Treatment of Recurrent Eczematous External Otitis with Honey Eardrops: A Proof-of-Concept Study.

Eczematous external otitis is a chronic inflammatory disease and often difficult to treat. Our objective was to investigate the clinical effect and in vitro antibacterial potential of medical honey eardrops as treatment of eczematous external otitis. In a prospective study, 15 patients diagnosed with recurrent eczematous external otitis were treated with medical honey eardrops for 2 weeks. The following clinical outcomes were evaluated: visual analog scale of ear complaints, score of eczema, and eradication of bacterial infection. Furthermore, the antibacterial effect of honey eardrops against different bacterial strains was tested in vitro. Treatment resulted in less discomfort and itching and decreased signs of eczema, with high patient satisfaction and without adverse reactions. Honey eardrops showed a strong in vitro inhibitory activity against all tested strains but did not eradicate Staphylococcus aureus infection in vivo. The results of this preliminary study indicate a possible role of honey eardrops in eczematous ear disease.

Temporomandibular joint involvement as a positive clinical prognostic factor in necrotising external otitis.

OBJECTIVE: Necrotising otitis externa is associated with high morbidity and mortality rates. This study investigated whether temporomandibular joint involvement had any prognostic effect on the course of necrotising otitis externa in patients who had undergone hyperbaric oxygen therapy after failed medical and sometimes surgical therapy. METHODS: A retrospective case series was conducted of patients in whom antibiotic treatment and surgery had failed, who had been hospitalised for further treatment and hyperbaric oxygen therapy. RESULTS: Twenty-three patients with necrotising otitis externa were identified. The temporomandibular joint was involved in four patients (17 per cent); these patients showed a constant gradual improvement in C-reactive protein and were eventually discharged free of disease, except one patient who was lost to follow up. Four patients (16 per cent) without temporomandibular joint involvement died within 90 days of discharge, while all patients with temporomandibular joint involvement were alive. Three patients (13 per cent) without temporomandibular joint involvement needed recurrent hospitalisation including further hyperbaric oxygen therapy; no patients with temporomandibular joint involvement required such treatment. CONCLUSION: Patients with temporomandibular joint involvement had lower rates of recurrent disease and no mortality. Therefore, we suggest considering temporomandibular joint involvement as a positive prognostic factor in necrotising otitis externa management.

Scedosporium apiospermum Otitis Complicated by a Temporomandibular Arthritis: A Case Report and Mini-Review.

Scedosporium apiospermum is an ubiquitous fungus responsible for various infections in immunocompromised and immunocompetent patients. Ear infections are infrequent. We report an exceptional case of S. apiospermum external otitis complicated by temporomandibular joint arthritis. After 6 months of antibiotherapy, diagnosis was established by mycological analysis of external auditory canal and infratemporal fossae needle sampling. A satisfactory outcome was obtained after 2 months of voriconazole alone. We have reviewed 15 cases of S. apiospermum otitis. Seven of these patients were immunocompromised. Most common clinical presentation included a chronic external otitis lasting months or years before complication stage. Most common clinical features included recurrent unilateral otalgia (11/15) and purulent otorrhea (13/15). Diagnosis was often made at later stage (12/15) with local extension to bones and/or soft tissues (9/15) or cerebral lethal dissemination (3/15).The extremely low incidence of S. apiospermum otomycosis and its non-specific presentation results in a frequent diagnosis delay. A mycological investigation should be performed in case of persistent external otitis and/or osteolysis despite prolonged antibiotic treatment to prevent further extension of the disease.

[Comparative characteristic of the local application of anti-inflammatory agents for the treatment of otitis externa and otitis media].

The objective of the present work was the clinical study of candibiotic exhibitic antibacterial, antimycotic, anti-inflammatory, and anesthetic properties when applied for the treatment of otitis externa and otitis media. This agent was included together with traditionally used systemic medications in the combined treatment of 26 patients. It was applied in the form of endoaural drops, transtubal administration through a catheter, and transtympanic pumping by the Politzer balloon technique (in case of perforation). In the patients with otomycosys, the preparation was used for the treatment of the external acoustic canal after the removal of fungal masses thrice daily for 1 month. Good clinical effect achieved in all the patients was manifest as the normal otoscopic picture and less frequent complaints on days 8-10 after the onset of therapy. Its maximum duration was 21 days. Positive dynamics (pain relief) was apparent within the first 2 days of the treatment. Fungal mycelium was absent after 14-16 days of the treatment in 100% of the patients initially presenting with yeast-like fungi.

Otitis externa por Staphylococcus aureus resistente a meticilina en un lactante / External otitis by Methicillin-resistant Staphylococcus aureus in an infant

Se presenta el caso clínico de un niño que presentó una otitis externa a los dos meses de edad. El cultivo ótico mostró un Staphylococcus aureus resistente a meticilina (SARM). Se realizó un estudio familiar en ambos padres resultando los cultivos nasales negativos. Posteriormente, estudiando la historia familiar se supo que la madre había tenido en el momento del parto un cultivo de herida quirúrgica positivo a SARM con el mismo antibiograma que el que presentaba el niño. Como en ese periodo de tiempo no se había hecho ningún tratamiento en el niño se volvió a repetir el cultivo para valorar la necesidad o no de tratamiento persistiendo el SARM. Se realizó tratamiento local con ciprofloxacino, siendo el cultivo de control negativo(AU)

We reported the case of a child two months old, with external otitis by Methicillin-Resistant Staphylococcus Aureus (MRSA). Nasal swabs were collected from the father and the mother with negative result. An intra-familial vertical transmission was identified later(AU)

A rare case of bilateral malignant otitis externa and osteomyelitis with lower cranial nerve sequelae.

The authors present the case of a 76-year-old male who presented with right-sided recurrent malignant otitis externa (MOE) and skull-base osteomyelitis. His management involved aggressive antimicrobial therapy and multiple hyperbaric oxygen treatments. After resolution of his right-sided infection, the patient returned a short time later with symptoms and findings consistent with new, left-sided MOE with involvement of the left skull-base. With repeat treatment, the patient is now cured of his infection but poses a challenge to the treating team about future management.

Otitis externa micótica y perforación timpánica: reporte de dos casos / Otomycosis and perforated tympanic membrane: two cases

La otitis externa constituye entre el 5 por ciento y 30 por ciento de las consultas de urgencia ORL y afecta al 10 por ciento de la población al menos 1 vez en la vida. La gran mayoría son de causa bacteriana, sólo el 15 por ciento a 20 por ciento son atribuidas a hongos. Las complicaciones son poco frecuentes alcanzando el 10 por ciento a 20 por ciento de los casos según la serie, siendo la perforación timpánica la más frecuente. Se presenta la evolución y tratamiento de 2 casos.

External otitis constitutes among 5 percent-30 percent of urgency ORL consultations and affects 10 percent of the population at least 1 time in their life. Most of them had a bacterial origin, only 15 percent to 20 percent are attributed to fungi. Otomycosis complications are slightly frequent reaching 10 percent to 20 percent of the cases according to diferent series, being the tympanic perforation the most frequent. We present 2 cases, their evolution and treatment.

Malignant otitis externa: case series.

BACKGROUND: In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population. METHOD: Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009. RESULTS: Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases. CONCLUSIONS: The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

[Malignant external otitis]. / Otitis externa necroticans.

Malignant external otitis or skull base osteomyelitis and osteoradionecrosis of the skull base and the skull are potentially life-threatening conditions. The standard methods of treatment involve the use of antibiotics, local treatment and, where necessary, surgical excision of necrotic tissue. These approaches do not provide a complete cure in many cases. Severe functional deficits and even death can occur in advanced stages. We conducted a long-term retrospective follow-up study and report on a multimodal approach that we have been using with great success since 1987. The four cornerstones of this treatment are surgical debridement, combinations of antibiotics, specific immunoglobulins, and adjunctive hyperbaric oxygen therapy. This multimodal treatment approach has proved to be highly effective in improving the survival and quality of life of the patients concerned. These excellent outcomes justify the high costs that this therapy admittedly involves.

Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation.

OBJECTIVE: We sought to document the diagnostic and management difficulties in masked skull base osteomyelitis secondary to malignant otitis externa, with emphasis on establishing diagnostic criteria in recurrence. STUDY DESIGN: Retrospective analysis of 3 cases of inadequately treated malignant otitis externa in elderly diabetic individuals leading to recurrence and atypical manifestations of skull base osteomyelitis on contralateral side with or without multiple cranial nerve involvement. RESULTS: Two of the 3 cases died of the disease despite aggressive treatment. One case was treated successfully with combination of antipsuedamonal microbial drugs for 8 to 12 weeks and hyperbaric oxygen therapy. Major complications such as thrombosis of lateral sinus and internal jugular vein, meningitis, ophthalmoplegia, blindness, cervical spine erosion and paralysis of all cranial nerves with exception of Ist cranial nerve were observed. CONCLUSION: There is high morbidity and mortality associated with skull base osteomyelitis. In partially treated cases of malignant otitis externa, atypical symptoms and findings of unilateral severe otalgia, unremitting headache, and presence of high ESR, unilateral OME, constitute diagnostic clues of skull base osteomyelitis. Such cases require further investigation with CT, MRI, Technetium 99 and gallium 67 scintigraphy and aggressive management.

Otitis externa aguda por Enterobacter cloacae

Enterobacter engloba a diferentes especies bacterianas que junto con Pseudomona son responsables de infecciones oportunistas, especialmente en enfermos hospitalizados. Presentamos 3 casos de otitis externa aguda debidos a Enterobacter cloacae que correspondían a 2 varones y 1 mujer, sin antecedentes personales de interés, atendidos en Urgencias de nuestro hospital. El Laboratorio de Microbiología al que remitimos las muestras óticas nos confirmó el aislamiento de este germen, poco frecuente como causa de otitis externa en la literatura y más aún en ausencia de inmunodepresión u hospitalización previa. La evolución de todos los pacientes fue satisfactoria tras el tratamiento. Realizamos una revisión de la literatura al respecto (AU)

Malignant otitis externa in an infant with selective IgA deficiency: a case report.

The occurrence of malignant otitis externa (MOE) in infancy is rare. We report a case of MOE in a neonate who was later identified to have selective IgA deficiency. She was successfully treated with oral ciprofloxacin, but developed external auditory canal stenosis, a deformed pinna, persistent facial nerve palsy, temporal bone erosion and hearing loss. No cases of MOE in selective IgA deficiency have been reported in literature. This is also the first report on the use of ciprofloxacin in infants with MOE.

Malignant otitis externa with optic neuritis.

Malignant otitis externa is a serious condition that presents difficulties in treatment, and also in monitoring its progress. A case of malignant otitis externa with optic neuritis is presented that remained refractory to standard treatment but was cured by adjuvant hyperbaric oxygen therapy. This is the only reported case that has survived this disease with optic neuritis. The usefulness of imaging techniques in this condition is discussed, as well as the ESR, in evaluating the effectiveness of treatment.

[Diagnostic criteria and therapy of malignant external otitis]. / Estado de los criterios diagnósticos y de la terapéutica de la otitis externa maligna.

The development of quinolone derivatives has completely changed the treatment and prognosis of malignant external otitis. Two cases are reported and the current diagnostic criteria are reviewed.

Malignant external otitis: treatment with fluoroquinolones.

Malignant external otitis (MEO) is still a potentially lethal disease. Early treatment based on a correct diagnosis is the most important single factor in achieving a cure for the disease. The preferred treatment is long-term systemic antibiotics followed by surgical intervention. Hyperbaric oxygen therapy may be supplemented in refractory cases. A new fluoroquinolone, Ciprofloxacin, has been successfully used in four cases of MEO which did not respond to the accepted treatment. Ciprofloxacin is active against a broad spectrum of bacteria, including Pseudomonas aeruginosa, and several clinical studies have demonstrated its efficacy in the treatment of urinary tract and soft tissue infections, osteomyelitis, pneumonia, and gastroenteritis. This report is the first of which we are aware to document the use of Ciprofloxacin in the treatment of MEO.

Subacute bacterial endocarditis following ear acupuncture.

Ear acupuncture followed by sepsis caused subacute bacterial endocarditis in a patient with rheumatic valve disease.

Complications of the treatment of malignant external otitis.

Malignant external otitis is an aggressive, potentially lethal infection of the temporal bone, the treatment of which is often fraught with complications. Among the reasons for these complications are the difficulty in assessing the extent of this disease, the uncertainty in determining the point at which treatment can be terminated, the toxic nature of the antibiotics used, and the technical difficulty of performing any surgery on the infected tissues. In those patients who receive inadequate initial therapy, the further extension of the disease itself represents a complication of treatment.