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Fournier I, Caron C, McMurtry CM, Lapointe A, Giguere C, Doré-Bergeron MJ, Bergeron M. Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children. Laryngoscope 2024; 134:2422-2429. [PMID: 37800866 DOI: 10.1002/lary.31095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Tympanostomy tube insertion (TTI) is typically accomplished under general anesthesia (GA) in the operating room. We aimed to compare pain between GA and local anesthesia (LA) in surgically naïve children undergoing TTI. Secondary objectives examined patient's quality of life (QoL) and parent's satisfaction. STUDY DESIGN Prospective single-center study. SETTING Tertiary pediatric academic center. METHODS Consecutive children who underwent TTI under GA were compared to patients under LA. Pain standardized observational pain scales (Face, Legs, Activity, Cry, Consolability Scale [FLACC], Children's hospital of Eastern Ontario Pain Scale [CHEOPS]) were completed pre-procedure, during the first tympanostomy and second tympanostomy, and post-procedure, as well as 1 week postoperatively. General health-related QoL (PedsQL) and QoL specific to otitis media (OM-6) were measured before insertion and 1 month postoperatively. Parental satisfaction was also evaluated using a qualitative scale. RESULTS LA group had statistically significant higher pain levels at the beginning (7.3 vs. 0), during the first tympanostomy (7.8 vs. 0), during the second tympanostomy (7.7 vs. 0), and at end of the procedure (6.9 vs. 0) with the FLACC scale (all p < 0.01). Results were similar with the CHEOPS scale. No pain was noted 1 week after surgery in either group. Both groups had similar improvement in their QoL (p > 0.05). Minor complication occurred at a similar rate (p > 0.05). Parents were equally satisfied with their choice of anesthesia in both groups when initially questioned after the procedure (p > 0.05). CONCLUSIONS Children experienced significantly less pain under GA than LA. If LA is to be used, pain and distress-reducing strategies are critical. Shared decision-making with families is essential. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2422-2429, 2024.
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Affiliation(s)
- Isabelle Fournier
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Camille Caron
- Faculty of Medecine, Université de Montréal, Montreal, Quebec, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Annie Lapointe
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Chantal Giguere
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Marie-Joëlle Doré-Bergeron
- Department of Paediatrics, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Paediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Mathieu Bergeron
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
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Ranzenigo M, van Soest TM, Hensen EF, Cinque P, Castagna A, Brouwer MC, van de Beek D. Otitis in patients with Community-Acquired Bacterial Meningitis: A Nationwide Prospective Cohort Study. Clin Infect Dis 2024:ciae221. [PMID: 38655694 DOI: 10.1093/cid/ciae221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Otitis is commonly associated with community-acquired bacterial meningitis but role of ear surgery as treatment is debated. In this study, we investigated the impact of otitis and ear surgery on outcome of adults with community-acquired bacterial meningitis. METHODS We analyzed episodes of adults with community-acquired bacterial meningitis from a nationwide prospective cohort study in the Netherlands, between March 2006 to July 2021. RESULTS A total of 2,548 episodes of community-acquired bacterial meningitis were evaluated. Otitis was present in 696 episodes (27%). In these patients the primary causative pathogen was Streptococcus pneumoniae (615 of 696 [88%]), followed by Streptococcus pyogenes (5%) and Haemophilus influenzae (4%). In 519 of 632 otitis episodes (82%) an ear-nose-throat specialist was consulted, and surgery was performed in 287 of 519 (55%). The types of surgery performed were myringotomy with ventilation tube insertion in 110 of 287 episodes (38%), mastoidectomy in 103 of 287 (36%) and myringotomy alone in 74 of 287 (26%). Unfavorable outcome occurred in 210 of 696 episodes (30%) and in 65 of 696 episodes was fatal (9%). Otitis was associated with a favorable outcome in a multivariable analysis (odds ratio 0.74; 95% CI 0.59-0.92; p =0.008). There was no association between outcome and ear surgery. CONCLUSIONS Otitis is a common focus of infection in community-acquired bacterial meningitis in adults, with S. pneumoniae being the most common causative pathogen. Presence of otitis is associated with a favorable outcome. Ear surgery's impact on the outcome of otogenic meningitis patients remains uncertain.
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Affiliation(s)
- Martina Ranzenigo
- Amsterdam UMC, location University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands
- IRCCS San Raffaele Scientific Institute, Unit of Infectious Diseases, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Thijs M van Soest
- Amsterdam UMC, location University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands
| | - Erik F Hensen
- LUMC, Department of Otorhinolaryngology and Head and Neck Surgery, Leiden, the Netherlands
| | - Paola Cinque
- IRCCS San Raffaele Scientific Institute, Unit of Infectious Diseases, Milan, Italy
| | - Antonella Castagna
- IRCCS San Raffaele Scientific Institute, Unit of Infectious Diseases, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Matthijs C Brouwer
- Amsterdam UMC, location University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Amsterdam UMC, location University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands
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Ahrens AP, Hyötyläinen T, Petrone JR, Igelström K, George CD, Garrett TJ, Orešič M, Triplett EW, Ludvigsson J. Infant microbes and metabolites point to childhood neurodevelopmental disorders. Cell 2024; 187:1853-1873.e15. [PMID: 38574728 DOI: 10.1016/j.cell.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/22/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
This study has followed a birth cohort for over 20 years to find factors associated with neurodevelopmental disorder (ND) diagnosis. Detailed, early-life longitudinal questionnaires captured infection and antibiotic events, stress, prenatal factors, family history, and more. Biomarkers including cord serum metabolome and lipidome, human leukocyte antigen (HLA) genotype, infant microbiota, and stool metabolome were assessed. Among the 16,440 Swedish children followed across time, 1,197 developed an ND. Significant associations emerged for future ND diagnosis in general and for specific ND subtypes, spanning intellectual disability, speech disorder, attention-deficit/hyperactivity disorder, and autism. This investigation revealed microbiome connections to future diagnosis as well as early emerging mood and gastrointestinal problems. The findings suggest links to immunodysregulation and metabolism, compounded by stress, early-life infection, and antibiotics. The convergence of infant biomarkers and risk factors in this prospective, longitudinal study on a large-scale population establishes a foundation for early-life prediction and intervention in neurodevelopment.
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Affiliation(s)
- Angelica P Ahrens
- Department of Microbiology and Cell Science, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32603, USA
| | - Tuulia Hyötyläinen
- School of Science and Technology, Örebro University, Örebro 702 81, Sweden
| | - Joseph R Petrone
- Department of Microbiology and Cell Science, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32603, USA
| | - Kajsa Igelström
- Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping 58185, Sweden
| | - Christian D George
- Department of Microbiology and Cell Science, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32603, USA
| | - Timothy J Garrett
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Matej Orešič
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro 702 81, Sweden; Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku 20520, Finland; Department of Life Technologies, University of Turku, Turku 20014, Finland
| | - Eric W Triplett
- Department of Microbiology and Cell Science, College of Agricultural and Life Sciences, University of Florida, Gainesville, FL 32603, USA.
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping 58185, Sweden
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Rigaut D, Briantais P, Jasmin P, Bidaud A. Efficacy and safety of a hydrocortisone aceponate-containing ear spray solution in dogs with erythemato-ceruminous otitis externa: A randomised, multicentric, single-blinded, controlled trial. Vet Dermatol 2024; 35:197-206. [PMID: 38093088 DOI: 10.1111/vde.13224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/04/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Erythemato-ceruminous otitis externa (ECOE) is frequently seen in dogs affected with an allergic skin disease, with recurrent secondary bacteria and yeast overgrowths (detected on cytological examination). OBJECTIVES The objective of the study was to compare the efficacy and safety of an ear spray containing only hydrocortisone aceponate glucocorticoid diester (HCA) to a control product (CTRL), an approved otic formulation containing prednisolone-miconazole-polymyxin combination, in dogs with ECOE. ANIMALS In total, 97 and 104 dogs with ECOE were respectively randomly assigned to the tested ear treatment product group (HCA) or the commercially available ear treatment control product group (CTRL). MATERIALS AND METHODS Dogs were treated for 7-14 days, as needed. At Day (D)0, D7, D14, D28 and D42, Otitis Index Score-3, hearing test, pruritus and pain visual analogue scales, and cytological scores were graded. The overall response to treatment also was assessed. RESULTS All clinical parameters decreased rapidly and in a similar way without any significant difference at any time between treatment groups. A good-to-excellent response to treatment was seen in >90% of dogs of both groups as early as D14. The treatment was considered safe in all dogs. CONCLUSIONS AND CLINICAL RELEVANCE A 7- to 14-day ear topical application of HCA alone to dogs with ECOE accompanied with bacterial and/or fungal (yeast) overgrowth was safe and led to no statistical difference in improvement of clinical scores relative to the CTRL combination. Based on these results, it may be necessary to reconsider the routine use of antimicrobial drugs such as antibiotics and antifungals as a first-line treatment for ECOE that is likely to have been caused by an allergic reaction.
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Stanger A, Buhmann G, Dörfelt S, Zablotski Y, Fischer A. Rapid hearing threshold assessment with modified auditory brainstem response protocols in dogs. Front Vet Sci 2024; 11:1358410. [PMID: 38511189 PMCID: PMC10951061 DOI: 10.3389/fvets.2024.1358410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Auditory brainstem response (ABR) is the gold standard for hearing testing in dogs. ABR is commonly used in puppies to diagnose congenital sensorineural deafness. Long test times limit the use for a more comprehensive hearing screening in veterinary practice. This study aimed to establish a super-fast hearing screening protocol in dogs. Methods Hearing thresholds were routinely measured with a mobile device designed for newborn hearing screening in 90 dogs. We introduced modifications of the ABR protocol, e. g., a binaural test mode, higher stimulus rates, a broadband chirp stimulus, and an algorithm for automatic peak V detection in a stepwise fashion. Hearing thresholds were then measured with fast protocols utilizing either 30 Hz click or 90 Hz broadband chirp stimuli with 80, 60, 40, 30, 20, 10, 0 and -10 dBnHL stimulation intensities. Interrater reliability, agreement between click and chirp hearing thresholds and correlations with clinical characteristics of the dogs were assessed. Results Using all innovations, the test time for hearing threshold assessment in both ears was reduced to 1.11 min (mean). The chirp stimulus accentuated both, peak V and the subsequent trough, which are essential features for judgement of the hearing threshold, but preceding peaks were less conspicuous. Interrater reliability and agreement between click and chirp hearing threshold was excellent. Dogs >10 years of age and dogs with abnormal hearing score or otitis score had significantly higher hearing thresholds than younger dogs (p ≤ 0.001) or dogs without abnormalities (p < 0.001). Conclusion The results demonstrate that modifications in ABR protocols speed-up test times significantly while the quality of the recordings for hearing threshold assessment is maintained. Modified ABR protocols enable super-fast hearing threshold assessment in veterinary practice.
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Affiliation(s)
| | | | | | | | - Andrea Fischer
- Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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6
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Buendia E, Germain PA. Evaluation of plasma canine C-reactive protein concentrations in dogs with otitis media, healthy dogs and dogs with chronic otitis externa. Vet Dermatol 2024. [PMID: 38379189 DOI: 10.1111/vde.13241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/21/2023] [Accepted: 01/28/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Otitis is characterised by inflammation of one or more of the structures of the ear. At present, to confirm or exclude otitis media (OM), it is most often necessary to perform a computed tomography (CT) scan or magnetic resonance imaging. Inflammation is an immune defence response found in many conditions that can be detected and tracked by measuring biological markers of inflammation as the Canine C-reactive protein (CRP). OBJECTIVES The objective of this study was to determine whether CRP measurement is useful as an adjunctive diagnostic tool in dogs with otitis and whether elevated concentrations correlated with disease severity/presence of OM. ANIMALS Twenty-four client-owned dogs were recruited over 1 year. MATERIALS AND METHODS The dogs were divided into three groups: chronic or recurrent otitis externa (CO), otitis media (OM) and H (healthy). The dogs with otitis underwent a CT scan of the head, measurement of the plasma CRP concentration and evaluation of a 0-3 Otitis Index Score 3 (OTIS3 score). RESULTS No dog (0%) in group H had an increased CRP value, compared to 20% in the CO group (one of five dogs) and 23% in the OM group (3 of 13 dogs). Plasma CRP concentrations show a statistically significant positive relationship with the OTIS3 score (p = 0.04). CONCLUSION AND CLINICAL RELEVANCE Plasma CRP concentration is not reliable as a discriminatory tool in cases of otitis, although there is a trend for elevation in cases with more severe disease. However, a larger study may provide a statistically more reliable correlation between the severity of OM and CRP concentrations.
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Affiliation(s)
- E Buendia
- Private Practitioner, CHV OnlyVet, Saint-Priest, France
| | - P A Germain
- Private Practitioner, CV Hutins, Saint-Julien-en-Genevois, France
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7
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Urkiola A, Domínguez E, Solà-Montrabeta M, Bardagí M. Prevalence of middle ear effusion in French bulldogs without clinical signs of otic disease: A retrospective study of magnetic resonance imaging (2017-2022). Vet Dermatol 2024. [PMID: 38284304 DOI: 10.1111/vde.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 12/18/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Canine middle ear effusion (MEE) is usually asymptomatic, being an incidental finding when computed tomography or magnetic resonance imaging (MRI) of the head is performed for other reasons unrelated to otic disease. The clinical relevance of the presence of material in the tympanic bulla (TB) remains uncertain, and more detail about its prevalence and appearance in MRI are required. OBJECTIVE To assess the prevalence of presence of material within the TB of French bulldogs (FB) with no clinical signs suggestive of otitis (externa, media or interna) that underwent high-field MRI for other medical reasons. ANIMALS Two hundred fifty-two TB of 126 FB were included in this study. MATERIALS AND METHODS Nonexperimental retrospective study in which MRI images were evaluated by a board-certified veterinary radiologist. RESULTS Fifty-eight per cent of the dogs had material in the TB lumen (46% of the TB) and 59% were bilaterally affected. The signal intensity of this material related to the grey matter was variable on T1w and mainly hyperintense on T2w sequences. CONCLUSION AND CLINICAL RELEVANCE FB are predisposed to MEE. This is important when assessing imaging studies of TB of FB with chronic otitis externa, as high percentage of cases may have concurrent MEE. MRI findings in FB with MEE are characterised by a hyperintense signal to the grey matter on T2w in most cases and variable on T1w sequences.
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Affiliation(s)
- Ane Urkiola
- AniCura Ars Veterinària Hospital Veterinari, Barcelona, Spain
| | | | | | - Mar Bardagí
- AniCura Ars Veterinària Hospital Veterinari, Barcelona, Spain
- Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
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8
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Roth S, Linxweiler M, Rehner J, Schmartz GP, Becker SL, Kühn JP. Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections. Emerg Infect Dis 2024; 30. [PMID: 38146955 PMCID: PMC10756363 DOI: 10.3201/eid3001.230385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
We describe detection of the previously rarely reported gram-positive bacterium Auritidibacter ignavus in 3 cases of chronic ear infections in Germany. In all 3 cases, the patients had refractory otorrhea. Although their additional symptoms varied, all patients had an ear canal stenosis and A. ignavus detected in microbiologic swab specimens. A correct identification of A. ignavus in the clinical microbiology laboratory is hampered by the inability to identify it by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Also, the bacterium might easily be overlooked because of its morphologic similarity to bacterial species of the resident skin flora. We conclude that a high index of suspicion is warranted to identify A. ignavus and that it should be particularly considered in patients with chronic external otitis who do not respond clinically to quinolone ear drop therapy.
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Lanera C, Lorenzoni G, Barbieri E, Piras G, Magge A, Weissenbacher D, Donà D, Cantarutti L, Gonzalez-Hernandez G, Giaquinto C, Gregori D. Monitoring the Epidemiology of Otitis Using Free-Text Pediatric Medical Notes: A Deep Learning Approach. J Pers Med 2023; 14:28. [PMID: 38248729 PMCID: PMC10817419 DOI: 10.3390/jpm14010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Free-text information represents a valuable resource for epidemiological surveillance. Its unstructured nature, however, presents significant challenges in the extraction of meaningful information. This study presents a deep learning model for classifying otitis using pediatric medical records. We analyzed the Pedianet database, which includes data from January 2004 to August 2017. The model categorizes narratives from clinical record diagnoses into six types: no otitis, non-media otitis, non-acute otitis media (OM), acute OM (AOM), AOM with perforation, and recurrent AOM. Utilizing deep learning architectures, including an ensemble model, this study addressed the challenges associated with the manual classification of extensive narrative data. The performance of the model was evaluated according to a gold standard classification made by three expert clinicians. The ensemble model achieved values of 97.03, 93.97, 96.59, and 95.48 for balanced precision, balanced recall, accuracy, and balanced F1 measure, respectively. These results underscore the efficacy of using automated systems for medical diagnoses, especially in pediatric care. Our findings demonstrate the potential of deep learning in interpreting complex medical records, enhancing epidemiological surveillance and research. This approach offers significant improvements in handling large-scale medical data, ensuring accuracy and minimizing human error. The methodology is adaptable to other medical contexts, promising a new horizon in healthcare analytics.
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Affiliation(s)
- Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
| | - Gianluca Piras
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Arjun Magge
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Davy Weissenbacher
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
| | | | - Graciela Gonzalez-Hernandez
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
- Società Servizi Telematici—Pedianet, 35100 Padova, Italy;
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
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Kloth C, Beck A, Sollmann N, Beer M, Horger M, Thaiss WM. Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications-Pictorial Review. Tomography 2023; 9:2190-2210. [PMID: 38133074 PMCID: PMC10747582 DOI: 10.3390/tomography9060170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Radiology and Radiation Therapy Lindau, Friedrichshafener Str. 83, 88131 Lindau (Lake Constance), Germany
| | - Annika Beck
- Institute of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany;
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Wolfgang Maximilian Thaiss
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
- Department of Nuclear Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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11
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D’Onofrio M, La Prova D, Galdiero MR, Cantone E, Tremante E, Mascolo M, Barbieri V, Di Nola C, Spadaro G, de Paulis A, Detoraki A. Early Ear, Nose and Throat Manifestations in Eosinophilic Granulomatosis with Poliangioitis: Results from Our Cohort Group and Literature Review. J Clin Med 2023; 12:6967. [PMID: 38002582 PMCID: PMC10672482 DOI: 10.3390/jcm12226967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, systemic necrotizing vasculitis affecting small-to-medium-sized vessels. EGPA's clinical manifestations are heterogeneous, affecting different organs and systems, and the upper respiratory tract can be affected by ear, nose and throat (ENT) involvement. The aim of our study was to assess type manifestations at the time of diagnosis in a cohort of EGPA patients and correlate findings with baseline variables (sex, age, antineutrophil cytoplasmic antibodies-ANCA-status) and literature reports. The main ENT manifestations in our patients at the time of diagnosis were: chronic rhinosinusitis with nasal polyposis (CRSwNP) (52%), turbinate hypertrophy (48%), nasal swelling (40%), rhinorrhea (40%), chronic rhinosinusitis without nasal polyposis (CRSsNP) (32%), nasal bone deformities (32%), nasal crusts (20%), nasal mucosal ulcers (12%), corditis (12%), hoarseness/dysphonia (12%), hearing loss (12%), mucoceles (4%) and eosinophilic rhinitis (4%). No correlations were found between sex, age, ANCA status and ENT clinical manifestations. A polymorphic ENT involvement is often observed in the early stages of EGPA. The presence of nasal, sinus, ear and/or laryngeal manifestations in patients with asthma and hypereosinophilia, independently of sex, age or ANCA status, should raise an alert for further investigation and differential diagnosis for EGPA. ENT specialists should be aware of their leading position in this diagnostic race.
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Affiliation(s)
- Mario D’Onofrio
- Department of Internal Medicine and Clinical Complexity, Division of Internal Medicine and Clinical Immunology, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy; (M.D.); (D.L.P.); (M.R.G.); (V.B.); (A.d.P.)
| | - Daniele La Prova
- Department of Internal Medicine and Clinical Complexity, Division of Internal Medicine and Clinical Immunology, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy; (M.D.); (D.L.P.); (M.R.G.); (V.B.); (A.d.P.)
| | - Maria Rosaria Galdiero
- Department of Internal Medicine and Clinical Complexity, Division of Internal Medicine and Clinical Immunology, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy; (M.D.); (D.L.P.); (M.R.G.); (V.B.); (A.d.P.)
- Center of Basic and Clinical Immunology Research, Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI), University of Naples “Federico II”, 80131 Naples, Italy;
| | - Elena Cantone
- Department of Neurosciences, Science of Reproduction and Odontostomatology, Division of ENT, University of Naples “Federico II”, 80131 Naples, Italy; (E.C.); (C.D.N.)
| | - Eugenio Tremante
- Department of General and Specialistic Surgery, Division of ENT, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Massimo Mascolo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Vittoria Barbieri
- Department of Internal Medicine and Clinical Complexity, Division of Internal Medicine and Clinical Immunology, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy; (M.D.); (D.L.P.); (M.R.G.); (V.B.); (A.d.P.)
| | - Claudio Di Nola
- Department of Neurosciences, Science of Reproduction and Odontostomatology, Division of ENT, University of Naples “Federico II”, 80131 Naples, Italy; (E.C.); (C.D.N.)
| | - Giuseppe Spadaro
- Center of Basic and Clinical Immunology Research, Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI), University of Naples “Federico II”, 80131 Naples, Italy;
| | - Amato de Paulis
- Department of Internal Medicine and Clinical Complexity, Division of Internal Medicine and Clinical Immunology, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy; (M.D.); (D.L.P.); (M.R.G.); (V.B.); (A.d.P.)
- Center of Basic and Clinical Immunology Research, Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI), University of Naples “Federico II”, 80131 Naples, Italy;
| | - Aikaterini Detoraki
- Department of Internal Medicine and Clinical Complexity, Division of Internal Medicine and Clinical Immunology, Azienda Ospedaliera Universitaria Federico II, 80131 Naples, Italy; (M.D.); (D.L.P.); (M.R.G.); (V.B.); (A.d.P.)
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González-Eslait FJ, Blanco-Sarmiento PA, Bejarano-Domínguez K, Barreto JM, Ruiz-Tejada E. Tracing of Helicobacter pylori in the middle ear and mastoid mucosa of patients under 18 years of age with chronic otitis media (with and without cholesteatomas). J Laryngol Otol 2023:1-4. [PMID: 37781780 DOI: 10.1017/s002221512300169x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE It has been estimated that about 5 million people of those affected with otitis media have cholesteatoma, however, its pathophysiology is unclear. In this study we aimed to detect Helicobacter pylori via polymerase chain reaction and real-time polymerase chain reaction in young patients with chronic otitis media. METHODS Patients included in our prospective cross-sectional study had middle-ear/mastoid inflammation and underwent surgical procedures. Middle-ear mucosa samples were collected, and genomic DNA was extracted for H pylori detection by polymerase chain reaction and real-time polymerase chain reaction analyses. Sociodemographic data and gastroesophageal reflux symptoms were analysed. RESULTS We included 49 patients with mean age of 12.7 ± 3.8 years. Twenty per cent of the patients were diagnosed with cholesteatoma. No increase in H pylori-amplified fluorescence was observed, indicating absence of H pylori. CONCLUSION Due to the absence of amplification for H pylori and the fact that albumin was amplified in all samples, we conclude that H pylori does not appear to be a causal factor.
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Affiliation(s)
- Francisco Javier González-Eslait
- Department of General Surgery, Section of Otorhinolaryngology, Universidad del Valle, Cali, Colombia
- Department of General Surgery, Section of Otorhinolaryngology, Clínica Imbanaco, Cali, Colombia
- Department of General Surgery, Section of Otorhinolaryngology, Hospital Universitario del Valle "Evaristo García," Cali, Colombia
| | | | | | - José María Barreto
- Department of General Surgery, Section of Otorhinolaryngology, Universidad del Valle, Cali, Colombia
- Department of General Surgery, Section of Otorhinolaryngology, Clínica de Otorrinolaringología y Cirugía Plástica, Cali, Colombia
| | - Emelina Ruiz-Tejada
- Department of General Surgery, Section of Otorhinolaryngology, Universidad del Valle, Cali, Colombia
- Department of General Surgery, Section of Otorhinolaryngology, Clínica de Otorrinolaringología y Cirugía Plástica, Cali, Colombia
- Department of General Surgery, Section of Otorhinolaryngology, Fundación Valle del Lili, Cali, Colombia
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Enright D, Cole G, Hatfield J. Evaluation of endoscopic-assisted feline lateral bulla osteotomy: a cadaveric study. J Feline Med Surg 2023; 25:1098612X231200375. [PMID: 37906180 DOI: 10.1177/1098612x231200375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES The aims of the study were to investigate if feline middle ear anatomy can be visualized using endoscopy via a lateral bulla approach and to determine if scope-assistance increases rates of successful entry into the hypotympanum during feline total ear canal ablation and lateral bulla osteotomy (TECA-LBO). METHODS A total of 13 feline cadaver heads underwent CT to confirm the absence of pre-existing middle ear disease. For each head, an electronic coin toss was used to determine which ear would undergo endoscope-assisted TECA-LBO; a traditional TECA-LBO without the use of the scope was performed on the contralateral side. In endoscope-assisted procedures, a 1.9 mm scope was intermittently inserted into the tympanic bulla via a lateral bulla approach and used to identify middle ear structures, visualize the bony septum and confirm entry into the hypotympanum. After the bilateral TECA-LBO, the cadaver heads were imaged again and assessed for evidence of entry through the septum. RESULTS Soft tissue and osseus structures of the middle ear were readily visualized with a 1.9 mm scope. Success rates for entry into the hypotympanum were high between both endoscope-assisted and traditional procedures, with entry confirmed for 12/13 ears in each group. CONCLUSIONS AND RELEVANCE Endoscope assistance can facilitate the identification and examination of middle ear structures but does not appear to increase the success rate of entry into the hypotympanum during feline TECA-LBO, as entry through the bony septum was consistently accomplished even without scope-assisted visualization. Alternative benefits to scope assistance may exist, and future studies to elucidate its impact on rates of intraoperative trauma to middle ear structures are indicated.
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Affiliation(s)
- Dory Enright
- Iowa State University College of Veterinary Medicine, Ames, IA, USA
| | - Grayson Cole
- Gulf Coast Veterinary Specialists, Houston, TX, USA
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Elfadadny A, Uchiyama J, Goto K, Imanishi I, Ragab RF, Nageeb WM, Iyori K, Toyoda Y, Tsukui T, Ide K, Kawamoto K, Nishifuji K. Antimicrobial resistance and genotyping of Pseudomonas aeruginosa isolated from the ear canals of dogs in Japan. Front Vet Sci 2023; 10:1074127. [PMID: 37546340 PMCID: PMC10397403 DOI: 10.3389/fvets.2023.1074127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/22/2023] [Indexed: 08/08/2023] Open
Abstract
The strong bond between dogs and their owners creates a close association that could result in the transfer of antibiotic-resistant bacteria from canines to humans, potentially leading to the spread of antimicrobial resistance genes. Pseudomonas aeruginosa, a common causative agent of persistent ear infections in dogs, is often resistant to multiple antibiotics. Assessing the antimicrobial resistance profile and genotype of P. aeruginosa is crucial for the appropriate use of veterinary pharmaceuticals. However, in recent years, few studies have been conducted on this bacterium in Japan. We determined the antimicrobial resistance profile and genotype of P. aeruginosa isolated from the ear canal of dogs in Japan in 2020. Analysis of antimicrobial resistance using disk diffusion tests indicated a high frequency of resistance to most antimicrobial agents. Particularly, 29 isolates from the ear canals of the 29 affected dogs (100%) were resistant to cefovecin, cefpodoxime, and florfenicol; however, they were susceptible to cefepime and piperacillin/tazobactam. Only 3.4, 10.3, and 10.3% of the isolates were resistant to ceftazidime, tobramycin, and gentamicin, respectively. Furthermore, upon analyzing the population structure using multilocus sequence typing, a considerably large clonal complex was not observed in the tested isolates. Three isolates, namely ST3881, ST1646, and ST532, were clonally related to the clinically isolated sequence types in Japan (such as ST1831, ST1413, ST1812, and ST1849), which is indicative of dog-to-human transmission. Considering the variation in antibiotic resistance compared to that reported by previous studies and the potential risk of dog-to-human transmission, we believe that the survey for antimicrobial resistance profile and population structure should be continued regularly. However, the prevalence of multidrug-resistant P. aeruginosa in dogs in Japan is not a crisis.
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Affiliation(s)
- Ahmed Elfadadny
- Laboratory of Internal Medicine, Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology, Fuchu, Japan
- Department of Animal Internal Medicine, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
| | - Jumpei Uchiyama
- Department of Bacteriology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kazuyoshi Goto
- Department of Bacteriology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Ichiro Imanishi
- Department of Microbiology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Rokaia F. Ragab
- Laboratory of Internal Medicine, Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Wedad M. Nageeb
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Keita Iyori
- Dermatological and Laboratory Service for Animals, Vet Derm Tokyo, Fujisawa, Japan
| | - Yoichi Toyoda
- Dermatological and Laboratory Service for Animals, Vet Derm Tokyo, Fujisawa, Japan
| | | | - Kaori Ide
- Laboratory of Internal Medicine, Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology, Fuchu, Japan
- Division of Animal Life Science, Institute of Agriculture, Graduate School, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Keiko Kawamoto
- Laboratory of Immunology and Infection Control, Department of Veterinary Medicine, School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Koji Nishifuji
- Laboratory of Internal Medicine, Cooperative Division of Veterinary Sciences, Graduate School of Agriculture, Tokyo University of Agriculture and Technology, Fuchu, Japan
- Division of Animal Life Science, Institute of Agriculture, Graduate School, Tokyo University of Agriculture and Technology, Fuchu, Japan
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Abi Zeid Daou C, Yammine Y, Daou AM, A R Feghali P, Najjar W, Barazi R. Incidence of pediatric tonsillitis, otitis and upper respiratory infectious entities in the pre and post COVID-19 quarantine eras. Acta Otolaryngol 2023; 143:423-428. [PMID: 37093858 DOI: 10.1080/00016489.2023.2200851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND At this point of the COVID-19 pandemic, with the worldwide loosening of health restrictions, there has been an observed jump in infectious load especially of the upper airways.Aims/Objectives: To shed light on children's immunity and potential health risks after the COVID-19 pandemic. METHODS A retrospective chart review from May 2019 to January 2022. Pediatric patients with a discharge diagnosis suggestive of an upper respiratory or ENT infection were included. The sample was divided into three groups according to the date of presentation. RESULTS A total 4356 patients were diagnosed with ENT infectious aetiology. The mean age was 4.69 years. The three periods studied were: Period-1 (May 2019-January 2020), period-2 (February 2020-April 2021) and period-3 (May 2021-January 2022). The distribution of adenoiditis and MEE is the same across all periods (p > .05). The incidence of URTI, AOM and tonsillitis were significantly highest during period-3 followed by period-1, which in turn was significantly higher than during period-2 (p < .05). The incidence of sinusitis was the highest during period-3 (p < .001). CONCLUSION There seems to be a heightened susceptibility to acute infection in children after the pandemic.Significance: It is important to keep in mind the changes in microbiota and implement measures to promote healthy gut flora, timely vaccination, and prompt medical interventions.Summary BoxWhat is already known: We already know that quarantine has significantly decreased infectious load especially in children.This study adds an objective assessment of this decrease with an assessment of the infectious load post-quarantine.This study is a model for future pandemics on the importance of vaccinations and the importance of microbiota changes after pandemics.
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Affiliation(s)
- Christophe Abi Zeid Daou
- Department of Otolaryngology & Head and Neck Surgery, American University of Beirut, Beirut, Lebanon
| | - Yara Yammine
- Department of Otolaryngology & Head and Neck Surgery, American University of Beirut, Beirut, Lebanon
| | - Anne-Marie Daou
- Department of Otolaryngology & Head and Neck Surgery, American University of Beirut, Beirut, Lebanon
| | | | | | - Randa Barazi
- Department of Otolaryngology & Head and Neck Surgery, American University of Beirut, Beirut, Lebanon
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Rosso C, Turati F, Saibene AM, Verduci E, Fuccillo E, Tavilla MC, Magnani M, Banderali G, Ferraroni M, De Corso E, Felisati G, Pipolo C. Nasal Cytology on 241 Children: From Birth to the First 3 Years of Life and Association with Common Airways Diseases. J Pers Med 2023; 13:jpm13040687. [PMID: 37109073 PMCID: PMC10146100 DOI: 10.3390/jpm13040687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Nasal cytology at birth and in the pediatric age is barely investigated regarding its association with the onset of common pediatric diseases. METHODS We enrolled 241 newborns within their first 24 h of life, studying their nasal cellular composition and repeating this at 1 and 3 years of life. We collected anamneses of perinatal factors and external factors (parental smoking, passive smoking, breastfeeding), and the prevalence of otitis, rhinosinusitis, bronchitis, asthma, and allergy at all timepoints. RESULTS 204 children completed the study. At birth, there was a prevalence of ciliated cells and rare neutrophils. At 1 and 3 years, ciliated cells started reducing in favor of muciparous cells and neutrophils. We found that caesarian delivery and nasogastric tube usage for choanal patency are significantly related to a certain cellular nasal composition. Additionally, development of upper respiratory tract infections, AOM (acute otitis media) and allergy correlates with specific cytological compositions which may predict those pathologies. CONCLUSIONS Our study is the first to show the normal nasal mucosa cellular composition and development in the first 3 years of life in a large cohort. Nasal cytology may be a tool for early risk assessment in the occurrence of upper airway disease.
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Affiliation(s)
- Cecilia Rosso
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20148 Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, 20148 Milan, Italy
| | - Federica Turati
- Branch of Medical Statistics, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Alberto Maria Saibene
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20148 Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, 20148 Milan, Italy
| | - Elvira Verduci
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Emanuela Fuccillo
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20148 Milan, Italy
| | - Maria Chiara Tavilla
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20148 Milan, Italy
| | - Mauro Magnani
- Department of Hand Surgery and Microsurgery, Gaetano Pini-CTO Orthopaedic Institute, University of Milan, 20122 Milan, Italy
| | - Giuseppe Banderali
- Pediatric Department, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20148 Milan, Italy
| | - Monica Ferraroni
- Branch of Medical Statistics, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
- Fondazione IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Eugenio De Corso
- Department of Otorhinolaryngology, La Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Felisati
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20148 Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, 20148 Milan, Italy
| | - Carlotta Pipolo
- Department of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, 20148 Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, 20148 Milan, Italy
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Everest S, Monteith G, Gaitero L, Samarani F. Suppression of inner ear signal intensity on fluid-attenuated inversion recovery magnetic resonance imaging in cats with vestibular disease. J Feline Med Surg 2023; 25:1098612X231168001. [PMID: 37102785 DOI: 10.1177/1098612x231168001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Otitis media/interna (OMI) is the most common cause of peripheral vestibular disease in cats. The inner ear contains endolymph and perilymph, with perilymph being very similar in composition to cerebrospinal fluid (CSF). As a very-low-protein fluid, it would be expected that normal perilymph should suppress on fluid-attenuated inversion recovery (FLAIR) MRI sequences. Based on this, we hypothesized that MRI FLAIR sequences should provide a non-invasive way of diagnosing inflammatory/infectious diseases such as OMI in cats, something that has previously been demonstrated in humans and, more recently, in dogs. METHODS This was a retrospective cohort study in which 41 cats met the inclusion criteria. They were placed into one of four groups, based on presenting complaint: clinical OMI (group A); inflammatory central nervous system (CNS) disease (group B); non-inflammatory structural disease (group C); and normal brain MRI (control group; group D). Transverse T2-weighted and FLAIR MRI sequences at the level of the inner ears bilaterally were compared in each group. The inner ear was selected as a region of interest using Horos, with a FLAIR suppression ratio calculated to account for variability in signal intensity between MRIs. This FLAIR suppression ratio was then compared between groups. Statistical analyses were performed by an experienced statistician, with a general linear model used to compare mean FLAIR suppression ratio, CSF nucleated cell count and CSF protein concentration between groups. RESULTS The OMI group (group A) had significantly lower FLAIR suppression scores compared with all other groups. The CSF cell count was also significantly increased in the OMI (group A) and inflammatory CNS disease (group B) groups compared with the control group (group D). CONCLUSIONS AND RELEVANCE This study demonstrates the utility of MRI FLAIR sequences in diagnosing presumptive OMI in cats, similarly to in humans and dogs. This study is relevant to practicing veterinary neurologists and radiologists in interpreting MRI findings in cats with suspected OMI.
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Affiliation(s)
- Stephen Everest
- Ontario Veterinary College Health Science Centre, University of Guelph, Guelph, ON, Canada
| | - Gabrielle Monteith
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Luis Gaitero
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Francesca Samarani
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
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Tran PT, Antonelli PJ, Winterstein AG. Quinolone Ear Drops and Achilles Tendon Rupture. Clin Infect Dis 2023; 76:e1360-e1368. [PMID: 36065683 DOI: 10.1093/cid/ciac709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delayed eardrum healing has been observed in the ear opposite to the ear treated with otic quinolones (OQ) in rats. Case reports describe tendinopathies after OQ treatment, suggesting adverse systemic effects. METHODS We studied patients aged 19 to 64 years with diagnosis of otitis externa or media in private insurance between 2005 and 2015. We compared OQ treatment against otic neomycin, oral amoxicillin, or azithromycin. Outcomes included Achilles tendon rupture (ATR), Achilles tendinitis (AT), and all-type tendon rupture (ATTR). We applied an active comparator, new-user design with 1-year look-back and ceased follow-up at initiation of systemic steroids or oral quinolones, external injury, hospitalization, and after 35 days. We used trimmed stabilized inverse probability of treatment weights to balance comparison groups in a survival framework. Negative outcomes (clavicle fractures or sports injuries) were examined to rule out differences from varied physical activity (unmeasured confounding). RESULTS We examined 1 501 009 treated otitis episodes. Hazard ratios (HR) for OQ exposure associated with ATR were 4.49 (95% confidence interval [CI], 1.83-11.02), AT 1.04 (95% CI, 0.73-1.50), and ATTR 1.71 (95% CI, 1.21-2.41). Weighted risk differences (RD) per 100 000 episodes for OQ exposure were ATR 7.80 (95% CI, 0.72-14.89), AT 1.01 (95% CI, -12.80 to 14.81), and ATTR 18.57 (95% CI, 3.60-33.53). Corresponding HRs for clavicle fractures and sports injuries were HR,1.71 (95% CI, 0.55-5.27) and HR,1.45 (95% CI, 0.64-3.30), suggesting limited residual confounding. CONCLUSIONS OQ exposure may lead to systemic consequences. Clinicians should consider this potential risk and counsel patients accordingly. Risk factors and mechanisms for this rare, adverse effect deserve further evaluation. Mechanistic and other clinical studies are warranted to corroborate this finding.
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Affiliation(s)
- Phuong T Tran
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Faculty of Pharmacy, HUTECH University, Ho Chi Minh City, Vietnam
| | - Patrick J Antonelli
- College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
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Gkrinia E, Bizaki-Vallaskangas A, Rautiainen M, Kivekäs I. Nocardia Farcinica Mastoiditis and Epidural Abscess in an Immunocompetent Patient: A Rare Entity. Ear Nose Throat J 2022:1455613221139400. [PMID: 36453208 DOI: 10.1177/01455613221139400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Nocardia is regarded as an opportunistic pathogen primarily affecting the respiratory system, whereas Nocardia farcinica is the species of the Nocardia family that is most frequently blamed for central nervous system impairment. The authors present the first case of mastoiditis caused by Nocardia farcinica, accompanied by intracranial complications. An immunocompetent 74-year-old woman who reported a three-week left ear discharge and a two-week facial nerve palsy was referred to our department. MRI revealed mastoiditis and epidural abscess. The bacterial cultures obtained during the surgical management of the patient confirmed the presence of Nocardia farcinica. Targeted antibiotic therapy was subsequently administrated, gradually resulting in favourable outcomes. Nocardia species provoke a disseminated infection that emerges not only among the immunosuppressed individuals but can also affect the healthy population. The nonspecific clinical manifestations in addition to the difficulties identifying the pathogen, remain obstacles to a punctual diagnosis. However, the combination of surgical debridement and antibiotic treatment with trimethoprim and sulfamethoxazole is considered the most appropriate management, leading to propitious results.
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Affiliation(s)
- Eleni Gkrinia
- Department of Ear and Oral Diseases and Otorhinolaryngology, Tampere University, Tampere, Finland
- ENT Department, University Hospital of Larissa and Department of Otorhinolaryngology - Head and Neck Surgery, University of Thessaly, Larissa, Greece
| | | | - Markus Rautiainen
- Department of Ear and Oral Diseases and Otorhinolaryngology, Tampere University, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Ear and Oral Diseases and Otorhinolaryngology, Tampere University, Tampere, Finland
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Herberger A, Hammond J, Miller A, Olson B. MRI of a middle ear cholesteatoma in a cat. Vet Radiol Ultrasound 2022; 63:E16-E20. [PMID: 35969351 DOI: 10.1111/vru.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/27/2022] Open
Abstract
A 9-year-old Maine coon cat presented with right-sided Horner and facial nerve paralysis. Magnetic resonance imaging (MRI) showed a heterogeneously contrast-enhancing mass occupying the right dorsolateral compartment of the tympanic cavity and extending into the ventromedial compartment, which was expanded and fluid filled. A ventral bulla osteotomy was performed to debulk the soft tissue mass. Histopathology revealed a cholesteatoma. The cat showed slow improvement of clinical signs and was euthanized eleven months postoperatively for unrelated causes. The MRI characteristics of middle ear cholesteatoma in the present case varied from those described in humans and dogs.
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Affiliation(s)
| | - James Hammond
- Pieper Memorial Veterinary Center, Middletown, Connecticut, USA
| | - Andrew Miller
- Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Benjamin Olson
- Pieper Memorial Veterinary Center, Middletown, Connecticut, USA
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21
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KuKanich KS, Bagladi-Swanson M, KuKanich B. Pseudomonas aeruginosa susceptibility, antibiogram and clinical interpretation, and antimicrobial prescribing behaviors for dogs with otitis in the Midwestern United States. J Vet Pharmacol Ther 2022; 45:440-449. [PMID: 35698441 DOI: 10.1111/jvp.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/04/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
Pseudomonas aeruginosa (P. aeruginosa) can cause otitis in dogs that is nonresponsive to empirical therapy. This study evaluated P. aeruginosa isolates (N = 216) from canine ear swabs submitted to the Kansas State Veterinary Diagnostic Laboratory from 2018-2020 to create an antibiogram and minimum inhibitory concentration distributions using Clinical Laboratory Standards Institutes breakpoints. Multidrug resistance was defined as non-susceptibility to ≥1 drug from ≥3 antimicrobial classes. Submitting veterinarians (N = 83) were invited to complete a survey about antimicrobial use and otitis management. Susceptibility was higher for aminoglycosides [gentamicin (82%, 177/216) and amikacin (81%, 175/216)] than fluoroquinolones [marbofloxacin (67%, 145/216), enrofloxacin (32%, 70/216), and orbifloxacin (18%, 39/216)]. Most responding veterinarians (54%, 15/28) prescribe topical aminoglycosides as first-line therapy for canine otitis, but 71% (15/21) prescribe fluoroquinolones if rods are seen cytologically. Ceftazidime, imipenem, and piperacillin-tazobactam showed high susceptibility and are used rarely. Multidrug resistance was present in 13% (28/216) of isolates. Based on in vitro susceptibility, topical aminoglycosides might be more effective than fluoroquinolones for P. aeruginosa otitis, but efficacy studies are required. Susceptibility testing is encouraged for cases not responding to empirical therapy but has limitations because topical preparations have high concentrations and otic breakpoints are not available.
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Affiliation(s)
- Kate S KuKanich
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Mary Bagladi-Swanson
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Butch KuKanich
- Department of Anatomy & Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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22
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Gurov AV, Lapenko EG, Kryukov AI. [Phage therapy of purulent-inflammatory pathology of the outer and middle ear]. Vestn Otorinolaringol 2022; 87:56-62. [PMID: 36107182 DOI: 10.17116/otorino20228704156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The steady growth of antibiotic resistance of bacteria and, as a result, difficulties in selecting effective drugs determine the search for an alternative strategy for the use of antimicrobials, and therapy based on the use of bacteriophages is such. Phage therapy in otorhinolaryngology is actively used for the treatment of rhinosinusitis, diseases of the pharynx and larynx. However, it should be noted that the use of this group of drugs in the treatment of ear diseases is not sufficiently covered. Currently, institutes and clinics around the world are undergoing many large multicenter studies aimed not only at finding effective bacteriophages against antibiotic-resistant bacteria, but also at isolating their enzymes (lysines), expression of transport proteins, genetic modifications that lead to the restoration of the sensitivity of bacteria to antimicrobial drugs. In this review, we sought to highlight modern works concerning the treatment of inflammatory ear diseases with bacteriophage preparations, the results of microbiological studies conducted in vitro, the main purpose of which was to combat multi-resistant strains of microorganisms - pathogens of purulent-inflammatory diseases of the outer and middle ear.
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Affiliation(s)
- A V Gurov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E G Lapenko
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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23
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Eswaran S, Kumar S, Saravanam PK. Cholesteatoma extending into the sternocleidomastoid muscle presenting as a Bezold abscess. BMJ Case Rep 2021; 14:e241160. [PMID: 34844957 PMCID: PMC8634368 DOI: 10.1136/bcr-2020-241160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/04/2022] Open
Abstract
Cholesteatoma is a non-neoplastic cystic lesion arising in the middle ear cleft with the propensity to spread and recur after surgery, but it is unusual to find cholesteatoma invading sternocleidomastoid muscle after 15 years of modified radical mastoidectomy and presenting as Bezold abscess. In this report, the authors highlight the fact that cholesteatoma recurrence if neglected can present as a Bezold abscess with the invasion of cholesteatoma from the mastoid tip into the sternocleidomastoid muscle. This requires complete excision of the cholesteatoma sac along with the surrounding soft tissue.
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Affiliation(s)
- Sudhagar Eswaran
- ENT, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sarath Kumar
- ENT, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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24
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Nunes Rodrigues TC, Vandenabeele SI. Pilot study of dogs with suppurative and non-suppurative Malassezia otitis: A case series. BMC Vet Res 2021; 17:353. [PMID: 34794441 PMCID: PMC8603560 DOI: 10.1186/s12917-021-03066-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rarely, Malassezia otitis presents as a painful, erosive otitis with an otic discharge containing Malassezia and neutrophils on cytology. There are no published reports of this type of suppurative Malassezia otitis (SMO). The role of Malassezia hypersensitivity in otitis is still unknown, and no association has been demonstrated with SMO. We compared Malassezia IgE levels, intradermal test and histology changes in SMO dogs with the more conventional Malassezia otitis (MO) presentation. Results Three dogs (case 1, case 2 and case 3) were diagnosed with SMO, one dog (case 4) was diagnosed with unilateral MO and unilateral SMO, and one dog (case 5) was diagnosed with MO. Only one case (case 4) with SMO/MO had a positive Intradermal Allergy Test (IDAT) and elevated IgE levels for Malassezia. Histopathology findings from SMO revealed: interface dermatitis (case 1 and 3), lymphocytic dermatitis (case 2) and chronic hyperplastic eosinophilic and lymphoplasmacytic dermatitis (case 4). Histopathology findings from MO showed perivascular dermatitis (case 4 and 5). All the cases were treated successfully. Conclusions SMO presents with a distinct clinical phenotype in comparison with conventional MO. No consistent aetiology could be isolated. In these clinical cases it is possible that previous treatments could have influenced the results. More research is needed to understand the possible aetiologies and the pathogenesis of SMO.
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Affiliation(s)
- Tania C Nunes Rodrigues
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.
| | - Sophie I Vandenabeele
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
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25
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Oliveira LS, Oliveira ACSD, Alcântara YB, Vieira CA, Ferreira DMDO, Chagas EFB, Frizzo ACF. Study of Binaural Auditory Cortical Response in Children with History of Recurrent Otitis. Int Arch Otorhinolaryngol 2021; 25:e490-e495. [PMID: 34737818 PMCID: PMC8558962 DOI: 10.1055/s-0040-1718527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Any type of sensory deprivation in childhood resulting from conductive hearing loss may impair the development of peripheral and central auditory pathway structures with negative consequences for binaural processing. Objective To characterize and compare monoaural and binaural auditory responses in neonates and children without and with a history of recurrent otitis. Methods The study included participants from 0 to 8 years and 11 months old, in good general health conditions, of both genders, divided into a control group, with no history of otitis, and a study group, with history of recurrent otitis. Cortical potential with speech stimulus /ba/-/da/ was used as collection procedure. The arithmetic calculation of the 512 points of the wave was performed to obtain the grand average of the waves of the subjects in both groups. The Shapiro-Wilk and mixed repeated measures analysis of covariance (ANCOVA) statistical tests were performed to analyze the group effect, the condition, and the interaction (group versus condition) controlling the effect of the age-sex covariable. Results There was a statistically significant difference between the groups for all latency values; and for the P1, N1, P2, and N2 latencies, the differences between the groups occurred in the three analyzed conditions (right and left ears and binaural), revealing the influence of sensory deprivation. There were no significant differences in relation to wave amplitudes. Conclusion There are differences in the cortical potential with speech stimuli and in the binaural interaction component of children with and without history of recurrent otitis.
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Affiliation(s)
- Leticia Sampaio Oliveira
- Department of Speech Therapy, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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26
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Vercelli C, Pasquetti M, Giovannetti G, Visioni S, Re G, Giorgi M, Gambino G, Peano A. In vitro and in vivo evaluation of a new phytotherapic blend to treat acute externa otitis in dogs. J Vet Pharmacol Ther 2021; 44:910-918. [PMID: 34258792 PMCID: PMC9290716 DOI: 10.1111/jvp.13000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/19/2021] [Accepted: 06/29/2021] [Indexed: 01/13/2023]
Abstract
Canine otitis externa is frequently encountered in veterinary practice, caused by primary factors with bacteria and yeast overgrowth acting as secondary and perpetuating factors. The pharmacological support includes anti-inflammatory, antimicrobials, and antimycotic drugs, but therapeutic failure and antimicrobial resistance are leading to alternative strategies based on phytotherapic products. This study aimed to evaluate an essential oil blend (Otogen® ) to treat otitis externa in dogs. The experimental design was divided in: (a) an in vitro approach, based on the European Normative UNI EN 1275:2006, to assess the efficacy of the product against the most frequently isolated microorganisms during otitis externa. (b) an in vivo part, 12 owned dogs presenting with acute otitis externa were enrolled. A significant growth reduction (>99.9%) of Malassezia pachydermatis and Candida albicans after 15 min of contact and Pseudomonas aeruginosa after 1 h of incubation was recorded. For Staphylococcus pseudintermedius, 50% of growth reduction were appreciated after 15 min. Results obtained in vivo after 7 days of blend administration, noted a significant improvement of all the considered parameters (most important were head shaking, erythema, and scraping). The results obtained may support the usefulness of the tested phytotherapic blend to manage acute otitis externa in dogs.
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Affiliation(s)
- Cristina Vercelli
- Department of Veterinary Science of Turin, University of Turin, Turin, Italy
| | - Mario Pasquetti
- Department of Veterinary Science of Turin, University of Turin, Turin, Italy
| | | | - Sara Visioni
- Department of Veterinary Science of Turin, University of Turin, Turin, Italy
| | - Giovanni Re
- Department of Veterinary Science of Turin, University of Turin, Turin, Italy
| | - Mario Giorgi
- Department of Veterinary Science of Pisa, University of Pisa, Pisa, Italy
| | - Graziana Gambino
- Department of Veterinary Science of Turin, University of Turin, Turin, Italy
| | - Andrea Peano
- Department of Veterinary Science of Turin, University of Turin, Turin, Italy
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27
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Affiliation(s)
- Stuti Chowdhary
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Arun Alexander
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Saranya Thangavel
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Lokesh Kumar Penubarthi
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
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28
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Abstract
We present a case of non-surgically managed bilateral osteonecrosis of the external auditory canal with a history of long-term medical therapy for osteoporosis. A 79-year-old woman with severe osteoporosis and destructive osteoarthritis received >10 years of once weekly bisphosphonate therapy before switching to denosumab. Four months later, the patient presented with bilateral loss of hearing and right-sided otalgia. Necrotising otitis externa, cholesteatoma and malignancy were considered but with histology, microbiological and CT assessment, bilateral osteonecrosis of the external auditory canal was diagnosed. Surgical debridement with canalplasty was avoided due to our patient's comorbidities. Treatment continued for 5 months with regular aural toilet, Terra-Cortril ointment and bismuth-iodine-paraffin paste packing. At 1-year follow-up, bilateral external auditory canals were completely re-epithelialised with no pain or affected hearing. We report the first case of bilateral osteonecrosis of the external auditory canal associated with denosumab and bisphosphonates with successful conservative management.
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Affiliation(s)
| | - Rupert George Ricks
- Ear, Nose and Throat (ENT) Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Joel Anthony Smith
- Ear, Nose and Throat (ENT) Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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29
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Bringhenti L, Pallu M, Silva JC, Tomazi T, Tomazi ACCH, Rodrigues MX, Cruzado-Bravo M, Bilby TR, Bicalho RC. Effect of treatment of pneumonia and otitis media with tildipirosin or florfenicol + flunixin meglumine on health and upper respiratory tract microbiota of preweaned Holstein dairy heifers. J Dairy Sci 2021; 104:10291-10309. [PMID: 34099293 DOI: 10.3168/jds.2020-19945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/19/2021] [Indexed: 01/02/2023]
Abstract
The objective of this randomized clinical study was to compare the effect of 2 antimicrobial interventions, tildipirosin or florfenicol + flunixin meglumine, used for treatment of pneumonia and extralabel treatment for otitis on health parameters and upper respiratory tract (URT) microbiota of preweaned Holstein calves. Housed preweaned Holstein heifers diagnosed with either otitis or pneumonia were assigned into 1 of 2 treatment groups, receiving a single subcutaneous injection of either 4 mg/kg of tildipirosin (TLD; n = 444) or 40 mg/kg of florfenicol combined with 2.2 mg/kg of a nonsteroidal anti-inflammatory, flunixin meglumine (FLF; n = 442). Calves were enrolled and treated on the day of diagnosis of the first case of pneumonia or otitis. If a calf had a recurrent case, the opposite drug was administered, respecting an interval of 5 d between drug injections. Blood samples for leukocyte counts were collected at 0, 2, 4, and 6 d after treatment, and rectal temperature was measured daily during the 5 d after treatment. Ear scores were observed from calves with otitis. Additionally, swabs of the URT were collected from a subset of 20 calves in each treatment group at d 0, 3, 6, 9, and 11 following enrollment for analysis of URT microbiota through next-generation sequencing of the 16S rRNA gene and quantitative PCR. Swabs were also collected from a comparative group of 20 healthy calves that did not receive any drug. No differences were observed between groups for recurrence risk of either pneumonia (TLD = 32.4%; FLF = 29.7%) or otitis (TLD = 72.7%; FLF = 73.6%). Similarly, no differences were observed for the total number of treatments for pneumonia (TLD = 1.45; FLF = 1.42) or otitis (TLD = 2.96; FLF = 3.07). On the other hand, both drugs reduced rectal temperature, ear scores, and leukocyte counts, with FLF calves having a greater reduction in rectal temperature within 4 d after treatment. Both TLD and FLF reduced the total bacterial load when compared with healthy untreated calves, but no differences were observed between treatment groups. Furthermore, compared with the untreated group, treated calves had lower mean relative abundances (MRA) of the genera Mannheimia, Moraxella, and Pasteurella within 11, 9, and 3 d after treatment, respectively; however, no significant differences were observed between TLD and FLF. On the other hand, MRA of Mycoplasma was not decreased by both treatments compared to untreated animals, and a higher MRA was observed in the TLD group during 11 d after treatment in comparison to FLF and untreated calves. Based on this data, we concluded that both drugs used in the study were effective in reducing rectal temperature, ear scores, leukocyte counts, and MRA of the genera Mannheimia, Pasteurella, and Moraxella in the URT, and calves treated with FLF had a greater reduction in rectal temperature.
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Affiliation(s)
- L Bringhenti
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853-6401
| | - M Pallu
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853-6401
| | - J C Silva
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853-6401
| | - T Tomazi
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853-6401
| | - A C C H Tomazi
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853-6401
| | - M X Rodrigues
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853-6401
| | - M Cruzado-Bravo
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853-6401
| | | | - R C Bicalho
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853-6401.
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30
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Chen T, Ashman PE, Bojrab DI, Johnson AP, Hong RS, Benson B, Svider PF. Diagnosis and management of eosinophilic otitis media: a systematic review. Acta Otolaryngol 2021; 141:579-587. [PMID: 33825596 DOI: 10.1080/00016489.2021.1901985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Eosinophilic Otitis Media (EOM) is a relatively newly defined entity of recurrent and resistant otitis media. OBJECTIVE To perform a systematic review of otologic manifestations, diagnosis and management of eosinophilic otitis media (EOM). METHODS 393 patients diagnosed with EOM of 26 studies met inclusion criteria and were assessed for demographics, otologic manifestations, diagnostic criteria fulfilled, and medical and surgical treatments. RESULTS Most common otologic manifestations were hearing loss (65%), otitis media with effusion (16%), tympanic membrane perforation (13%), and otorrhea (13%). 93% had a predominantly eosinophilic middle ear effusion, 95% had asthma, 85% had a highly viscous middle ear effusion, 71% had nasal polyposis, and 58% had resistance to conventional treatment. For treatment, 39% received intratympanic steroid injections, 33% received systemic steroids, 17% received steroid ear drops and 13% received a biological agent. 39% of patients underwent a surgical intervention with 26% receiving functional endoscopic sinus surgery and 18% receiving myringotomy with tube insertion. Success rates were highest with use of intratympanic steroids (45%), systemic steroids (26%), and biological agents (58%). CONCLUSION Intratympanic steroids show the most efficacy in treating EOM, and aggressive optimization of asthma may be beneficial in resolving otologic symptoms. Surgery should be reserved for refractory cases and complications.
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Affiliation(s)
- Tiffany Chen
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ, USA
| | - Peter E. Ashman
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Andrew P. Johnson
- Department of Otolaryngology – Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Robert S. Hong
- Michigan Ear Institute, Farmington Hills, MI, USA
- Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brian Benson
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
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Asroel HA, Lelo A, Munir D, Bashiruddin J, Hadi RS. Poguntano effect on cell viability in cholesteatoma keratinocyte of chronic suppurative otitis media. Med Glas (Zenica) 2020; 17:451-6. [PMID: 32662611 DOI: 10.17392/1155-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/29/2020] [Accepted: 06/19/2020] [Indexed: 11/18/2022]
Abstract
Aim Chronic Suppurative Otitis Media (CSOM) with or without cholesteatoma is a global major problem and it is becoming a burden especially in developing countries. Studies have found that ethanol extracts of Puguntano leaves obtained by the percolation and socletation methods have phytochemical contents that provide anti-inflammatory effect. The aim of this study was to investigate the effects of ethanol extract and Puguntano on the viability of cholesteatoma keratinocytes. Methods This in vitro experimental study included 8 groups of the cholesteatoma keratinocyte culture: not given puguntano leaf ethanol extract, three positive control groups given different concentrations of dexamethasone, and four groups that were given different concentrations of ethanol extract of leaf Puguntano. Results A statistically significant decrease in procalcitonin level (p<0.001) and an amount of bacterial colonies (p<0.001) in four groups were found. Conclusion This study showed that Puguntano leaf extract has the same effect as dexamethasone in terms of suppressing cell viability and has lower side effects compared to dexamethasone as other herbal medicines. Thus, the ethanol extract of Puguntano leaves can be used as an alternative for the prevention of cholesteatoma.
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32
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Engert T, Metternich FU. Rare case of ballooning herniation of the tympanic membrane. BMJ Case Rep 2021; 14:14/5/e241839. [PMID: 34035025 PMCID: PMC8154966 DOI: 10.1136/bcr-2021-241839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Herniation of the tympanic membrane is a rare benign malformation of the tympanic membrane into the external auditory canal. It may be asymptomatic or associated with symptoms such as aural fullness, tinnitus, otalgia or hearing loss. We present a case of a symptomatic herniation of the tympanic membrane and its surgical therapy with hernia excision and tympanoplasty. An internal review board exemption was obtained.
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Affiliation(s)
- Tobias Engert
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Aarau AG, Aarau, Aargau, Switzerland
| | - Frank Uwe Metternich
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Aarau AG, Aarau, Aargau, Switzerland
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33
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Fujita Y, Imataka G, Ohkusu M, Yoshihara S. Cerebral haemorrhagic infarction associated with acute otitis media in a 4-year-old boy. BMJ Case Rep 2021; 14:14/5/e242098. [PMID: 34020990 DOI: 10.1136/bcr-2021-242098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - George Imataka
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Misako Ohkusu
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
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34
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Thangavel S, Penubarthi LK, Alexander A, Saxena SK. Surgical corridors for congenital aural atresia with otogenic cerebellar abscess and lateral sinus thrombosis. BMJ Case Rep 2021; 14:e239403. [PMID: 34011658 PMCID: PMC8137245 DOI: 10.1136/bcr-2020-239403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/03/2022] Open
Abstract
The following is a case report of an adolescent with mental retardation who had congenital aural atresia with contralateral congenital facial palsy. She developed multiple intracranial complications (cerebellar abscess and lateral sinus thrombosis) due to cholesteatoma. We managed her in a multidisciplinary approach. This report discusses case management, emphasising the meticulous intraoperative steps taken in identifying the landmarks and precautions adopted to avoid postoperative facial palsy and other complications.
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Affiliation(s)
- Saranya Thangavel
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Arun Alexander
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sunil Kumar Saxena
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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35
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Ringrose T, Biggs TC, Hilton JM, Crossley E, Basil M, Graham-Hart L, Megadmi H, Buckland J, Pringle MB. Examining the utility of nuclear medicine imaging in the diagnosis and management of necrotising otitis externa. Clin Otolaryngol 2021; 46:1159-1163. [PMID: 33966334 DOI: 10.1111/coa.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/04/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Ringrose
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
| | - Timothy C Biggs
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
| | - Jennifer M Hilton
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
| | - Eleanor Crossley
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
| | - Malik Basil
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
| | - Louis Graham-Hart
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
| | - Hakim Megadmi
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
| | - Jonathan Buckland
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
| | - Mike B Pringle
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Cosham, UK
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36
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Chen T, Ashman PE, Bojrab DI, Johnson AP, Benson B, Hong RS, Svider PF. Otologic Manifestations of Langerhans Cell Histiocytosis: A Systematic Review. Otolaryngol Head Neck Surg 2021; 166:48-59. [PMID: 33945752 DOI: 10.1177/01945998211004590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To perform a systematic review to investigate common otologic manifestations of Langerhans cell histiocytosis, the incidence of these findings, methods for diagnosis, as well as medical and surgical management. DATA SOURCES PubMed/MEDLINE, Embase, and Cochrane Library. REVIEW METHODS A search of PubMed/MEDLINE, Embase, and Cochrane Library for all articles published between 1963 to 2020 was performed with variations and combinations of the following search terms: Langerhans cell histiocytosis, eosinophilic granuloma, Letterer-Siwe, Hand-Schüller-Christian, otitis, otologic, ear. A review of the references of all included articles was also conducted. RESULTS Sixty-two articles encompassing 631 patients met inclusion criteria. Otologic symptoms at presentation were found in 246 (39%) patients in the reported studies with 48% reporting bilaterality. The mean age was 14.8 years with a male predominance (64%). The most common otologic presenting symptom was otorrhea (46%). A majority had the multisystem variant (52%). The most common treatment modalities were chemotherapy (52%), followed by surgery (50%), systemic steroids (45%), and radiotherapy (31%). Surgery was performed in 75.8% with unisystem involvement and in 50.6% with multisystem involvement. The most effective treatments included radiotherapy (56% success rate, 17% of treated patients), systemic steroids (44% success, 20% treated), chemotherapy (41% success, 21% treated), and surgical modalities (36% success, 19% treated). CONCLUSIONS Otologic manifestations that occur with the multisystem variant or are at high risk for central nervous system involvement necessitate systemic treatment. For unifocal lesions, surgery is recommended. Lastly, radiotherapy should be reserved for extensive lesions involving vital structures or presenting in older patients.
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Affiliation(s)
- Tiffany Chen
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Peter E Ashman
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Andrew P Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Brian Benson
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.,Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Robert S Hong
- Michigan Ear Institute, Farmington Hills, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Peter F Svider
- Hackensack University Medical Center, Hackensack, New Jersey, USA.,Bergen Medical Associates, Emerson, New Jersey, USA
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37
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Meade ZS, Porter RG. Blastomyces Induced Otomastoiditis With Local Soft Tissue Invasion: A Case Report. Ear Nose Throat J 2021:1455613211006001. [PMID: 33866867 DOI: 10.1177/01455613211006001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this report is to document a very rare case of Blastomycosis dermatitidis mastoiditis with extension into the retromastoid soft tissue and surrounding muscle. Blastomycosis dermatitidis is a dimorphic fungus of endemic areas which classically infiltrates the lungs; however, dissemination presenting as otomastoiditis is exceedingly rare. The patient was an immunocompetent 27-year-old male with no significant preexisting health conditions. He had significant work exposure to dust and soil and was referred to our department for evaluation of otalgia with headaches, hearing loss, and intermittent facial paralysis. Initially, the extent of the infection was unknown. Based on extensive disease on magnetic resonance imaging, the patient was scheduled for urgent tympanoplasty and mastoidectomy. Postoperative treatment with itraconazole resolved any further manifestations and halted further soft tissue invasion. It is important to consider uncommon fungal infections in the workup of persistent otalgia, especially when presenting with facial paralysis and a history of environmental exposure to soil and dust. This type of infection should be considered regardless of immunodeficiency status. Early detection may prevent hearing loss and local invasion into surrounding structures.
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Affiliation(s)
| | - Ryan G Porter
- Carle Illinois College of Medicine, Champaign, IL, USA.,Department of Otolaryngology-Head & Neck Surgery, Carle Health, Urbana, IL, USA
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38
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Bringhenti L, Pallu M, Silva J, Tomazi T, Tomazi AC, Rodrigues MX, Duarte LM, Bilby TR, Bicalho RC. Effect of metaphylactic administration of tildipirosin on the incidence of pneumonia and otitis and on the upper respiratory tract and fecal microbiome of preweaning Holstein calves. J Dairy Sci 2021; 104:6020-6038. [PMID: 33685693 DOI: 10.3168/jds.2020-19572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Abstract
The objectives of this study were to evaluate the effect of the metaphylactic use of a semi-synthetic long-acting macrolide (tildipirosin) on the prevention of pneumonia and otitis in preweaning Holstein calves, as well as its effects on the microbiome of their upper respiratory tract (URT) and feces. Newborn healthy Holstein heifers, collectively housed, were randomly allocated to 1 of 2 treatment groups: treatment (TRT; n = 932) or control (CTR; n = 927). Calves in the TRT group received a single subcutaneous injection of 4 mg/kg tildipirosin (Zuprevo, Merck Animal Health) at 7 ± 7 d of life. Calves in the CTR group received no drug injection. All enrolled calves were evaluated from 1 to 63 ± 3 d of life (weaning age) and monitored daily for any adverse health events during this period. Daily physical examination was performed to diagnose pneumonia and otitis, and body weight was measured weekly in all animals. From a randomly selected subset of 217 calves, blood samples for biochemical variables analysis and swabs were collected weekly from the URT and rectum for analysis of the nasal and fecal microbiome, respectively, via next-generation sequencing of the 16S rRNA gene. Total bacterial load was evaluated using quantitative PCR. In addition, another subset of 26 calves was randomly selected and fecal swabs were collected in a more intensive sampling to investigate the short-term effect of tildipirosin administration on the fecal microbiome. We performed general mixed linear models and logistic regression to analyze continuous and binary outcomes, respectively. Tildipirosin metaphylaxis reduced the incidence of otitis (CTR = 47.03%; TRT = 37.55%) and tended to reduce the incidence of pneumonia (CTR = 20.71%; TRT = 17.38%) and the overall mortality risk (CTR = 6.69%; TRT = 4.94%). We observed no significant differences between groups for mortality due to pneumonia (CTR = 0.86%; TRT = 0.97%) or mortality due to otitis (CTR = 2.05%; TRT = 1.39%). Calves in the TRT group had a higher average daily gain than calves in the CTR group. Furthermore, metaphylaxis had no significant effects on the total bacterial load, genus, or phylum analysis of the fecal microbiome from the 2 subset groups. However, for the URT microbiota, we observed a significant decrease in total bacterial load for the TRT group compared to the CTR group 1 week after metaphylactic injection. Tildipirosin metaphylaxis decreased the mean relative abundance of the genera Mannheimia, Moraxella, and Pasteurella but significantly increased the mean relative abundance of Mycoplasma. Although tildipirosin had no positive effect on Mycoplasma, it reduced the mean relative abundance of important pathogenic bacteria in the URT and had positive effects for the control of otitis. The metaphylactic use of tildipirosin can be a suitable strategy for the control of otitis on farms with a high prevalence of this disease.
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Affiliation(s)
- Leonardo Bringhenti
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401
| | - Mariana Pallu
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401
| | - Josiane Silva
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401
| | - Tiago Tomazi
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401
| | - Ana C Tomazi
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401
| | - Marjory X Rodrigues
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401
| | - Livia M Duarte
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401
| | | | - Rodrigo C Bicalho
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401.
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39
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Adigbli D, Rozen V, Darbar A, Janin P. Early intravenous immunoglobulin therapy for group A β-haemolytic streptococcal meningitis with toxic shock syndrome. BMJ Case Rep 2021; 14:e238472. [PMID: 33664027 PMCID: PMC7934773 DOI: 10.1136/bcr-2020-238472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 11/03/2022] Open
Abstract
A woman in her forties was transferred to a Sydney (Australia)-based tertiary hospital, following presentation to a regional hospital with group A Streptococcus (GAS) otomastoiditis; complicated by meningitis, venous sinus thrombosis, haemorrhagic cerebral infarction and subdural empyema. She rapidly deteriorated with profound cardiovascular collapse. Despite initiation of high dose vasoactive therapy, she remained shocked and developed multiorgan dysfunction syndrome. Early intravenous immunoglobulin therapy (140 g in two doses) was initiated as an adjunct to antimicrobial, surgical and supportive care for refractory streptococcal toxic shock syndrome. Over the course of a twelve-day intensive care unit stay she made good progress with de-escalation of her vasoactive supportive care and reversal of her organ injuries. She was subsequently discharged to ward-based care. At her three-month follow-up appointment she had significantly reduced neurological deficit. Five months following her presentation to hospital she had returned to full-time work.
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Affiliation(s)
- Derick Adigbli
- Intensive Care Unit, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Valerie Rozen
- Haematology, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Archie Darbar
- Microbiology, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Pierre Janin
- Intensive Care Unit, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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40
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D’Andreano S, Cuscó A, Francino O. Rapid and real-time identification of fungi up to species level with long amplicon nanopore sequencing from clinical samples. Biol Methods Protoc 2021; 6:bpaa026. [PMID: 33506108 PMCID: PMC7820110 DOI: 10.1093/biomethods/bpaa026] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/02/2020] [Accepted: 12/18/2020] [Indexed: 12/21/2022] Open
Abstract
The availability of long-read technologies, like Oxford Nanopore Technologies, provides the opportunity to sequence longer fragments of the fungal ribosomal operon, up to 6 Kb (18S-ITS1-5.8S-ITS2-28S) and to improve the taxonomy assignment of the communities up to species level and in real-time. We assess the applicability for taxonomic assignment of amplicons targeting a 3.5 Kb region (V3 18S-ITS1-5.8S-ITS2-28S D2) and a 6 Kb region (V1 18S-ITS1-5.8S-ITS2-28S D12) with the What's in my pot (WIMP) classifier. We used the ZymoBIOMICSTM mock community and different microbiological fungal cultures as positive controls. Long amplicon sequencing correctly identified Saccharomyces cerevisiae and Cryptococcus neoformans from the mock community and Malassezia pachydermatis, Microsporum canis and Aspergillus fumigatus from the microbiological cultures. Besides, we identified Rhodotorula graminis in a culture mislabelled as Candida spp. We applied the same approach to external otitis in dogs. Malassezia was the dominant fungal genus in dogs' ear skin, whereas Ma. pachydermatis was the main species in the healthy sample. Conversely, we identified a higher representation of Ma. globosa and Ma. sympodialis in otitis affected samples. We demonstrate the suitability of long ribosomal amplicons to characterize the fungal community of complex samples, either healthy or with clinical signs of infection.
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Affiliation(s)
- Sara D’Andreano
- SVGM, Servei Veterinari de Genètica
Molecular, Universitat Autònoma de Barcelona, 08193,
Bellaterra, Barcelona, Spain
- Vetgenomics, Edifici EUREKA, Parc de Recerca de la
UAB, Campus UAB, 08193, Bellaterra, Barcelona, Spain
| | - Anna Cuscó
- Vetgenomics, Edifici EUREKA, Parc de Recerca de la
UAB, Campus UAB, 08193, Bellaterra, Barcelona, Spain
| | - Olga Francino
- SVGM, Servei Veterinari de Genètica
Molecular, Universitat Autònoma de Barcelona, 08193,
Bellaterra, Barcelona, Spain
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41
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Mehrkens LR, Townsend KL, Cooley SD, Milovancev M, Newsom LE. Experience level as a predictor of entry into the hypotympanum during feline total ear canal ablation and lateral bulla osteotomy. J Feline Med Surg 2021; 23:900-905. [PMID: 33438505 DOI: 10.1177/1098612x20983264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The study hypotheses were as follows: (1) owing to the unique anatomy of the feline middle ear, the hypotympanum would be entered in less than 100% of cats during total ear canal ablation and lateral bulla osteotomies (TECA-LBOs); and (2) incomplete penetration of the septum and subsequent failure to enter the hypotympanum is more likely to occur in surgeries performed by a novice surgeon when compared with an experienced surgeon and may be under-recognized. METHODS Head CT was performed in 12 feline cadavers to confirm absence of gross ear disease. A novice surgeon and an experienced surgeon were randomly assigned to perform TECA-LBO on the left or right ear. Surgeons were blinded to each other's surgical technique. CT of cadavers was performed after the procedure. Successful penetration of the septum, entry into the hypotympanic cavity and amount of bone removed in bulla osteotomy, quantified via CT, were compared between the novice surgeon and experienced surgeon. RESULTS The novice surgeon entered the hypotympanum in 3/12 (25%) procedures, compared with 9/12 (75%) procedures performed by the experienced surgeon. The experienced surgeon performed a larger osteotomy than the novice surgeon (3301 mm vs 1376 mm, P<0.0023). Regardless of surgeon experience, more bone was removed in surgeries in which the hypotympanum was entered. CONCLUSIONS AND RELEVANCE Our results underscore the need for familiarity with feline middle ear anatomy when performing TECA-LBOs. Postoperative CT is recommended for novice surgeons to confirm entry into the hypotympanum.
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Affiliation(s)
- Lea R Mehrkens
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | - Katy L Townsend
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | - Stacy D Cooley
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | - Milan Milovancev
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | - Lauren E Newsom
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
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42
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Alex A, Philip A, Paulose AA, Mammen MD, Lepcha A. Skull base osteomyelitis with secondary cavernous sinus thrombosis: a rare presentation of an animate foreign body in the ear. BMJ Case Rep 2021; 14:e236723. [PMID: 33431445 PMCID: PMC7802718 DOI: 10.1136/bcr-2020-236723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 01/13/2023] Open
Abstract
A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.
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Affiliation(s)
- Anu Alex
- Department of ENT-Otology, Neurotology & Cochlear Implant Unit, Christian Medical College and Hospital Vellore, Vellore, India
| | - Ajay Philip
- Department of ENT-Otology, Neurotology & Cochlear Implant Unit, Christian Medical College and Hospital Vellore, Vellore, India
| | - Antony Abraham Paulose
- Department of ENT-Otology, Neurotology & Cochlear Implant Unit, Christian Medical College and Hospital Vellore, Vellore, India
| | - Manju Deena Mammen
- Department of ENT-Otology, Neurotology & Cochlear Implant Unit, Christian Medical College and Hospital Vellore, Vellore, India
| | - Anjali Lepcha
- Department of ENT-Otology, Neurotology & Cochlear Implant Unit, Christian Medical College and Hospital Vellore, Vellore, India
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43
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Somani SN, Schneider AL, Welch KC, Alexiev BA, Matsuoka AJ. Probable neurosarcoidosis presenting as acute on chronic otorrhoea: a difficult diagnosis. BMJ Case Rep 2020; 13:13/11/e237676. [PMID: 33139371 DOI: 10.1136/bcr-2020-237676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An elderly African American woman presented to our clinic following 9 months of right-sided unilateral headache, otorrhoea and progressive hearing loss. Despite treatment with topical and oral antibiotics, her clinical condition worsened, and imaging showed mastoid coalescence with an associated subgaleal abscess. She underwent right mastoidectomy and was discharged 3 days later on broad-spectrum intravenous antibiotics despite negative operative cultures. Six weeks later, she was hospitalised with diplopia secondary to a right lateral rectus palsy. Imaging showed abscess resolution but progressive bony remodelling and enhancement of the lateral extending into anterior skull base. Chest CT demonstrated upper lobe predominant pulmonary micronodules, and mastoid biopsy on revision surgery was notable for non-caseating granulomas. Further extensive work-up could not identify an alternative cause, and a presumptive diagnosis of neurosarcoidosis was made. The patient was initiated on intravenous steroids, experienced symptomatic improvement and was thereafter transitioned to oral steroid taper on discharge.
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Affiliation(s)
- Shaan N Somani
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexander L Schneider
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Borislav A Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akihiro J Matsuoka
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA .,Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA.,The Hugh Knowles Center for Clinical and Basic Science in Hearing and Its Disorders, Evanston, Illinois, USA
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44
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Kryukov AI, Bondareva GP, Gorovaya EV, KishinevskY AE, Tsarapkin GY. [Eustachian tube drug delivery to the tympanum in patients with otitis media with effusion]. Vestn Otorinolaringol 2020; 85:11-15. [PMID: 32885630 DOI: 10.17116/otorino20208504111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are no reliable data on the volume of the drug reaching the affected tympanic cavity during the catheterization of Eustachian tube (ET). Objective: to conduct an experiment and to study the effectiveness of administering a drug into the tympanic cavity of the middle ear using an original ear catheter, which allows catheterization of ET in the direction of its lumen. The study included patients with unilateral OME (n=21, the duration of the disease from 2 to 3 months), who were recommended for the ventilation tube insertion. The main inclusion criterion was 3 degree of patency of the ET. The experiment was performed under endotracheal anesthesia. ET was catheterized before insertion of the ventilation tube, with a 0.9% saline in a volume of 7 ml, which was previously tinted with Brilliant Green. A syringe with a contrast solution was connected to an ear catheter and the drug was injected into the middle ear by the air-liquid substitution method. Otoscopically evaluated the following parameters: the volume of the injected drug (in ml) for the initial (V1), partial (V2) and complete filling of the tympanic cavity (V3). As a result, it was found that 18 patients (85.7%) achieved full or partial filling of the tympanic cavity with a stained preparation: V1=2.25 ml, V2=7.0 ml in 11 (52.4%) patients, V3=4.29 ml - in 7 (33.3%) patients. In this case, the minimum loss of the liquid form of the drug during CT catheterization is 1:2. In 3 (14.3%) patients there were no endoscopic signs of contrasting of the tympanic cavity.
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Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - G P Bondareva
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E V Gorovaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A E KishinevskY
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - G Yu Tsarapkin
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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45
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Shenton C, Beena M, Rhodes A. Extensive skull base osteomyelitis found radiologically after resolution of otitis externa. BMJ Case Rep 2020; 13:13/8/e237508. [PMID: 32843393 DOI: 10.1136/bcr-2020-237508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Meera Beena
- Otorhinolaryngology, Blackpool Victoria Hospital, Blackpool, UK
| | - Amy Rhodes
- Otorhinolaryngology, Blackpool Victoria Hospital, Blackpool, UK
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46
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Lee GY, Yang SJ. Complete genome sequence of a methicillin-resistant Staphylococcus schleiferi strain from canine otitis externa in Korea. J Vet Sci 2020; 21:e11. [PMID: 31940690 PMCID: PMC7000899 DOI: 10.4142/jvs.2020.21.e11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 11/20/2022] Open
Abstract
The increase in canine skin and soft tissue infections, such as pyoderma and otitis, caused by Staphylococcus schleiferi strains, is of significant zoonotic concern. In this study, we report the first complete genome sequence for a methicillin-resistant clinical isolate of S. schleiferi (MRSS) designated as SS4, obtained from a dog with otitis externa, in Korea. The genome of SS4 strain was of 2,539,409 bp and presented high G+C content ratio (35.90%) with no plasmid. Comparative analysis of SS4 genome revealed that it is closely related to 2142-05 and 5909-02 strains isolated from the canine skin infections in the USA.
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Affiliation(s)
- Gi Yong Lee
- School of Bioresources and Bioscience, Chung-Ang University, Anseong 17546, Korea
| | - Soo Jin Yang
- School of Bioresources and Bioscience, Chung-Ang University, Anseong 17546, Korea.
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47
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Morris MC, Chapman TJ, Pichichero ME, Broderick G. Immune Network Modeling Predicts Specific Nasopharyngeal and Peripheral Immune Dysregulation in Otitis-Prone Children. Front Immunol 2020; 11:1168. [PMID: 32595639 PMCID: PMC7301607 DOI: 10.3389/fimmu.2020.01168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
Acute otitis media (AOM) pathogenesis involves nasopharyngeal colonization by potential otopathogens and a viral co-infection. Stringently-defined otitis prone (sOP) children show characteristic patterns of immune dysfunction. We hypothesized that otitis proneness is largely a result of altered signaling between immune components that are otherwise competent, resulting in increased susceptibility to infection by bacterial otopathogens. To test this, we constructed a regulatory immune network model linking immune cells and signaling elements known to be involved in AOM and/or dysregulated in sOP children. The alignment of immune response mechanisms with data from in vivo and in vitro experimental observations produced 82 putative immune network models, each describing variants of immune regulatory networks consistent with available observations. Analysis of these models suggested that new measurements of serum levels of IL-4 and CXCL8 could refine competing models and resulted in the elimination of 38 of the models. Further analysis of the remaining 44 models suggested specific deviations in the predicted regulation of nasopharyngeal and peripheral immunity during response to AOM. Specifically, immune responses active in sOP children during AOM were characterized by early and constitutive activation of pro-inflammatory signaling in the nasopharynx and a Th2- and Treg-dominated profile in the periphery. We conclude that sOP children have altered regulation of key immune mediators during both health and pathogenesis. This altered regulation may be amenable to therapeutic intervention.
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Affiliation(s)
- Matthew C. Morris
- Center for Clinical Systems Biology, Research Institute, Rochester General Hospital, Rochester, NY, United States
| | - Timothy J. Chapman
- Center for Infectious Diseases and Immunology, Research Institute, Rochester General Hospital, Rochester, NY, United States
| | - Michael E. Pichichero
- Center for Infectious Diseases and Immunology, Research Institute, Rochester General Hospital, Rochester, NY, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Research Institute, Rochester General Hospital, Rochester, NY, United States
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States
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Barbosa TJ, Zhang M, Wang HE. Patient with swollen ear. J Am Coll Emerg Physicians Open 2020; 1:294-295. [PMID: 33000048 PMCID: PMC7493492 DOI: 10.1002/emp2.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Timothy J. Barbosa
- Department of Emergency MedicineThe University of Texas Health Science Center at HoustonHoustonTexas
| | - Musi Zhang
- Department of Emergency MedicineThe University of Texas Health Science Center at HoustonHoustonTexas
| | - Henry E. Wang
- Department of Emergency MedicineThe University of Texas Health Science Center at HoustonHoustonTexas
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Rusetsky YY, Meitel IY, Anikin AV, Pashkova AE, Arutyunyan SK, Rozmanov EO, Krasivicheva OV. [External ear canal parameters and endoscopic otosurgery in children]. Vestn Otorinolaringol 2020; 85:24-29. [PMID: 32885632 DOI: 10.17116/otorino20208504124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Main difficulties of endoscopic ear surgery in children could be connected with width of external ear canal (EEC) and endoscope diameter discrepancy. OBJECTIVE To investigate EEC parameters in children, to determine cross section and to develop the recommendations whenever possible of endootosurgery performance in children. MATERIAL AND METHODS Research included two stages. First - average values determination of narrowest site EEC in children according to computer tomograms. Second - determination of age of the patient and the amount of acoustical pass at which there are specifications for performance of interventions endoscopic. RESULTS EEC square: 1-3 years - 12.6±1.91 mm2, diameter is 4.01±0.59 mm; 4-7 years - 16.8±1.34 mm2, diameter is 5.34±0.43 mm; 8-11 years - 21.7±1.38 mm2, diameter is 6.9±0.45 mm; 12-18 years - 31.3±4.27 mm2, diameter is 9.96±1.4 mm. The difference between parameters at each of age groups was statistically reliable. Comfortable work endoscopically is possible with EEC square 20.4±3.19 mm2 and more. This corresponds to average value of EEC in 8-18 years. CONCLUSIONS Endoscopic ear surgery is inexpedient in children up to 4 years. It is necessary to expect that intervention will be exigeant and transition to the microscopic equipment is required in case of 4-7 years old patients. Endoscopic ear surgery can be used with success to performance of various manipulations and surgical interventions on a middle ear in patients 8-18 years old.
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Affiliation(s)
- Yu Yu Rusetsky
- National Medical Research Center for Children's Health, Moscow, Russia
| | - I Yu Meitel
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A V Anikin
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A E Pashkova
- National Medical Research Center for Children's Health, Moscow, Russia
| | - S K Arutyunyan
- National Medical Research Center for Children's Health, Moscow, Russia
| | - E O Rozmanov
- National Medical Research Center for Children's Health, Moscow, Russia
| | - O V Krasivicheva
- National Medical Research Center for Children's Health, Moscow, Russia
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Abstract
Respiratory viruses are responsible for a variety of clinical syndromes including the common cold, acute otitis media, laryngitis, sinusitis, pneumonia, bronchiolitis, influenza-like illness, and exacerbations of asthma and chronic obstructive pulmonary disease. Diagnosis of respiratory viral infections is primarily clinical and is further supported by laboratory techniques such as antigen detection, serology, and nucleic acid detection. Preventive strategies are based on avoidance of risk factors and, in case of influenza, vaccination. Treatment modalities include over-the-counter and non-specific remedies along with a small number of specific antiviral medications such as the influenza neuraminidase inhibitors or palivizumab against respiratory syncytial virus.
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