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

BACKGROUND: In humans, the acidic pH of the ear canal plays a protective role against infection and a change towards alkalinity of the external auditory canal (EAC) is a local factor in the progression of acute to chronic otitis externa (OE). The use of acidic preparations alone for treatment of OE without concurrent antibiotic use is well-documented in humans. In dogs, only one study has investigated the EAC pH in healthy dogs and in dogs with OE, and investigations to understand the role of EAC pH in the pathogenesis of canine OE are lacking. HYPOTHESIS/OBJECTIVES: To obtain physiological EAC pH values in beagle dogs. To develop a model of re-acidification of the EAC in dogs and to investigate how an acidic solution may accelerate the return to a physiological pH. ANIMALS: Ten healthy beagle dogs in a laboratory setting. MATERIALS AND METHODS: A model of re-acidification of the EAC was developed by instillation of a pH 10.1 phosphate-buffered saline (PBS) solution and the subsequent acidic effect of an ear cleaner containing lipacids was evaluated in this model. RESULTS: Mean physiological EAC pH was 6.12 (± 0.36). EAC re-acidification took up to 9 h in this model. Mean pH values dropped immediately to 6.38 (± 0.27) on ears treated with an acidic ear cleaner. No abrupt drop was observed of the mean pH values for the control ears. CONCLUSION AND CLINICAL IMPORTANCE: This study confirms that physiological EAC pH in dogs is acidic. This model of re-acidification of the EAC pH allows investigations on acidic properties of topical ear products in healthy ears.

Contexte - Chez l'homme, le pH acide du conduit auditif joue un rôle protecteur contre l'infection et l'évolution vers l'alcalinité du conduit auditif externe (CAE) et est un facteur local de progression de l'otite externe (OE) aiguë à chronique. L'utilisation de préparations acides seules pour le traitement de l'OE sans utilisation concomitante d'antibiotiques est bien documentée chez l'homme. Chez les chiens, une seule étude a étudié le pH du CAE chez les chiens en bonne santé et chez les chiens atteints d'OE, et les recherches pour comprendre le rôle du pH du CAE dans la pathogenèse de l'OE canine font défaut. Hypothèses/objectifs - Obtenir des valeurs physiologiques de pH du CAE chez des chiens beagle. Développer un modèle de réacidification du CAE chez le chien et étudier comment une solution acide peut accélérer le retour à un pH physiologique. Animaux - Dix chiens beagle de laboratoire en bonne santé. Matériels et méthodes - Un modèle de réacidification du CAE a été développé par instillation d'une solution saline tamponnée (PBS) à pH 10,1 et l'effet acide ultérieur d'un nettoyant pour oreilles contenant des lipacides a été évalué dans ce modèle. Résultats - Le pH physiologique moyen du CAE était de 6,12 (± 0,36). La réacidification du CAE a pris jusqu'à 9 h dans ce modèle. Les valeurs moyennes du pH chutent immédiatement à 6,38 (± 0,27) sur les oreilles traitées avec un nettoyant auriculaire acide. Aucune chute brutale n'a été observée des valeurs moyennes de pH pour les oreilles témoins. Conclusion et importance clinique - Cette étude confirme que le pH physiologique du CAE chez le chien est acide. Ce modèle de réacidification du pH du CAE permet des investigations sur les propriétés acides des produits topiques auriculaires dans des oreilles saines.

Introducción; en humanos, el pH ácido del canal auditivo juega un papel protector contra la infección y un cambio hacia la alcalinidad del canal auditivo externo (EAC) es un factor local en la progresión de la otitis externa (OE) aguda a crónica. El uso de preparaciones ácidas solas para el tratamiento de la OE sin el uso concomitante de antibióticos está bien documentado en humanos. En perros, solo un estudio ha investigado el pH de EAC en perros sanos y en perros con OE, y faltan investigaciones para comprender el papel del pH de EAC en la patogenia de la OE canina. Hipótesis/objetivos - Obtener valores de pH fisiológico de EAC en perros beagle. Desarrollar un modelo de reacidificación del EAC en perros e investigar cómo una solución ácida puede acelerar el retorno a un pH fisiológico. Animales- diez perros beagle sanos en un laboratorio. Materiales y métodos- se desarrolló un modelo de reacidificación del EAC mediante la instilación de una solución salina tamponada con fosfato (PBS) de pH 10,1 y se evaluó en este modelo el efecto ácido subsiguiente de un limpiador de oídos que contenía lípidos. Resultados - El pH fisiológico medio del EAC fue de 6,12 (± 0,36). La reacidificación de EAC tomó hasta 9 h en este modelo. Los valores medios de pH cayeron inmediatamente a 6,38 (± 0,27) en los oídos tratados con un limpiador de oídos ácido. No se observó una caída abrupta de los valores medios de pH para los oíds de control. Conclusión e importancia clínica- este estudio confirma que el pH fisiológico de EAC en perros es ácido. Este modelo de reacidificación del pH de EAC permite realizar investigaciones sobre las propiedades ácidas de los productos tópicos para el oído en oídos sanos.

Contexto - Em humanos, o pH ácido do conduto auditivo exerce uma grande função protetora contra infecções e a alcalinização do conduto auditivo externo (CAE) é um fator local de progressão de otite externa (OE) aguda para crônica. A utilização unicamente de formulações ácidas para o tratamento de OE sem a utilização concomitante de antibióticos é bem documentada em humanos. Em cães, apenas um estudo investigou o pH do CAE em cães saudáveis com OE, e são escassas as pesquisas investigando o papel do pH do CAE na patogênese da OE. Hipótese/objetivos - Se obter os valores fisiológicos do pH dos CAEs de cães Beagle. Desenvolver um modelo de re-acidificação do CAE em cães e investigar como uma solução ácida pode acelerar o retorno ao pH fisiológico original. Animais - Dez cães Beagle saudáveis de laboratório. Materiais e Métodos - Um modelo de re-acidificação do CAE foi desenvolvido por instilação de solução salina tamponada com fosfato (PBS) com um pH 10,1 e o efeito acidificante subsequente de um limpador de ouvido contendo ácidos lipídicos foi avaliado neste modelo. Resultados - O pH fisiológico médio do CAE foi de 6,12 (± 0,36). A re-acidificação do CAE levou até 9h neste modelo. Os valores médios de pH caíram imediatamente para 6,38 (± 0,27) nas orelhas tratadas com um limpador otológico ácido. Não foi observada queda abrupta dos valores médios de pH para as orelhas controle. Conclusão e importância clínica - Este estudo confirmou que o pH fisiológico do CAE de cães é ácido. Este modelo de re-acidificação do pH do CAE permite investigações sobre as propriedades acidificantes de produtos otológicos tópicos para orelhas saudáveis.

Clinical analysis and nonsurgical management of 11 dogs with aural cholesteatoma.

BACKGROUND: Aural cholesteatomas, also called tympanokeratomas, are destructive and expansile growths of keratinizing epithelium that develop in the middle ear. They have been reported sporadically in dogs, and surgery is usually the recommended treatment. OBJECTIVES: To describe the common clinical, radiological and histological findings of cholesteatoma; to report on the outcome of conservative management. ANIMALS: Eleven dogs (13 ears) with cholesteatomas. METHODS AND MATERIALS: Medical records were reviewed for dogs diagnosed with cholesteatoma between 2012 and 2018. All dogs had computed tomography (CT) and/or magnetic resonance imaging (MRI) followed by trans-canal endoscopic procedure (TEP) for removal and biopsy of middle ear lesions. Dogs were then treated with in-clinic flushing initially weekly tapered to monthly, as well as at-home ear cleaning and application of topical otic steroid medication, initially daily then tapered to once or twice weekly. RESULTS: Nine dogs had a history of chronic otitis externa; head tilt or facial paralysis was present in seven and four cases, respectively. Otic examination identified a protruding nodule in seven ears. CT demonstrated soft tissue-like material in 12 bullae and expansion in seven bullae. MRI revealed minimally contrast-enhancing bulla contents in 12 ears. Post-TEP and with maintenance medical treatment, nine ears had no further signs of middle ear disease during a mean follow-up of 27.9 months. CONCLUSIONS AND CLINICAL IMPORTANCE: The results suggest that otitis externa may not necessarily precede cholesteatoma in all dogs. MRI appears to be more sensitive than CT for identifying cholesteatomas. Conservative treatment of cholesteatomas could be useful before or as an alternative to surgery.

Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment.

Scalping is considered a complex wound with difficult treatment, requiring early surgical intervention, reconstructive plastic surgery, and a multidisciplinary team. The reconstruction of the scalp frequently requires a combination of therapies, including temporary coverage, such as negative pressure wound therapy (NPWT). Complications of NPWT, such as bleeding, infection, and pain, have been described. However, there is no report of acute otitis externa (AOE) because of NPWT. In this article, we present an unprecedented clinical case - a female patient who developed AOE after scalping treatment with NPWT applied over the head and ear canal. We consider that it may be a result of the direct physical action of subatmospheric pressure, the presence of dressing covering the external meatus, and alteration of the bacterial population.

Complication Rates After Bilateral versus Unilateral Total Ear Canal Ablation with Lateral Bulla Osteotomy for End-Stage Inflammatory Ear Disease in Dogs: 79 Ears.

OBJECTIVE: To determine whether perioperative complication rates are different between unilateral (ULS) versus single-stage bilateral (BLSS) total ear canal ablation-lateral bulla osteotomy (TECA-LBO) surgeries. STUDY DESIGN: Retrospective case series. ANIMALS: Fifity-seven dogs (79 ears) undergoing TECA-LBO at a single institution over 14 years. METHODS: Medical records of dogs undergoing TECA-LBO for end-stage inflammatory non-neoplastic ear disease from March 1999 to September 2013 at the Colorado State University Veterinary Teaching Hospital were evaluated for intraoperative and early postoperative complications associated with the procedure. Inclusion criteria were clinical and/or histopathologic diagnosis of chronic otitis externa, surgical treatment by TECA-LBO, and a minimum of 2 week follow-up data. RESULTS: Twenty dogs (40 ears) underwent BLSS and 37 dogs (39 ears) had ULS. Complications were recorded for 29 of 40 ears (72.5%) in the BLSS group (40.0% facial nerve, 15.0% ocular, and 32.5% minor incisional complications) and 25 of 39 ears (64.1%) in the ULS group (33.3% facial nerve, 12.8% ocular, and 23.1% minor incisional complications). Dogs undergoing BLSS did not have a significantly higher total complication rate, or higher neurologic, ocular, or incisional complication rates, than the ULS procedure. No major anesthetic complications affecting outcome were recorded for either group. CONCLUSION: Anesthetic and early surgical complication rates after ULS and BLSS were not significantly different in our study. Offering single-stage bilateral TECA-LBO procedures for otherwise healthy dogs with end-stage inflammatory otitis externa is a viable treatment option without additional risk for complication.

[The current views of the treatment of diffuse external otitis].

The objective of the present study was to evaluate the clinical effectiveness and safety of the local application of triderm for the treatment of diffuse external otitis. The study included 68 patients presenting with bacterial and fungal diffuse external otitis. The treatment in the form of local empiric therapy was continued till the results of microbiological treatment became apparent. The beneficial outcome achieved in 91.2% of the patients was clinically manifest as the regression of the inflammatory process in the external auditory meatus. No complications, such as ototoxic events, either local or systemic allergic reactions, were documented. The authors substantiate the possibility of the application of the medication under consideration for the treatment of diffuse external otitis based on the knowledge of the mechanism of the actin of its constituent components, viz. betamethasone, dipropionate, gentamicin sulfate, and clotrimazole, taking into account the occurrence of the most common causative agents of diffuse external otitis. It is concluded that triderm is a safe medication for the local application and, probably, for the initial empiric therapy of diffuse external otitis to be continued till the results of the microbiological treatment become apparent.

[Acute external otitis and its differential diagnosis]. / Die akute Otitis externa und ihre Differenzialdiagnosen.

Acute external otitis is an inflammation of the ear canal, which can involve the pinna and the tympanic membrane. The history typically differentiates the presence of predisposing factors or contact with potentially contaminated water (swimmer's ear). A sudden onset with occurrence of ear pain, itching, otorrhea, and a physical examination revealing an inflammation of the ear canal and pain caused by manipulation on the tragus or pulling the pinna are crucial to the diagnosis. In uncomplicated acute external otitis, without the presence of risk factors, the therapy consists of cleaning the ear canal, application of topical medication and sufficient analgesic therapy. In the presence of a perforated tympanic membrane or the presence of a tympanostomy tube no ototoxic drugs may be prescribed. In general, the inflammation is responsive to the treatment, within 48-72 hours and is generally resolved after 6-7 days.

Risk of otitis externa following manual cerumen removal.

OBJECTIVES: Based on an interpretation of a recent Joint Commission protocol to sterilize instruments coming into contact with mucous membranes, there has been institutional interest in sterile packaging of cerumen curettes used for manual cerumen removal. To date, there are no studies that have assessed the risk of otitis externa (OE) following cerumen removal and the utility of sterile packaging is questionable. The objective of this study is to assess the incidence of OE following cerumen disimpaction prior to the implementation of sterile packaging at our institution. METHODS: This was a retrospective chart review. Over a I-year period, 1457 episodes of manual cerumen removal took place in the otolaryngology clinic. Charts were assessed for signs or symptoms of OE within 2 weeks of the procedure through follow-up phone calls and clinic visits in the otolaryngology division. RESULTS: There were no patients who followed up with symptoms or signs suggestive of OE in the 2-week postprocedure period. CONCLUSION: There is no evidence that OE is a complication of manual cerumen removal when performed by otolaryngologists using clean technique. Unnecessary sterilization of tools leads to increased cost and time for this common outpatient procedure performed by the otolaryngologist.

Short- and long-term outcomes of subtotal ear canal ablation and lateral bulla osteotomy in French bulldogs.

The objective of this retrospective study was to report the overall peri-operative complications and short- to long-term outcomes of subtotal ear canal ablation and lateral bulla osteotomy in French bulldogs with otitis media. Medical records from 2018 to 2021 were reviewed for preoperative neurological signs, surgical technique, postoperative complications, and long-term outcomes. Postoperative complications, such as a head tilt, nystagmus, ataxia, facial nerve dysfunction, as well as skin or wound infection, were recorded. Eighteen client-owned dogs (20 ears) were included in the study. Postoperative complications were observed in 5/18 dogs (6/20 ears) with 2 of them being considered major complications. Referring veterinarians and owner telephone follow-up (mean: 33 mo, range: 17 to 56 mo) were obtained for all patients. Total recovery was reported in 9/18 dogs (11/20 ears) with a postoperative improvement of the vestibular signs and facial nerve paresis within 8 wk. All dogs maintained the pinnas' natural, erect morphology, and movement.

L'objectif de cette étude rétrospective était de rapporter les complications peropératoires globales et les résultats à court et à long terme de l'ablation subtotale du conduit auditif et de l'ostéotomie de la bulle latérale chez les bouledogues français atteints d'otite moyenne. Les dossiers médicaux de 2018 à 2021 ont été examinés pour les signes neurologiques préopératoires, la technique chirurgicale, les complications postopératoires et les résultats à long terme. Les complications postopératoires, telles qu'une inclinaison de la tête, un nystagmus, une ataxie, un dysfonctionnement du nerf facial, ainsi qu'une infection de la peau ou des plaies, ont été enregistrées. Dix-huit chiens de propriétaires (20 oreilles) ont été inclus dans l'étude. Des complications postopératoires ont été observées chez 5/18 chiens (6/20 oreilles) dont 2 ont été considérées comme des complications majeures. Les vétérinaires référents et le suivi téléphonique des propriétaires (moyenne : 33 mois, intervalle : 17 à 56 mois) ont été obtenus pour tous les patients. Une récupération totale a été rapportée chez 9/18 chiens (11/20 oreilles) avec une amélioration postopératoire des signes vestibulaires et une parésie du nerf facial en 8 semaines. Tous les chiens ont conservé la morphologie et le mouvement naturels et dressés des pinnas.(Traduit par Docteur Serge Messier).

Fungal Infections of the External Auditory Canal and Emerging Pathogens.

Fungal infections of the external auditory canal can range from common (otomycosis) to life threatening (necrotizing otitis externa). Proper identification of fungal pathogens is necessary to guide appropriate therapy, and a high index of suspicion for fungal causes of ear canal disease is critical. Fungal pathogens may be an especially important cause of ear canal disease in certain populations, including patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients. Opportunistic fungal infections of the ear canal are an emerging concern.

ENT function in a 14-days guinness scuba dive.

Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances.

Bilateral mastoiditis from red tide exposure.

BACKGROUND: Bilateral mastoiditis in adults has previously been reported only in association with diabetes mellitus or immunocompromised patients. OBJECTIVES: To describe a case of bilateral mastoiditis in a healthy adult and to investigate the etiology. CASE REPORT: A 53-year-old woman presented to the Emergency Department with bilateral otitis externa and mastoiditis after scuba diving during a harmful algal bloom, commonly known as a "red tide." The levels of coliform bacteria recorded at the time and location of her dive exceeded health regulatory limits and correlate with her atypical culture results. CONCLUSION: Elevated bacterial counts that result from harmful algal blooms may account for this rare infection.

[Exostoses of the external auditory canal in professional diving. A case for the German Social Accident Insurance Institution]. / Berufstaucher mit Gehörgangsexostosen. Ein Fall für die Berufsgenossenschaft.

Exostoses of the external auditory canal are often diagnosed incidentally but may also cause complications, e.g., conductive hearing loss and/or recurrent inflammations of the external ear canal due to stenosis. This paper presents current scientific data on the pathogenesis of ear canal exostoses, which obviously focus on the cold water hypothesis. We present a case of an expert opinion on occupational illness and discuss whether the legal preconditions for recognition "like an occupational disease" according to article 9(2) Social Code Book VII are met. A systematic reporting of suspected cases is recommended in order to obtain reliable data on the epidemiology and the clinical course of external auditory exostoses among individuals occupationally exposed to cold water and to enter an expert discussion on the reasonability of an inclusion in the list of occupational diseases.

[Anomalies of the first branchial cleft - a review]. / Fehlbildungen der ersten Kiemenfurche - eine Übersicht.

BACKGROUND: Fistulas, sinus or cysts which trace back to anomalies of the first branchial cleft are seldom compared to lateral neck cysts and fistulas. For their accurate diagnosis and safe treatment special embryological and anatomical knowledge is necessary. MATERIAL AND METHODS: Embryology, anatomy, diagnosis and therapy are described and explained by 2 case studies in context to the current literature. RESULTS AND CONCLUSION: Sonography and contrast-enhanced radiological methods represent the fundamental pillar of the diagnosis. Therapeutically, the complete extirpation is the first choice. Surgeries on children, patients with extended fistulas and special cases of fistula routes require particular carefulness. In certain cases with pronounced findings and low levels of symptoms a "wait-and-see" strategy can be justified. Surgically, protection of the facial nerve and prevention of recurrences are the greatest challenge.

[When external otitis does not heal]. / Kun korvakäytävätulehdus ei paranekaan.

An illness initially started as external otitis in a healthy and physically fit middle-aged person turned out to be a difficult-to-manage Langerhans cell histiocytosis. The disease occurs mostly in children, and international clinical guidelines have accordingly been devised mainly for juvenile patients. Treatment of adult patients is thus essentially empirical. The disease may affect several organs, as in our case report, in which the disease after progression to a multisystemic disease led to secondary leukemia and death of the patient.

[Local antibacterial therapy for the inflammatory diseases of the external and middle ear].

The objective of the present study was to estimate the efficacy and safety of candibioic designed for the treatment of the patients presenting with diffuse otitis externa and chronic otitis media. The open randomized trial included 40 patients with diffuse otitis externa and 40 ones with chronic otitis media who had undergone a surgical sanitation procedure. Their standard clinical and otorhinolaryngological examination was supplemented by the characteristic of clinical symptoms and personal complaints using the 10-score scale. The composite preparation candibiotic was found to be equally effective for the treatment of both diffuse otitis externa and chronic otitis media. The results of the study give reason to recommend the use of candibiotic as an efficacious and safe drug for the treatment of these conditions.

Chronic Otitis Externa Secondary to Tympanic Membrane Electrode Placement in Rhesus Macaques (Macaca mulatta).

Otitis externa (OE) is a condition that involves inflammation of the external ear canal. OE is a commonly reported condition in humans and some veterinary species (for example, dogs, cats), but has not been reported in the literature in macaques. Here, we present a case series of acute and chronic OE likely precipitated by abrasion of the ear canal with a tympanic membrane electrode in 7 adult male rhesus macaques (Macaca mulatta). All animals displayed purulent, mucinous discharge from 1 or both ears with 3 macaques also displaying signs of an upper respiratory tract (URT) infection during the same period. A variety of diagnostic and treatment options were pursued including consultation with an otolaryngologist necessitated by the differences in response to treatment in macaques as compared with other common veterinary species. Due to the nature of the studies in which these macaques were enrolled, standard audiological testing was performed before and after OE, including tympanometry, auditory brainstem responses (ABRs), and distortion product otoacoustic emissions (DPOAEs). After completion of study procedures, relevant tissues were collected for necropsy and histopathology. Impaired hearing was found in all macaques even after apparent resolution of OE signs. Necropsy findings included abnormalities in the tympanic membrane, ossicular chain, and middle ear cavity, suggesting that the hearing impairment was at least partly conductive in nature. We concluded that OE likely resulted from mechanical disruption of the epithelial lining of the ear canal by the ABR electrode, thereby allowing the development of opportunistic infections. OE, while uncommon in macaques, can affect them and should be included as a differential diagnosis of any macaque presenting with otic discharge and/or auricular discomfort.

[External otitis in children: etiology and principles of therapy].

External otitis accounts for 21 to 25% of all inflammatory ear diseases. This paper presents the original data providing a deeper insight into etiology of this disease taking into consideration the great variety of its pathogenic agents, the possibility of development of mixed forms, and changes of whether conditions at the peak of morbidity. In addition, the results of assessment of the efficacy of Pimafucort designed for both mono- and combined therapy of the disease of interest are reported.