Otoscopy and tympanometry outcomes from the National Health and Nutrition Examination Survey (NHANES).

PURPOSE: The purpose of the study was to estimate the prevalence of conductive pathologies based on tympanometric and otoscopic findings in adults in the U.S. and examine relationships between abnormal findings and audiometrically defined or reported perceived hearing loss and tinnitus. MATERIALS AND METHODS: Data from 3409 individuals aged 20-69 years from the 1999-2000 and 2000-2002 cycles of the National Health and Nutrition Examination Survey (NHANES) were analyzed. Outcomes included report of ear tubes, self-perceived hearing loss, and tinnitus (yes or no). Otoscopy involved screening for presence of cerumen (ear wax) and physical abnormality for each ear. Ear-specific tympanometry included measures of middle ear pressure, external ear volume, tympanometric width, and admittance/compliance for each ear. Mean and prevalence estimates are provided applying sample weights. A multivariate ordinal regression model adjusting for age, sex, race/ethnicity, and education was used to examine relationships between otoscopy or tympanometry measures with hearing loss and tinnitus. RESULTS: Approximately 12% of the sample showed evidence of abnormal tympanometry and 12% showed evidence of abnormal otoscopy in at least one ear. Measured hearing loss was consistently related to tympanometry outcomes, in both univariate and adjusted models, but perceived hearing loss and tinnitus were not related to abnormal tympanometry or otoscopy. The most common reason for abnormal otoscopy was presence of excessive or impacted cerumen, representing an estimated 10% of the population. CONCLUSIONS: With 1 out of 10 adults having excessive cerumen, adults considering over-the-counter (OTC) hearings aids may benefit from an ear examination prior to purchase.

The Outcome of Cerumen Removal in the Pediatric Emergency Department.

OBJECTIVE: Cerumen obstructs the visualization of the tympanic membrane (TM) in up to 40% of children, sometimes posing a challenge to rule out the diagnosis of acute otitis media (AOM) as the source of otalgia (for verbal children), irritability, fever, and febrile seizures. We aim to determine the rate at which removing the cerumen from blocking the view of the TM could change the management of these patients in the pediatric emergency department (PED). METHODS: We retrospectively investigated all medical records of patients who underwent cerumen removal in the PED at a tertiary children's hospital from 2018 to 2019. We analyzed the effect of the procedure on the subsequent workup during their PED visit. RESULTS: Of 482 children who presented to the PED with otalgia, irritability, fever, and/or febrile seizures and who were referred to an otolaryngologist for subsequent treatment after preliminary evaluation in the PED, 176 were included in the study group after having the cerumen removed from one or both ears. Seventy-three of them were given a diagnosis of AOM, 93 had a normal-appearing TM, and 10 had external otitis. Twenty-one percent of those with AOM and 46% of those with a normal TM ( P = 0.008) had blood drawn as part of their workup in their PED visit. The rate of chest x-rays was also significantly less for the AOM group (16% vs 30%, P = 0.03), and they also underwent fewer urine tests ( P = NS). CONCLUSION: Cerumen removal changes the management of children in the PED who present with a possible diagnosis of an ear infection. Cerumen removal could avoid unnecessary laboratory and imaging studies, which could save time, costs, and suffering.

Identification of cattle poisoning by Bifenthrin via earwax analysis by HS/GC-MS.

The use of pyrethroids has increased over recent years, and corresponds to a higher exposure of animals to pesticide residues in the environment and diet. Here, an outbreak of pyrethroid poisoning in beef cattle was reported occurring in Midwestern Brazil. After veterinary evaluation, it was observed that the bovines presented common pyrethroid intoxication symptoms. Aiming to identify the cattle poising by pyrethroid, earwax samples were collected from two groups: exposed and nonexposed animals from the same farm. Blind earwax analyses of the bovines were carried out using headspace/gas chromatography-mass spectrometry (HS/GC-MS). The HS/GC-MS analysis detected the presence of bifenthrin in the earwax analysis of the exposed animals, confirmed by the comparison of its MS fragments with a bifenthrin standard, and also by its retention time relative to the internal standard. In summary, HS/GC-MS analysis of earwax emerges as a tool that can be used in the detection and monitoring of bifenthrin poisoning in cattle, as a useful veterinary diagnosis that ensures animal health and the safety of their products.

Educating Nursing Staff in a Long-Term Care Facility on Cerumen Impactions and Cerumenolytic Administration.

The current article examines the importance of educating nursing staff in a long-term care facility (LTCF) on cerumen impactions and the proper administration of cerumenolytics. An educational session on cerumen impactions and cerumenolytic administration was provided to nursing staff with pre-, post-, and follow-up tests. Findings included an increase in confidence levels of the nursing learning objectives post-education, as well as an overall improvement in knowledge retention. According to the nurses surveyed, they had never been educated on either topic. It is estimated that up to 65% of residents aged >65 years living in LTCFs are affected by cerumen impactions and the many symptoms associated with them, including hearing loss. Therefore, education on these topics for nursing staff who care for this high-risk population would be beneficial. [Journal of Gerontological Nursing, 47(4), 35-43.].

A volatolomic approach using cerumen as biofluid to diagnose bovine intoxication by Stryphnodendron rotundifolium.

An innovative volatolomic approach employs the detection of biomarkers present in cerumen (earwax) to identify cattle intoxication by Stryphnodendron rotundifolium Mart., Fabaceae (popularly known as barbatimão). S. rotundifolium is a poisonous plant with the toxic compound undefined and widely distributed throughout the Brazilian territory. Cerumen samples from cattle of two local Brazilian breeds ('Curraleiro Pé-Duro' and 'Pantaneiro') were collected during an experimental intoxication protocol and analyzed using headspace (HS)/GC-MS followed by multivariate analysis (genetic algorithm for a partial least squares, cluster analysis, and classification and regression trees). A total of 106 volatile organic metabolites were identified in the cerumen samples of bovines. The intoxication by S. rotundifolium influenced the cerumen volatolomic profile of the bovines throughout the intoxication protocol. In this way, it was possible to detect biomarkers for cattle intoxication. Among the biomarkers, 2-octyldecanol and 9-tetradecen-1-ol were able to discriminate all samples between intoxicated and nonintoxicated bovines. The cattle intoxication diagnosis by S. rotundifolium was accomplished by applying the cerumen analysis using HS/GC-MS, in an easy, accurate, and noninvasive way. Thus, the proposed bioanalytical chromatography protocol is a useful tool in veterinary applications to determine this kind of intoxication.

Cerumen impaction was composed of abnormal exfoliation of keratinocytes that was correlated with infection.

OBJECTIVE: This study investigated the exact composition and tried to be helpful in explaining the etiologic mechanism of cerumen impaction in the external auditory canal (EAC). METHODS: A hundred impacted cerumen samples and 15 normal cerumen samples were collected by manual removal and divided into 2 groups. All samples were examined via microbial culture, hematoxylin-eosin staining, periodic acid-Schiff staining, and fungal fluorescent staining. RESULTS: Eighty-eight patients in group 1 were in the habit of using cotton buds. Forty-seven impacted cerumen samples tested positive for microbes, while only 1 sample of normal cerumen tested positive for microbes (p < .05). The most commonly isolated bacterium and fungus was Staphylococcus aureus and Aspergillus terreus respectively. All cerumen samples were composed of exfoliated keratinocytes and microorganisms assessed via pathologic examination. However, unlike normal cerumen, impacted cerumen contained nucleated keratinocytes and infiltrated neutrophils. Recurrent impaction was found only among patients who tested mold culture-positive. CONCLUSION: Impacted cerumen is composed of abnormal exfoliated keratinocytes that was correlated with microbial-induced neutrophil-mediated inflammation. Mold infection is highly correlated with recurrent cerumen impaction. Microbial culture of removed impacted cerumen is strongly recommended. Ear cleaning with cotton buds, particularly when the EAC is wet might be one of the important causes of cerumen impaction which is need further studied. LEVEL OF EVIDENCE: 2b.

Temporary threshold shift following ear canal microsuction.

Objectives: To investigate a temporary threshold shift (TTS) of hearing and pain/discomfort caused by the microsuction procedure. Hearing loss induced by impacted cerumen was also investigated.Design: Impacted cerumen was removed from patients using microsuction. Hearing assessments were carried out before the procedure, immediately after and 1-week later. Hearing thresholds measured in different sessions were compared to determine the TTS caused by the microsuction procedure and hearing loss induced by impacted cerumen. A questionnaire was used to evaluate the pain/discomfort experienced by patients.Study Sample: 30 patients (50 ears) were recruited from a cerumen removal clinic.Results: Significant hearing loss caused by impacted earwax was found across individual frequencies (mean 11.4 dB, maximum 38.1 dB). A TTS appeared in 43/50 (86%) ears, ranging from 0 to 16.2 dB averaged across frequencies between 0.25 and 8 kHz, with the highest TTS at 6 kHz. Pain and discomfort levels were both rated low, the mean levels were 1.2 (SD = 0.5) and 1.6 (SD = 0.5) respectively on a scale from 1 to 10.Conclusions: Microsuction appears to be a well-tolerated and preferred procedure for removing impacted cerumen. Because of the significant TTS induced by the microsuction procedure, safety concerns from a hearing perspective should be raised with the patient.

Comparison of three methods for the diagnosis of otoacariasis due to Otodectes cynotis in dogs and cats.

BACKGROUND: The diagnosis of otoacariasis due to Otodectes cynotis is based on the visualization of the parasite, either directly by otoscopy or indirectly after microscopic examination of cerumen collected by several methods. OBJECTIVES: To compare the sensitivity of three techniques: conventional handheld otoscopy, Volkmann's curette sampling and cotton-tipped swabbing. ANIMALS: Five dogs and 12 cats (30 naturally infested ears). METHODS AND MATERIALS: For each case, following otoscopy, the order of examinations (swab or curette) was chosen randomly and the samples were observed on a slide mixed with lactophenol and covered with a coverslip. Parasite detection was noted as positive or negative and parasitic stages were counted separately. RESULTS: The diagnostic sensitivity of otoscopy alone was 67% (positive in 20 of 30 cases), using the curette sampling it was 93% (28/30) and 57% (17/30) for the swabbing. The curette technique had a significantly higher sensitivity than classic ear-swabbing (P = 0.001) or otoscopy alone (P = 0.02). Combining otoscopy and the curette, we obtained a sensitivity of 100% compared to 86% when otoscopy and swabbing were combined. Moreover, the parasite count in the curette samples (average 25 ± 30 SD) was significantly higher than the swab samples (4.5 ± 11) (P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE: When suspecting O. cynotis infestation, otoscopic examination should be performed. To confirm the nature of the parasites observed or whenever this examination result is negative, doubtful or cannot be performed, the curettage sampling method for microscopic cerumen examination is recommended.

WITHDRAWN: Ear drops for the removal of ear wax.

BACKGROUND: Problems attributed to the accumulation of wax (cerumen) are among the most common reasons for people to present to their general practitioners with ear trouble. Treatment for this condition often involves use of a wax softening agent (cerumenolytic) to disperse the cerumen, reduce the need for, or facilitate syringing, but there is no consensus on the effectiveness of the variety of cerumenolytics in use. OBJECTIVES: To assess the effectiveness of ear drops (cerumenolytics) for the removal of symptomatic ear wax. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008 issue 2); MEDLINE; EMBASE; CINAHL; ISI Proceedings; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was April 2008. SELECTION CRITERIA: We identified all randomised controlled trials in which a cerumenolytic was compared with no treatment, a placebo, or other cerumenolytics in participants with obstructing or impacted ear wax, and in which the proportion of participants with sufficient clearance of the external canal to make further mechanical clearance unnecessary (primary outcome measure) was stated or calculable. DATA COLLECTION AND ANALYSIS: The two authors reviewed all the retrieved trials and applied the inclusion criteria independently. MAIN RESULTS: Nine trials satisfied the inclusion criteria. In all, 679 participants received one of 11 different cerumenolytics. One trial compared active treatments with no treatment, three compared active treatments with water or a saline 'placebo', and all nine trials compared two or more active treatments. Eight trials included syringing as a secondary intervention.Overall, results were inconclusive. The majority of comparisons showed no difference between treatments.  Meta-analysis of two high quality trials produced a statistical difference in favour of triethanolamine polypeptide over saline in preventing the need for syringing, but no other significant differences between treatments.In three trials of high to moderate quality, no difference was found between the effectiveness of either sodium bicarbonate ear drops, chlorbutanol, triethanolamine polypeptide oleate condensate or docusate sodium liquid versus a sterile water or saline 'placebo'.One trial of moderate methodological quality found all three treatments - sodium bicarbonate ear drops, chlorbutanol and sterile water - to be significantly better than no treatment at preventing the need for syringing.None of the higher quality trials demonstrated superiority of one agent over another in direct comparisons. AUTHORS' CONCLUSIONS: Trials have been heterogeneous and generally of low or moderate quality, making it difficult to offer any definitive recommendations on the effectiveness of cerumenolytics for the removal of symptomatic ear wax. Using drops of any sort appears to be better than no treatment, but it is uncertain if one type of drop is any better than another. Future trials should be of high methodological quality, have large sample sizes, and compare both oil-based and water-based solvents with placebo, no treatment or both.

Ear drops for the removal of ear wax.

BACKGROUND: Ear wax (cerumen) is a normal bodily secretion that can become a problem when it obstructs the ear canal. Symptoms attributed to wax (such as deafness and pain) are among the commonest reasons for patients to present to primary care with ear trouble.Wax is part of the ear's self-cleaning mechanism and is usually naturally expelled from the ear canal without causing problems. When this mechanism fails, wax is retained in the canal and may become impacted; interventions to encourage its removal may then be needed. Application of ear drops is one of these methods. Liquids used to remove and soften wax are of several kinds: oil-based compounds (e.g. olive or almond oil); water-based compounds (e.g. sodium bicarbonate or water itself); a combination of the above or non-water, non-oil-based solutions, such as carbamide peroxide (a hydrogen peroxide-urea compound) and glycerol. OBJECTIVES: To assess the effects of ear drops (or sprays) to remove or aid the removal of ear wax in adults and children. SEARCH METHODS: We searched the Cochrane ENT Trials Register; Cochrane Register of Studies; PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 March 2018. SELECTION CRITERIA: Randomised controlled trials (RCTs) in which a 'cerumenolytic' was compared with no treatment, water or saline, an alternative liquid treatment (oil or almond oil) or another 'cerumenolytic' in adults or children with obstructing or impacted ear wax. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcomes were 1) the proportion of patients (or ears) with complete clearance of ear wax and 2) adverse effects (discomfort, irritation or pain). Secondary outcomes were: extent of wax clearance; proportion of people (or ears) with relief of symptoms due to wax; proportion of people (or ears) requiring further intervention to remove wax; success of mechanical removal of residual wax following treatment; any other adverse effects recorded and cost. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS: We included 10 studies, with 623 participants (900 ears). Interventions included: oil-based treatments (triethanolamine polypeptide, almond oil, benzocaine, chlorobutanol), water-based treatments (docusate sodium, carbamide peroxide, phenazone, choline salicylate, urea peroxide, potassium carbonate), other active comparators (e.g. saline or water alone) and no treatment. Nine of the studies were more than 15 years old.The overall risk of bias across the 10 included studies was low or unclear. PRIMARY OUTCOME: proportion of patients (or ears) with complete clearance of ear waxSix studies (360 participants; 491 ears) contributed quantitative data and were included in our meta-analyses.Active treatment versus no treatmentOnly one study addressed this comparison. The proportion of ears with complete clearance of ear wax was higher in the active treatment group (22%) compared with the no treatment group (5%) after five days of treatment (risk ratio (RR) 4.09, 95% confidence interval (CI) 1.00 to 16.80); one study; 117 ears; NNTB = 8) (low-quality evidence).Active treatment versus water or salineWe found no evidence of a difference in the proportion of patients (or ears) with complete clearance of ear wax when the active treatment group was compared to the water or saline group (RR 1.47, 95% CI 0.79 to 2.75; three studies; 213 participants; 257 ears) (low-quality evidence). Two studies applied drops for five days, but one study only applied the drops for 15 minutes. When we excluded this study in a sensitivity analysis it did not change the result.Water or saline versus no treatmentThis comparison was only addressed in the single study cited above (active versus no treatment) and there was no evidence of a difference in the proportion of ears with complete wax clearance when comparing water or saline with no treatment after five days of treatment (RR 4.00, 95% CI 0.91 to 17.62; one study; 76 ears) (low-quality evidence).Active treatment A versus active treatment BSeveral single studies evaluated 'head-to-head' comparisons between two active treatments. We found no evidence to show that one was superior to any other.Subgroup analysis of oil-based active treatments versus non-oil based active treatmentsWe found no evidence of a difference in this outcome when oil-based treatments were compared with non-oil-based active treatments. PRIMARY OUTCOME: adverse effects: discomfort, irritation or painOnly seven studies planned to measure and did report this outcome. Only two (141 participants;176 ears) provided useable data. There was no evidence of a significant difference in the number of adverse effects between the types of ear drops in these two studies. We summarised the remaining five studies narratively. All events were mild and reported in fewer than 30 participants across the seven studies (low-quality evidence).Secondary outcomesThree studies reported 'other' adverse effects (how many studies planned to report these is unclear). The available information was limited and included occasional reports of dizziness, unpleasant smell, tinnitus and hearing loss. No significant differences between groups were reported. There were no emergencies or serious adverse effects reported in any of the 10 studies.There was very limited or no information available on our remaining secondary outcomes. AUTHORS' CONCLUSIONS: Although a number of studies aimed to evaluate whether or not one type of cerumenolytic is more effective than another, there is no high-quality evidence to allow a firm conclusion to be drawn and the answer remains uncertain.A single study suggests that applying ear drops for five days may result in a greater likelihood of complete wax clearance than no treatment at all. However, we cannot conclude whether one type of active treatment is more effective than another and there was no evidence of a difference in efficacy between oil-based and water-based active treatments.There is no evidence to show that using saline or water alone is better or worse than commercially produced cerumenolytics. Equally, there is also no evidence to show that using saline or water alone is better than no treatment.

Cerumen Impaction: Diagnosis and Management.

Cerumen production is a normal and protective process for the ear canal. However, cerumen should be removed when it causes symptoms (e.g., hearing loss, itching, pain, tinnitus) or prevents assessment of the external auditory canal, the tympanic membrane, or audiovestibular system. Cerumen should also be removed when it limits examination in patients who cannot communicate their symptoms, such as those with dementia or developmental delay, nonverbal patients with behavioral changes, and young children with fever, speech delay, or parental concerns. Patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, and those taking antiplatelet or anticoagulant medications, should be counseled about the increased risk of bleeding in the external auditory canal when cerumen is removed. Effective treatment options include cerumenolytic agents, irrigation with or without cerumenolytic pretreatment, and manual removal. Home irrigation with a bulb syringe may be appropriate for selected adults. Cotton-tipped swabs, ear candling, and olive oil drops or sprays should be avoided. If multiple attempts to remove the impacted cerumen-including a combination of treatments-are ineffective, clinicians should refer the patient to an otolaryngologist. Persistent symptoms despite resolution of the impaction should also prompt further evaluation for an alternative diagnosis.

Practice patterns of South African audiologists in cerumen management: a pilot study.

OBJECTIVE: To determine the training, self-reported competence and practice patterns of South African audiologists (SAAs) regarding cerumen management (CM). DESIGN: Prospective cross-sectional survey. An online questionnaire was completed by SAA between July and September 2016. The questionnaire addressed sections on educational training, experience and practice patterns of SAAs regarding CM. STUDY SAMPLE: Three hundred and fifty-six SAAs responded to an email invitation sent to 382 actively-practicing audiologists. RESULTS: Majority of the participants (85%) were employed for less than 10 years. Forty-nine percent received less than 10 hours of theoretical training while 57% received less than 10 hours of clinical education. A total of 96% of the participants indicated they felt competent to perform CM, with 96% preferring manual, ear syringing, or a combination of the two. Handwashing pre- and post-procedure was the preferred method of infection prevention and control by 87% of the participants with 66% of these indicating they only wore gloves. Majority (85%) of the participants indicated that they always explained the possible complications of CM to their patients. CONCLUSION: Findings from this study indicate that South African audiologists feel that they are adequately trained and competent to perform CM.

Prevalence and causes of hearing impairment in Fundong Health District, North-West Cameroon.

OBJECTIVE: To estimate the prevalence and causes of hearing impairment in Fundong Health District, North-West Cameroon. METHODS: We selected 51 clusters of 80 people (all ages) through probability proportionate to size sampling. Initial hearing screening was undertaken through an otoacoustic emission (OAE) test. Participants aged 4+ years who failed this test in both ears or for whom an OAE reading could not be taken underwent a manual pure-tone audiometry (PTA) screening. Cases of hearing impairment were defined as those with pure-tone average ≥41 dBHL in adults and ≥35 dBHL in children in the better ear, or children under age 4 who failed the OAE test in both ears. Each case with hearing loss was examined by an ear, nose and throat nurse who indicated the main likely cause. RESULTS: We examined 3567 (86.9%) of 4104 eligible people. The overall prevalence of hearing impairment was 3.6% (95% confidence interval [CI]: 2.8-4.6). The prevalence was low in people aged 0-17 (1.1%, 0.7-1.8%) and 18-49 (1.1%, 0.5-2.6%) and then rose sharply in people aged 50+ (14.8%, 11.7-19.1%). Among cases, the majority were classified as moderate (76%), followed by severe (15%) and profound (9%). More than one-third of cases of hearing impairment were classified as unknown (37%) or conductive (37%) causes, while sensorineural causes were less common (26%). CONCLUSIONS: Prevalence of hearing impairment in North-West Cameroon is in line with the WHO estimate for sub-Saharan Africa. The majority of cases with known causes are treatable, with impacted wax playing a major role.

A Novel Association between the 27-bp Deletion and 538G>A Mutation in the ABCC11 Gene.

A single nucleotide polymorphism in the ABCC11 gene, 538G>A (rs17822931), is known to determine human ear wax type. The G/G and G/A genotypes correspond to the wet type, while the A/A genotype corresponds to the dry type. Another earwax determinant, a 27-bp deletion (Δ27) downstream from the rs17822931 site, is a rare variant that leads to the dry phenotype. In a previous report, we found an individual with the G allele who unexpectedly showed the dry type of earwax, leading to the identification of Δ27. We also demonstrated that the Δ27 allele was present in individuals of Japanese, Thai, native North American, Andean, and Bolivian ancestry but absent in those of European and African ancestry. Here, we assessed the Δ27 allele frequency among Japanese and Ukrainian individuals and identified a novel association between the Δ27 and 538G>A mutations. The Δ27 allele frequency was 0.002 (3/1,520; one individual is heterozygous, and another is homozygous) among Japanese individuals and 0 (0/794) among Ukrainians. We also found a previously unreported homozygous genotype for both the Δ27 and A alleles. Our findings suggest that the Δ27 deletion may have occurred in an ABCC11 gene with the 538G>A mutation.

Natural products isolated from Tetragonula carbonaria cerumen modulate free radical-scavenging and 5-lipoxygenase activities in vitro.

BACKGROUND: Propolis and cerumen are plant-derived products found in honeybees and stingless bees, respectively. Although propolis is an ancient folk medicine, the bioactivities of cerumen obtained from Australian native stingless bees (Tetragonula carbonaria) have not been widely studied. Therefore, we investigated selected anti-oxidant and anti-inflammatory properties of T. carbonaria cerumen. METHODS: A methanolic extract was prepared from the combined cerumen of 40 T. carbonaria hives, and HPLC was used to screen for chemical constituents that scavenged 2,2-azobis(2-methylpropionamidine) dihydrochloride (AAPH). The ability of cerumen extracts to scavenge 1,1-diphenyl-2-picrylhydrazyl (DPPH) and to interfere with leukotriene B4 (LTB4) production in ionomycin-stimulated human neutrophils was also examined. RESULTS: The extract dose-dependently scavenged DPPH (EC50 = 27.0 ± 2.3 µg/mL); and inhibited the 5-lipoxygenase (5-LOX)-mediated oxidation of linoleic acid (IC50 = 67.1 ± 9.6 µg/mL). Pre-treatment of isolated human neutrophils with the methanolic cerumen extract additionally inhibited the ionomycin-stimulated production of LTB4 from these cells (IC50 = 13.3 ± 5.3 µg/mL). Following multi-solvent extraction, the free radical-scavenging and 5-LOX-inhibiting activities of the initial cerumen extract were retained in a polar, methanol-water extract, which contained gallic acid and a range of flavonone and phenolic natural products. CONCLUSIONS: The findings identify free radical scavenging activity, and interference by extracts of T. carbonaria cerumen in 5-LOX-LTB4 signaling. Further investigation is needed to determine whether the extracts will provide therapeutic benefits for medical conditions in which oxidative stress and inflammation are implicated, including cardiovascular disease and impaired wound healing.

Otoscopic examinations reveal high prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa.

OBJECTIVE: To determine the prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa. DESIGN: Cross-sectional retrospective review of otoscopy results obtained during a school health screening campaign conducted between March and June 2015. Descriptive statistics through percentages and frequency tables were used to analyse the data. Logistic regression was used to determine associations between age, gender and pathologies observed. STUDY SAMPLE: Medical folders of 1089 pupils. RESULTS: Forty-nine percent had normal otoscopy results. A significant 36% (n = 392) had impacted cerumen. Furthermore, 45% of those with impacted cerumen were bilaterally impacted. Additionally, 4% presented with foreign bodies and a further 8% had otitis externa and otitis media. The remaining 3% had tympanic membrane perforations. The odds of developing outer and middle ear pathologies were higher in pupils below 6 years of age (p = 0.046). CONCLUSION: This study highlights a high prevalence of outer and middle ear pathologies in paediatrics in Limpopo and therefore recommends comprehensive baseline and periodic screenings; to identify children with outer and middle ear pathologies and need further management, and consequently prevent the complications of these pathologies. Additionally, this report highlights a rising need for large-scale research to provide comprehensive analysis of these pathologies.

The Effect of Ethnicity on Human Axillary Odorant Production.

Previous findings from our laboratory highlighted marked ethnic differences in volatile organic compounds (VOCs) from cerumen among individuals of Caucasian, East Asian, and African-American descent, based, in part, on genetic differences in a gene that codes for a transport protein, which is a member of the ATP-binding cassette transporter, sub-family C, member 11 (ABCC11). In the current work, we hypothesized that axillary odorants produced by East Asians would differ markedly from those obtained from individuals of European or African descent based on the pattern of ethnic diversity that exists in ABCC11. Using gas chromatography/mass spectrometry (GC/MS) we examined differences in axillary odorant VOCs among 30 individuals of African-American, Caucasian, and East Asian descent with respect to their ABCC11 genotype. While no qualitative differences in the type of axillary odorants were observed across ethnic groups, we found that characteristic axillary odorants varied quantitatively with respect to ethnic origin. We propose that ABCC11 is not solely responsible for predicting the relative amounts of volatiles found in axillary secretions and that other biochemical pathways must be involved.

Innovative technologies in diagnosing acute otitis media.

New guidelines for managing acute otitis media include stricter criteria for properly diagnosing the condition and ensuring an accurate diagnosis before clinicians make treatment decisions. This is key because of the increase in antibiotic-resistant pathogens. This article focuses on how clinicians can use ancillary techniques and technologies to improve diagnostic accuracy for acute otitis media. Techniques include proper cerumen removal, visualizing the tympanic membrane with the correct otoscope, pneumatic otoscopy, using a spectral gradient acoustic reflectometer, and tympanometry.

Does cerumen have a risk for transmission of HIV?

Human immunodeficiency virus (HIV) is mainly transmitted via sexual activity, mother-to-child transmission, and contact with body fluids, such as saliva and semen. Cerumen, however, has not been investigated for its capability to transmit HIV. The purpose of this study was to evaluate the potential of cerumen for transmission of HIV infection. This study was conducted among 42 treatment-naive HIV-infected patients with positive HIV RNA and 27 HIV-infected patients with negative HIV RNA receiving antiviral treatment. Simultaneous blood samples were studied as positive controls. Sixty-nine prospectively collected cerumen specimens were analyzed for the presence of HIV RNA by real-time polymerase chain reaction (PCR). None of the 69 cerumen specimens were positive for HIV RNA. These results conclude that cerumen in HIV-positive patients with or without antiretroviral therapy (ART) carry only an insignificant risk of transmission. However, standard infection control precautions should be applied carefully in all examinations and surgical operations of the ears.