Impact of Reduced Acidic Earwax pH and Earwax-Determinant Genotypes in Acquired Middle Ear Cholesteatoma

OBJECTIVE

The development of acquired middle ear cholesteatoma is associated with a single nucleotide polymorphism, 538G>A, in the human adenosine triphosphate-binding cassette transporter C11 (ABCC11) gene, which is a determinant of the earwax morphotype, such as wet- and dry-type earwax; however, the mechanism underlying this association is unclear. We focused on the earwax pH and aimed to elucidate the mechanism between ABCC11 genotypes and acquired middle ear cholesteatoma.

STUDY DESIGN

Prospective observational study.

SETTING

Single-center, academic hospital.

METHODS

We recruited 40 patients with acquired middle ear cholesteatoma who underwent surgery and 115 controls with no history of middle ear cholesteatoma. We assessed the earwax pH and ABCC11 genotypes in all participants. Clinical information was collected from the patients with cholesteatoma.

RESULTS

The earwax pH was significantly less acidic in patients with cholesteatoma and those carrying wet earwax genotypes (ABCC11 538G/G or 538G/A) than in the controls and those carrying the dry earwax genotype (ABCC11 538A/A), respectively. Furthermore, earwax pH was significantly positively correlated with high preoperative cholesteatoma stages in the patients with cholesteatoma.

CONCLUSION

Our results show that the less acidic earwax pH was significantly related to the development and progression of acquired middle ear cholesteatoma. The less acidic earwax pH may play an important role in the mechanism underlying the association between acquired middle ear cholesteatoma and the ABCC11 gene at site 538.

Perspectives of Italian Physicians and Patients in the Treatment of Otitis Externa: A Real-Life Study

(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.

To Determine the PH of External Auditory Canal in Otitis Externa: A Prospective Observational Study in a Tertiary Health Care Centre

Otitis externa is an inflammatory condition of the external auditory canal which occurs due to any trauma, changes in the PH of the skin of external auditory canal. The normal PH of the external auditory canal skin should be in the acidic medium. This inhibits the growth of certain infectious microorganisms. Once the external canal skin PH becomes alkaline, the chances of inflammation of the skin increases. To assess the pH of the external auditory canal in cases of otitis externa with secretion and compare the treatment efficacy of treating it with topical anti-inflammatory like ichthammol glycerine, topical steroid cream and oral antibiotics. A prospective observational study involved a total of 120 patients who came with symptoms and signs of external otitis. pH of external canal was measured during first visit and at 42 days. The patients were divided into three groups. First group was treated with Ichthammol glycerine, second group was treated with Ichthammol glycerine with topical steroid cream and third group was treated with oral antibiotics with topical steroid cream. Patients were analyzed based on severity score during first visit, at 7 days, at 21 days and 42 days. This study involved 64(53.3%) patients were male and 56(46.7%) were females. The mean age group involved in the study was 42.50 years. The mean PH value in the external auditory canal during the first visit was alkaline (6.09) and the mean PH value at 42 days was changed to acidic (4.95) which was statistically significant (p = 0.00). There was significant reduction in the severity score in the oral antibiotic with topical steroid cream, followed by IG with topical steroid cream followed by Ichthammol glycerine (p = 0.001). In this study we have analyzed the pH level favorable in causing otitis externa and the best available treatment for the same. It has been observed that the alkaline Ph is more favorable in causing otitis externa. Efficacy of Topical corticosteroid with antibiotics is maximum in the management of otitis externa.

A Comparative Study of Antibiotic-steroid Pack with Glycerine Pack in Treatment of Acute Otitis Externa

Objective

To compare the clinical efficacy of Antibiotic-Steroid pack with Glycerine pack for relieving pain and oedema in cases of acute otitis externa.

Study Design

A COMPARATIVE STUDY.

Setting

Tertiary care center ( S.N.Medical college, Bagalkot).

Subjects

20 patients clinically diagnosed with acute otitis externa.

Results

There were 10 patients in antibiotic-steroid pack group and 10 patients in glycerine group. There was female predominance in both the treatment groups and disease was most common in age group 12-20 years. There was no statistical significant decrease in pain and oedema in both the groups. But early reduction in sign and symptoms was noted in antibiotic-steroid group than glycerine group.

Conclusions

Since the control of pain and edema is more and hence the number of visits is less in steroid-antibiotic packing group, so it is worthwhile to use steroid-antibiotic than glycerine pack.

Effect of an ear cleaner instillation containing lipacids in a model of re-acidification of the external auditory canal in dogs

Background

In humans, the acidic pH of the ear canal plays a protective role against infection and a change towards alkalinity of the external auditory canal (EAC) is a local factor in the progression of acute to chronic otitis externa (OE). The use of acidic preparations alone for treatment of OE without concurrent antibiotic use is well‐documented in humans. In dogs, only one study has investigated the EAC pH in healthy dogs and in dogs with OE, and investigations to understand the role of EAC pH in the pathogenesis of canine OE are lacking.

Hypothesis/objectives

To obtain physiological EAC pH values in beagle dogs. To develop a model of re‐acidification of the EAC in dogs and to investigate how an acidic solution may accelerate the return to a physiological pH.

Animals

Ten healthy beagle dogs in a laboratory setting.

Materials and Methods

A model of re‐acidification of the EAC was developed by instillation of a pH 10.1 phosphate‐buffered saline (PBS) solution and the subsequent acidic effect of an ear cleaner containing lipacids was evaluated in this model.

Results

Mean physiological EAC pH was 6.12 (± 0.36). EAC re‐acidification took up to 9 h in this model. Mean pH values dropped immediately to 6.38 (± 0.27) on ears treated with an acidic ear cleaner. No abrupt drop was observed of the mean pH values for the control ears.

Conclusion and clinical importance

This study confirms that physiological EAC pH in dogs is acidic. This model of re‐acidification of the EAC pH allows investigations on acidic properties of topical ear products in healthy ears.

Background – In humans, the acidic pH of the ear canal plays a protective role against infection and a change towards alkalinity of the auditory canal (EAC) is a local factor in the progression of acute to chronic otitis externa (OE). The use of acidic preparations alone for treatment of OE without concurrent antibiotic use is well‐documented in humans. In dogs, only one study has investigated the EAC pH in healthy dogs and in dogs with OE, and investigations to understand the role of EAC pH in the pathogenesis of canine OE are lacking.

Hypothesis/objectives –To obtain physiological EAC pH values in beagle dogs. To develop a model of re‐acidification of the EAC in dogs and to investigate how an acidic solution may accelerate the return to a physiological pH.

Conclusion and clinical importance – This study confirms that physiological EAC pH in dogs is acidic. This model of re‐acidification of the EAC pH allows investigations on acidic properties of topical ear products in healthy ears.

Wine, Honey, and Boiling Oil: A Modern Understanding of Ancient Wound Care Practices

The origins of wound care date back to ancient civilizations. From boiling oil to honey to wine, healers and caregivers have adopted a fascinating array of items to cleanse, dress, and bandage wounds over the ages. While wound care practices have developed over time, the physicians and surgeons of ancient times and the Middle Ages helped build the foundation for present-day wound care. A modern scientific understanding of these treatments illustrates why practitioners abandoned some practices while others remain in use today.

Targeting bacteria causing otitis media using nanosystems containing nonspherical gold nanoparticles and ceragenins

Aim: To evaluate the antibacterial and antibiofilm activity of ceragenin-conjugated nonspherical gold nanoparticles against the most common agents of otitis media. Methods: Minimal inhibitory and bactericidal concentrations and colony-counting assays, as well as colorimetric and fluorimetric methods, were used to estimate the antibacterial activity of compounds in phosphate-buffered saline and human cerumen. The nanosystems' biocompatibility and ability to decrease IL-8 release was tested using keratinocyte cells. Results: The tested compounds demonstrated strong antimicrobial activity against planktonic and biofilm cultures at nontoxic doses due to the induction of oxidative stress followed by the damage of bacterial membranes. Conclusion: This study indicates that ceragenin-conjugated nonspherical gold nanoparticles have potential as new treatment methods for eradicating biofilm-forming pathogens associated with otitis media.

Direct interactions with influenza promote bacterial adherence during respiratory infections

Epidemiological observations and animal models have long shown synergy between influenza virus infections and bacterial infections. Influenza virus infection leads to an increase in both the susceptibility to secondary bacterial infections and the severity of the bacterial infections, primarily pneumonias caused by Streptococcus pneumoniae or Staphylococcus aureus. We show that, in addition to the widely described immune modulation and tissue-remodelling mechanisms of bacterial-viral synergy, the virus interacts directly with the bacterial surface. Similar to the recent observation of direct interactions between enteric bacteria and enteric viruses, we observed a direct interaction between influenza virus on the surface of Gram-positive, S. pneumoniae and S. aureus, and Gram-negative, Moraxella catarrhalis and non-typeable Haemophilus influenzae, bacterial colonizers and pathogens in the respiratory tract. Pre-incubation of influenza virus with bacteria, followed by the removal of unbound virus, increased bacterial adherence to respiratory epithelial cells in culture. This result was recapitulated in vivo, with higher bacterial burdens in murine tissues when infected with pneumococci pre-incubated with influenza virus versus control bacteria without virus. These observations support an additional mechanism of bacteria-influenza virus synergy at the earliest steps of pathogenesis.

Otic drug delivery systems: formulation principles and recent developments

Disorders of the ear severely impact the quality of life of millions of people, but the treatment of these disorders is an ongoing, but often overlooked challenge particularly in terms of formulation design and product development. The prevalence of ear disorders has spurred significant efforts to develop new therapeutic agents, but perhaps less innovation has been applied to new drug delivery systems to improve the efficacy of ear disease treatments. This review provides a brief overview of physiology, major diseases, and current therapies used via the otic route of administration. The primary focuses are on the various administration routes and their formulation principles. The article also presents recent advances in otic drug deliveries as well as potential limitations. Otic drug delivery technology will likely evolve in the next decade and more efficient or specific treatments for ear disease will arise from the development of less invasive drug delivery methods, safe and highly controlled drug delivery systems, and biotechnology targeting therapies.

Identification of volatile organic compounds in human cerumen

We report here the initial examination of volatile organic compounds (VOCs) emanating from human earwax (cerumen). Recent studies link a single nucleotide polymorphism (SNP) in the adenosine triphosphate (ATP) binding cassette, sub-family C, member 11 gene (ABCC11) to the production of different types of axillary odorants and cerumen. ABCC11 encodes an ATP-driven efflux pump protein that plays an important function in ceruminous apocrine glands of the auditory canal and the secretion of axillary odor precursors. The type of cerumen and underarm odor produced by East Asians differ markedly from that produced by non-Asians. In this initial report we find that both groups emit many of the same VOCs but differ significantly in the amounts produced. The principal odorants are volatile organic C2-to-C6 acids. The physical appearance of cerumen from the two groups also matches previously reported ethnic differences, viz., cerumen from East Asians appears dry and white while that from non-Asians is typically wet and yellowish-brown.

Role of pH of External Auditory Canal in Acute Otitis Externa

Prospective and interventional. We studied the pH of external auditory canal (EAC) in normal individuals and patients with acute otitis externa (AOE), its variation with change of temperature and humidity, different symptoms and number of symptoms at presentation (Day 0) and various stages of treatment in 100 normal ears and forearms and 50 ears having AOE. The mean pH of normal EAC was 3.950 ± 1.199 while that of forearm was 4.775 ± 0.910. There was increase in the number of patients with increase in relative humidity, however, the change in the pH of EAC was statistically not significant (p > 0.05). Significant fall in pH was observed at 1 and 2 weeks of treatment. The normal EAC pH is relatively more acidic as compared to that of forearm skin and it became more alkaline in cases of AOE with reversion back to acidic pH after treatment. Acidification of the EAC is the only treatment required in most cases. No significant change in pH of ears was observed with changes of temperatures and humidity.

Dilute vinegar therapy for the management of spontaneous external auditory canal cholesteatoma

The purpose of this study is to evaluate the efficiency of conservative dilute vinegar therapy in the management of spontaneous external auditory canal cholesteatoma (EACC). From 2000 to 2007, 19 patients presented to our clinic with spontaneous EACC. EACC was divided into four grades based on the temporal bone computed tomography: grade I with flattening of bony external canal, grade II with partial destruction of inferior bony canal, grade III with total destruction of inferior bony canal and grade IV with bony destruction into the middle ear and mastoid cavity. Clinical findings and treatment results were recorded. Microscopic local cleansing and dilute vinegar therapy was conducted in the ears with grades I, II and III. Combined mastoid surgery and dilute vinegar therapy was conducted in four ears with stage IV. There were no recurrences after average of 31 months follow-up. Spontaneous EACC can be effectively controlled with dilute vinegar therapy after microscopic local cleansing. However, surgery must be considered in the cases which have involved the mastoid and middle ear. Dilute vinegar therapy in combination with microscopic local cleansing was effective in the management of spontaneous EACC. Dilute vinegar therapy is an easy, cost-effective, and home-based cleansing method to prevent EACC and promotes healing. However, long-term follow-up may reveal frequent recurrence of cholesteatoma debris and involvement of middle ear or mastoid cavity, and then meticulous debridement with skin graft or surgical intervention should be considered.