of the Negev, Beer-Sheva, Israel Soroka University Medical Center, Beer-Sheva, Israel
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Yang HC, Cho YB, Cho HH. Retained Cotton Bud-induced Severe Otitis Externa That Mimics Malignant Otitis Externa. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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19
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Affiliation(s)
- JD Osguthorpe
- Medical University of South Carolina, Charleston, South Carolina
| | - DR Nielsen
- American Academy of Otolaryngology, Head and Neck Surgery, Alexandria, Virginia
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20
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In Vitro Efficacy of a Consumer-Marketed Ear Cleaning Tool. Otol Neurotol 2014; 35:e195-8. [DOI: 10.1097/mao.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Épidémiologie des otomycoses au centre hospitalier et universitaire de Yopougon (Abidjan-Côte d’Ivoire). J Mycol Med 2014; 24:e9-15. [DOI: 10.1016/j.mycmed.2013.07.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 07/08/2013] [Accepted: 07/19/2013] [Indexed: 11/18/2022]
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Abstract
Context: Self-ear-cleaning has been reported to be common from several hospital-based studies and it has been associated with some diseases of the ear. Aims: To determine community-based prevalence of self-ear-cleaning and its sociodemographic correlates among educated young adults in Nigeria. Settings and Design: A cross-sectional survey conducted in a National Youth Service Corps camp in Nigeria. Subjects and Methods: Semistructured questionnaires were administered on a randomly selected sample of 1280 respondents. The outcome variable was self-ear-cleaning. Independent variables were sociodemographic variables, materials used and ear-cleaning habits. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS) version 15 was utilized for univariate, bivariate, and multiple logistic regression analysis. Results: There were 1012 respondents (M: F = 1.05:1). Mean age was 25.3 (standard deviation, 2.34). Prevalence of self-ear-cleaning was 93.4%. Mean age at first cleaning was 7.6 years. Cotton buds were the most frequently used objects (in 85.1%). Prevalence was high irrespective of sociodemographic class, significantly higher among females (χ2 = 4.549, P = 0.033), those who believed the habit was beneficial (χ2 = 114.185, P < 0.001) and those whose parents and siblings practiced the habit. Significant predictive factors were self-ear-cleaning in respondent's father [odds ratio (OR) P = 0.011) and owning cotton buds (OR = 0.192, P = 0.007). Conclusions: Self-ear-cleaning is almost universal. Most of the population is, therefore, at risk of possible harmful effects. Also, medical advice against self-ear-cleaning is not widely known. Rather, the erroneous perception that self-ear-cleaning is beneficial is common. Collaborative health education efforts targeted at families and schools and campaigns and advocacy for legislation regulating the sale of cotton buds are recommended.
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Affiliation(s)
- Adedayo Olugbenga Olaosun
- Department of Surgery, Otorhinolaryngology Unit, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria
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Guidi JL, Wetmore RF, Sobol SE. Risk of Otitis Externa Following Manual Cerumen Removal. Ann Otol Rhinol Laryngol 2014; 123:482-4. [DOI: 10.1177/0003489414526850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Based on an interpretation of a recent Joint Commission protocol to sterilize instruments coming into contact with mucous membranes, there has been institutional interest in sterile packaging of cerumen curettes used for manual cerumen removal. To date, there are no studies that have assessed the risk of otitis externa (OE) following cerumen removal and the utility of sterile packaging is questionable. The objective of this study is to assess the incidence of OE following cerumen disimpaction prior to the implementation of sterile packaging at our institution. Methods: This was a retrospective chart review. Over a 1-year period, 1457 episodes of manual cerumen removal took place in the otolaryngology clinic. Charts were assessed for signs or symptoms of OE within 2 weeks of the procedure through follow-up phone calls and clinic visits in the otolaryngology division. Results: There were no patients who followed up with symptoms or signs suggestive of OE in the 2-week postprocedure period. Conclusion: There is no evidence that OE is a complication of manual cerumen removal when performed by otolaryngologists using clean technique. Unnecessary sterilization of tools leads to increased cost and time for this common outpatient procedure performed by the otolaryngologist.
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Affiliation(s)
- Jessica L. Guidi
- Division of Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ralph F. Wetmore
- Division of Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Steven E. Sobol
- Division of Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Sugiura S, Yasue M, Sakurai T, Sumigaki C, Uchida Y, Nakashima T, Toba K. Effect of cerumen impaction on hearing and cognitive functions in Japanese older adults with cognitive impairment. Geriatr Gerontol Int 2014; 14 Suppl 2:56-61. [DOI: 10.1111/ggi.12251] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Saiko Sugiura
- Department of Otorhinolaryngology; National Institute for Longevity Science; Obu Japan
| | - Minori Yasue
- Department of Otorhinolaryngology; National Institute for Longevity Science; Obu Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders; National Institute for Longevity Science; Obu Japan
| | - Chieko Sumigaki
- Center for Comprehensive Care and Research on Memory Disorders; National Institute for Longevity Science; Obu Japan
| | - Yasue Uchida
- Department of Otorhinolaryngology; National Institute for Longevity Science; Obu Japan
- Department of Otorhinolaryngology; Aichi Medical University; Nagakute Japan
| | - Tsutomu Nakashima
- Department of Otorhinolaryngology; Graduate School of Medicine; Nagoya University; Nagoya Japan
| | - Kenji Toba
- National Institute for Longevity Science; National Center for Geriatrics and Gerontology; Obu Japan
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Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, Huang WW, Haskell HW, Robertson PJ. Clinical Practice Guideline. Otolaryngol Head Neck Surg 2014; 150:S1-S24. [DOI: 10.1177/0194599813517083] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology—Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE. Purpose The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists–head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed. Action Statements The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours to confirm the diagnosis of diffuse AOE and to exclude other causes of illness.
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Affiliation(s)
- Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, New York, USA
| | - Seth R. Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, DC
| | - C. Ron Cannon
- Head and Neck Surgical Group, PLLC, Jackson, Mississippi, USA
| | - Peter S. Roland
- Deptartment of Otolaryngology, University of Texas Southwestern School of Medicine, Dallas, Texas, USA
| | | | | | - William W. Huang
- Department of Dermatology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | | | - Peter J. Robertson
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Abstract
Earache, a common emergency department presentation, may be caused by a variety of conditions, some distant from the ear. This article discusses the diagnosis and treatment of acute otitis media, otitis media with effusion, otitis externa, otitis media with ruptured tympanic membrane or tympanostomy tubes, malignant otitis externa, mastoiditis and petrositis, traumatic ruptured tympanic membrane, cerumen impactions, and foreign bodies in the ears.
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Mösges R, Baues CM, Schröder T, Sahin K. Acute bacterial otitis externa: efficacy and safety of topical treatment with an antibiotic ear drop formulation in comparison to glycerol treatment. Curr Med Res Opin 2011; 27:871-8. [PMID: 21332272 DOI: 10.1185/03007995.2011.557719] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To demonstrate the efficacy and safety of an antibiotic ear drop formulation combining polymyxin B sulfate, neomycin sulfate and gramicidin (PS) in patients with acute bacterial otitis externa (AOE). The combination was compared to glycerol ear drops, a non-pharmacologic treatment of AOE. METHODS An active controlled, double-blind, randomized, parallel group, multicenter clinical trial study design was performed in ear, nose and throat (ENT) practices with a planned interim analysis for sample size adaptation. In total, 244 patients aged 19-84 with no previous episode of otitis externa within the last year were randomized to receive either PS or glycerol ear drops thrice daily for 10 ± 2 days. OUTCOME MEASURES Absolute change in the clinical symptom score (CSS) (with subscores redness, swelling, pain, and secretion) from Day 1 to 4 was measured. As second endpoints, absolute change in CSS, individual subscores, pain perception measured on a visual analog scale (VAS) and intake of paracetamol 500 mg tablets were noted. Moreover, patient's assessment of efficacy at Day 10 and the frequency and type of adverse events were noted. RESULTS On Day 4, the CSS showed a clear advantage for the PS group over the glycerol group, being lower by 0.6 (p < 0.03); the clinical outcome was even more pronounced after 10 days (p = 0.006). The swelling subscore showed a statistically significant difference favoring the PS treatment group in Days 1-4 (p = 0.01) and Days 1-10 (p = 0.003). More PS- than glycerol-receiving patients rated the efficacy as good (glycerol: 32%; PS: 36%) or very good (glycerol: 38%; PS: 48%). Males, patients with AOE for >2 days and those with positive microbiologic findings profited most from PS therapy. CONCLUSION This study proves that PS is an effective and well-tolerated drug, showing results superior to glycerol, especially in patients with a longer pre-existing condition before therapy. The absence of a group treated with another established antibiotic is a limitation of this trial.
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Affiliation(s)
- R Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Faculty of Medicine, University of Cologne, Germany.
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Drobnic F. Impacto sobre la salud de los compuestos utilizados en el tratamiento del agua en las piscinas. Estado de la cuestión. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1886-6581(09)70107-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Recurrent exacerbation of chronic external otitis represents a special challenge for the attending physician. The goal of our study was to evaluate the effectiveness of novel topical immunomodulators acting through an anti-inflammatory, nonsteroidal mechanism. PATIENTS AND METHODS In a prospective study, in 33 patients an ear wick containing tacrolimus ointment (Protopic 0.1%) was inserted every 2-3 days. Altogether, the wick was changed three times. Therapeutic outcomes were assessed by reexaminations, video-otoscopy, and a standardized findings sheet. RESULTS Twenty-eight patients showed significant improvement of clinical symptoms, with 13 of them showing complete healing (follow-up 10-22 months). Relapses (15 cases) were associated with significantly extended symptom-free intervals and reduced numbers of further recurrent episodes. CONCLUSIONS Because of the safe and successful anti-inflammatory effects, topical immunomodulators represent a new alternative in chronic inflammatory stages of otherwise therapy-resistant external otitis.
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Affiliation(s)
- P P Caffier
- HNO-Klinik und Poliklinik , Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin.
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Mösges R, Domröse CM, Löffler J. Topical treatment of acute otitis externa: clinical comparison of an antibiotics ointment alone or in combination with hydrocortisone acetate. Eur Arch Otorhinolaryngol 2007; 264:1087-94. [PMID: 17503066 DOI: 10.1007/s00405-007-0314-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 04/02/2007] [Indexed: 10/23/2022]
Abstract
The study was designed to investigate the potential contribution of hydrocortisone acetate to the efficacy and safety of an antibiotics ointment in the treatment of acute otitis externa (AOE). In a double-blind study 151 patients with a unilateral acute bacterial otitis externa were randomized either to receive an ointment with polymyxin-B sulfate (7,500 I.E./g) + bacitracin (300 I.E./g) alone (AB) or the same antibiotic ointment with 10 mg hydrocortisone acetate/g ointment (AB + HC). Primary efficacy endpoint was the change of an aggregate clinical symptom score (CSS) (subscores: redness, swelling, pain and secretion) found at Visit 2 versus baseline (Visit 1). Secondary outcome parameters were the change of the CSS from Visit 1 to the study termination, and the changes in the subscores and of a visual analog scale for pain. In the group treated with AB + HC, significantly more patients with severe redness [14 (56%) vs. 7 (28%), P = 0.045] or severe secretion [23 (70%) vs. 10 (40%), P = 0.024] at inclusion were symptom-free at the last visit. Fewer pain-relieving tablets (1.1 +/- 2.2 vs. 2.3 +/- 4.6 paracetamol tablets) were used in the AB + HC-group. In the steroid group there was a slightly larger though not significant reduction in CSS at Visit 2 and Visit 3 versus baseline. Similar results were documented for redness, pain and secretion. No serious adverse events occurred. Both ointments are effective and safe in the topical treatment of AOE. Hydrocortisone acetate combined with the antibiotics improved individual symptoms better as did the steroid-free ointment.
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Affiliation(s)
- Ralph Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Faculty of Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany.
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Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, Kokemueller P, Marcy SM, Roland PS, Shiffman RN, Stinnett SS, Witsell DL. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2006. [PMID: 16638473 DOI: 10.1016/j.otohns.2006.02.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This guideline provides evidence-based recommendations to manage diffuse acute otitis externa (AOE), defined as generalized inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The primary purpose is to promote appropriate use of oral and topical antimicrobials and to highlight the need for adequate pain relief. STUDY DESIGN In creating this guideline, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) selected a development group representing the fields of otolaryngology-head and neck surgery, pediatrics, family medicine, infectious disease, internal medicine, emergency medicine, and medical informatics. The guideline was created with the use of an explicit, a priori, evidence-based protocol. RESULTS The group made a strong recommendation that management of AOE should include an assessment of pain, and the clinician should recommend analgesic treatment based on the severity of pain. The group made recommendations that clinicians should: 1) distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the ear canal; 2) assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); and 3) use topical preparations for initial therapy of diffuse, uncomplicated AOE; systemic antimicrobial therapy should not be used unless there is extension outside of the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The group made additional recommendations that: 4) the choice of topical antimicrobial therapy of diffuse AOE should be based on efficacy, low incidence of adverse events, likelihood of adherence to therapy, and cost; 5) clinicians should inform patients how to administer topical drops, and when the ear canal is obstructed, delivery of topical preparations should be enhanced by aural toilet, placing a wick, or both; 6) when the patient has a tympanostomy tube or known perforation of the tympanic membrane, the clinician should prescribe a nonototoxic topical preparation; and 7) if the patient fails to respond to the initial therapeutic option within 48 to 72 hours, the clinician should reassess the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. And finally, the panel compiled a list of research needs based on limitations of the evidence reviewed. CONCLUSION This clinical practice guideline is not intended as a sole source of guidance in evaluating patients with AOE. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition and may not provide the only appropriate approach to the diagnosis and management of this problem. SIGNIFICANCE This is the first, explicit, evidence-based clinical practice guideline on acute otitis externa, and the first clinical practice guideline produced independently by the AAO-HNSF.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital.
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Lorente-Guerrero J, Sabater-Mata F, Rodríguez-Martínez R, Pou-Fernández J, López-Avila J, García-Criado E. Diagnóstico y tratamiento antimicrobiano de las otitis externas. Med Clin (Barc) 2006; 126:507-13. [PMID: 16624232 DOI: 10.1157/13086848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- Paula Dimmitt
- Children's Medical Center of Dallas, Dallas, Texas 75232, USA.
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Abstract
Ear injuries caused by cotton buds are commonly seen in ear, nose and throat (ENT) practice. We asked 1000 patients attending an ENT referral clinic whether they used cotton buds to clean the ear canal. Of the 325 who responded, 171 said they did. The frequency of use was no higher in those with ear complaints than in those with nose and other complaints. 15-20% of respondents disagreed with the statements that cotton buds can cause infections, wax impaction or perforations. On the evidence of this survey, manufacturers' warnings need to be fortified.
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Affiliation(s)
- Jonathan C Hobson
- Royal National Throat Nose & Ear Hospital, 330 Gray's Inn Road, London WC1X 8DA, UK.
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Abstract
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.
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Affiliation(s)
- Mao-Che Wang
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
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