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Hanson MB, Adams M. Follow the Wax: The Natural Protection of the Ear Canal and Its Biome. Otolaryngol Clin North Am 2023; 56:863-867. [PMID: 37517877 DOI: 10.1016/j.otc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
The external canal is a unique environment that has an elaborate mechanism for self-cleaning and protection. The fundamental basis of this is the epithelial migration of the desquamating layers of the keratinizing epithelium that lines the entire canal and ear drum. This migratory movement results in a "conveyor belt" effect where the dead skin is moved out of the bony ear canal to the cartilaginous portion, where it is lifted off with the help of glandular skin secretions and the hairs of the canal to form what we call "ear wax." The ear wax has numerous protective properties and is essential to the health of the external ear. The protective properties are due to chemical properties of the wax, in addition to intrinsic chemical secretions by the sebaceous and cerumen apocrine glands. The protection also comes from a diverse population of organisms that exist in the external ear that are usually saprophytic, commensal, and symbiotic, but in some cases, they can become parasitic and pathologic. Detection and quantification of the members of this biome has been difficult, and their overall role in the normal biome of the ear and their transition into pathogens remain an area of active research and investigation.
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Affiliation(s)
- Matthew B Hanson
- Department of Otolaryngology, SUNY, SUNY Downstate College of Medicine, Kings County Hospital Center, 450 Clarkson Avenue, PO Box 126, Brooklyn, NY 11203, USA.
| | - Matthew Adams
- Resident Physician, Departmentof Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
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Feldman I, Krausz J, Levinkron O, Gutovitz J, Edison N, Cohen E, Krauthammer M, Briscoe D. Is Demodex Blepharitis Connected With Cataract Surgery? Am J Ophthalmol 2023; 254:31-35. [PMID: 37257549 DOI: 10.1016/j.ajo.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE To determine whether there is an increased incidence of Demodex of the eyelashes among patients after cataract extraction surgery. DESIGN Prospective, noncomparative clinical study. METHODS A cohort of patients who underwent cataract extraction surgery had several eyelashes removed preoperatively that were examined independently by the hospital laboratory for the presence of the Demodex mite. This was repeated 3 weeks after surgery. During several postoperative weeks, patients received the standard treatment of steroid drops alone for a period as individually required. RESULTS A total of 62 patients were included in the study (31 men and 31 women), with a mean age of 71.04 years (range, 47-87). In the group positive for Demodex, the male-to-female ratio was 2:3 (P = .2772). Demodex colonization was observed in 22.58% of samples before cataract surgery and in 32.26% after cataract surgery and topical postoperative steroid therapy (P = .0143). CONCLUSIONS There is a statistically significant increase in Demodex colonization of eyelashes after cataract surgery and postoperative topical steroid treatment. Although Demodex colonization does not necessarily cause blepharitis, our findings of increased colonization should raise the possibility of Demodex blepharitis being considered by ophthalmologists in patients with chronic postoperative eye discomfort after cataract surgery. This study was carried out at the Emek Medical Center.
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Affiliation(s)
- Ilan Feldman
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.)
| | - Judit Krausz
- The Tissue Diagnostics and Cancer Research Institute, Emek Medical Center, Afula, Technion Faculty of Medicine, Israel (J.K. N.E.)
| | - Oz Levinkron
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.)
| | - Joel Gutovitz
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.)
| | - Natalia Edison
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.); The Tissue Diagnostics and Cancer Research Institute, Emek Medical Center, Afula, Technion Faculty of Medicine, Israel (J.K. N.E.)
| | - Eyal Cohen
- Division of Ophthalmology, Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (E.C., M.K.)
| | - Mark Krauthammer
- Division of Ophthalmology, Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (E.C., M.K.)
| | - Daniel Briscoe
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.).
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Comparison of Therapeutic Effects of Topical Calcineurin Inhibitor and Moisturizing Cream on Pruritic External Auditory Canal. J Clin Med 2021; 10:jcm10194313. [PMID: 34640333 PMCID: PMC8509200 DOI: 10.3390/jcm10194313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/02/2022] Open
Abstract
Although pruritic external auditory canal (PEAC) is a relatively common symptom, particularly in the geriatric population, its pathophysiology and appropriate treatment remain to be elucidated. We compared the therapeutic efficacy of pimecrolimus, a topical calcineurin inhibitor (CI), and a moisturizing cream (MC) in patients with PEAC. Thirty-nine patients (73 ears) were prospectively enrolled and treated topically twice daily with the CI (n = 20, 39 ears) or the MC (n = 19, 34 ears) for two weeks. The change in itching sensation was evaluated subjectively using a self-questionnaire at immediately, one month, and two months after self-application, and objectively by changes in erythema grading. Although topical treatment with the CI resulted in a more rapid improvement than treatment with the MC in patients with PEAC, the final outcomes did not differ between the groups. Furthermore, similar improvements in erythema scores were noted. The results of this study suggest that the MC, which rejuvenates the normal physiological status of the ear canal skin, may greatly benefit those elderly patients more susceptible to PEAC, without any concerns about adverse events and underlying comorbidities. Expanding upon the understanding of the role of moisturizers in the treatment of pruritic ears merits attention, as this knowledge provides a good example of the clinical guidelines for the management of PEAC.
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Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone. Head Neck Pathol 2018; 12:328-349. [PMID: 30069844 PMCID: PMC6081288 DOI: 10.1007/s12105-018-0952-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/13/2018] [Indexed: 12/13/2022]
Abstract
A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.
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Therapeutic effect of Castellani's paint in patients with an itchy ear canal. The Journal of Laryngology & Otology 2017; 130:934-938. [PMID: 27774921 DOI: 10.1017/s0022215116008744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the effects of Castellani's paint on symptomatic relief and skin flora in patients with an itchy external ear canal. METHODS Subjective pruritus scores, and erythema and desquamation scores, were noted in 61 patients with an itchy external ear canal. External ear canal skin swabs were taken for bacterial and fungal cultures. Patients were then randomly divided into three groups: either Castellani's paint (group one) or steroid ear drops (group two) were instilled, or non-impacted cerumen was removed (group three). Patients were re-assessed at one month after the initial visit. RESULTS After treatment, subjective pruritus scores were significantly lower in all groups, erythema scores were significantly decreased in group one, and desquamation scores were significantly reduced in groups one and two, when compared with pre-treatment scores. Reproduction density of bacteria including normal flora was decreased in group one. However, the types of bacteria that constitute the normal flora of the external ear canal were unchanged. CONCLUSION Castellani's paint can be administered safely, effectively and easily, without affecting the type of external ear canal skin bacteria, in patients with an itchy external ear canal.
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Magenta red, Castellani's paint and an array of autumn colours. The Journal of Laryngology & Otology 2016; 130:887-888. [PMID: 27774928 DOI: 10.1017/s0022215116009130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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