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1.
PLoS One ; 15(3): e0229226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163427

RESUMO

In medicine, a misdiagnosis or the absence of specialists can affect the patient's health, leading to unnecessary tests and increasing the costs of healthcare. In particular, the lack of specialists in otolaryngology in third world countries forces patients to seek medical attention from general practitioners, whom might not have enough training and experience for making correct diagnosis in this field. To tackle this problem, we propose and test a computer-aided system based on machine learning models and image processing techniques for otoscopic examination, as a support for a more accurate diagnosis of ear conditions at primary care before specialist referral; in particular, for myringosclerosis, earwax plug, and chronic otitis media. To characterize the tympanic membrane and ear canal for each condition, we implemented three different feature extraction methods: color coherence vector, discrete cosine transform, and filter bank. We also considered three machine learning algorithms: support vector machine (SVM), k-nearest neighbor (k-NN) and decision trees to develop the ear condition predictor model. To conduct the research, our database included 160 images as testing set and 720 images as training and validation sets of 180 patients. We repeatedly trained the learning models using the training dataset and evaluated them using the validation dataset to thus obtain the best feature extraction method and learning model that produce the highest validation accuracy. The results showed that the SVM and k-NN presented the best performance followed by decision trees model. Finally, we performed a classification stage -i.e., diagnosis- using testing data, where the SVM model achieved an average classification accuracy of 93.9%, average sensitivity of 87.8%, average specificity of 95.9%, and average positive predictive value of 87.7%. The results show that this system might be used for general practitioners as a reference to make better decisions in the ear pathologies diagnosis.


Assuntos
Otopatias/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Adolescente , Adulto , Cerume/diagnóstico por imagem , Criança , Árvores de Decisões , Diagnóstico por Computador/métodos , Diagnóstico Precoce , Humanos , Masculino , Pessoa de Meia-Idade , Miringoesclerose/diagnóstico por imagem , Otite Média/diagnóstico por imagem , Sensibilidade e Especificidade , Máquina de Vetores de Suporte , Adulto Jovem
2.
Vet Parasitol Reg Stud Reports ; 15: 100267, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30929937

RESUMO

Visceral leishmaniosis (VL) remains a serious public health problem in Brazil. Dogs are the main hosts of the parasite, developing canine leishmaniosis (CanL), hence the importance of an accurate diagnosis of the animals. Recently, the application of qPCR method to non-invasive samples obtained from dogs with CanL has shown high sensitivity. Thus, we analyzed by qPCR blood, hair (from healthy zones and cutaneous lesions) and cerumen of 16 dogs with confirmed leishmaniosis from Araçatuba, a Brazilian endemic area. Cerumen-qPCR showed the highest sensitivity (87.5%), followed by hair (lesions: 78.57%, healthy skin: 62.5%), and blood (68.75%). We also analyzed blood, hair and cerumen of 5 healthy dogs from a non-endemic area, obtaining 100% of specificity in all samples. The use of cerumen and hair for qPCR analysis provides high reliability, taking into account the sensitivity and total specificity of the method. The non-invasive sampling procedure without the need of specific conditions of storage and transport support the usefulness of hair and cerumen for the diagnosis of CanL.


Assuntos
Cerume/parasitologia , Doenças do Cão/diagnóstico , Cabelo/parasitologia , Leishmaniose Visceral/veterinária , Reação em Cadeia da Polimerase em Tempo Real , Animais , Anticorpos Antiprotozoários/sangue , Brasil , Doenças do Cão/parasitologia , Cães/parasitologia , Leishmania infantum/genética , Leishmania infantum/isolamento & purificação , Leishmaniose Visceral/sangue , Leishmaniose Visceral/diagnóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
3.
Vet Dermatol ; 30(4): 334-e96, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31025463

RESUMO

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.


Assuntos
Doenças do Gato/diagnóstico , Curetagem/métodos , Doenças do Cão/diagnóstico , Infestações por Ácaros/veterinária , Otoscopia/métodos , Animais , Doenças do Gato/parasitologia , Gatos , Cerume/parasitologia , Doenças do Cão/parasitologia , Cães , Orelha/parasitologia , Infestações por Ácaros/diagnóstico , Psoroptidae , Sensibilidade e Especificidade
4.
S Afr J Commun Disord ; 66(1): e1-e7, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30843412

RESUMO

BACKGROUND:  There is evidence that the factors contributing to the prevalence and aetiology of hearing impairment vary widely from one country to another. In South Africa, as in other low-income and middle-income countries, more context-specific information on the estimated prevalence of hearing impairment and the factors that contribute to its onset is required. AIM:  The aim of this study was to provide decision-makers and hearing health professionals with local and accurate information on the prevalence of ear and hearing disorders in the Elias Motsoaledi Local Municipal (EMLM) area of the Limpopo province, South Africa. METHODS:  The World Health Organization (WHO) protocol for population-based surveys of prevalence and causes of deafness, hearing impairment and other ear diseases was utilised. A random multi-stage cluster sampling strategy, two-stage sampling, was utilised to select the seven municipal wards and 357 households through the probability proportional to size method. A total of 850 participants were included in the study. RESULTS:  The overall prevalence of hearing impairment was 19.88% (95% confidence interval [CI]: 0.15-0.2) and 8.94 (95% CI: 0.08-0.12) for disabling hearing impairment. The prevalence of ear disease was 13.19% (95% CI: 0.10-0.15), with impacted cerumen and otitis media reported most often. Associations with hearing impairment were established for age, gender and hypertension. CONCLUSION:  The study has shown a higher prevalence of disabling hearing impairment in the rural EMLM area of the Limpopo province compared to global prevalence rates. In addition, known factors associated with hearing impairment were confirmed.


Assuntos
Perda Auditiva/epidemiologia , Adolescente , Adulto , Idoso , Cerume , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Otite Média/epidemiologia , Prevalência , Fatores de Risco , População Rural , África do Sul/epidemiologia , Adulto Jovem
5.
Auris Nasus Larynx ; 46(5): 803-807, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30898404

RESUMO

OBJECTIVE: In this study, we aimed to evaluate the diagnoses of the infants who were admitted to our outpatient clinic with the complaint of pulling on the ear and to identify the related factors which may contribute to the diagnosis. METHODS: This prospective study included a total of 102 infants who were admitted to our hospital with the complaint of tugging and pulling on, touching, and rubbing the ears on the shoulder or pillow and shaking the head between July 2016 and July 2017. The complaints were evaluated throughout the day, and the application seasons, the person referred the patient to the ear, nose, and throat (ENT) specialist, the child development specialist and child psychiatrist, allergy and atopy histories, and the relationship between the results and diagnoses were evaluated. RESULTS: 46.1% of the patients had normal examination findings, while the second most common finding was cerumen in 37.2%, and the third one was otitis media with effusion (OME) in 16.7%. In infants who were directly referred by the family, normal and serological diagnosis were found to be statistically significantly higher than that of OME diagnosis, whereas in the infants referred by the family physicians and pediatrist, the OME was found to be statistically significantly higher than normal and cerumen levels. The presence of additional complaints in the OME group was found to be higher than normal and cerumen group. In those with complaints during the day, the most common finding was OME, while it was cerumen in those with complaints a few times in a day and normal examination finding in those tugging on their ears only, when they were falling asleep, indicating statistical significance. Of 47 infants with normal physical examination findings, 37 were assessed by the child psychiatrist, and depression was found in six of one of the parents during the family interviews. CONCLUSION: In this study, the majority of the infants referred to the ENT outpatient clinic had normal examination findings, while the rate of OME diagnosis was high. Considering the negative consequences of EOM in infants, the diagnosis of the EOM becomes extremely important. If there are no otologic pathologies in the majority of infants who were admitted with ear pulling and tugging, the possibility of different factors in etiology gives rise to thought. Therefore, further studies are required to prove this condition.


Assuntos
Cerume , Orelha , Comportamento do Lactente/fisiologia , Otite Média com Derrame/fisiopatologia , Otopatias , Feminino , Humanos , Lactente , Masculino , Otite Média com Derrame/diagnóstico , Pediatras , Médicos de Família , Estudos Prospectivos , Encaminhamento e Consulta , Estações do Ano
6.
Ann Otol Rhinol Laryngol ; 128(8): 704-707, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30924345

RESUMO

OBJECTIVES: The aim of this study was to assess a new device designed to safely remove cerumen from the external auditory canal in an office setting with minimal training. METHODS: The research was conducted in the Department of Otolaryngology at Kaplan Medical Center in Israel. Patients with cerumen were treated with the device. Efficacy, safety, and pain were evaluated using scales developed for this experiment. The cerumen obstruction scale (0-5) was assessed before and after the procedure. Improvement by 2 or more grades was considered to indicate at successful procedure. RESULTS: Fifty-nine ears in 46 patients were treated. Seventeen patients (37%) had recurrent cerumen impaction, and 14 (30.4%) used cotton swabs frequently. Fifty-two ears (88%) had hard cerumen. The procedure was successful in 51 ears (86.4%). In 48 ears (81%) there was no pain or mild pain, and in 11 ears (19%), the patient reported the procedure to be uncomfortable. Seven patients (15.2%) asked to abort the procedure because of discomfort or pain. In 39 ears (66%), the cerumen was evacuated easily. Inspection after the procedure revealed no injury in 56 ears (95%). Three ears (5%) had mild irritation of the ear canal, and none had injury to the tympanic membrane. Median length of the procedure was 30 ± 42.1 seconds (range, 2-240 seconds). The median number of insertions of the device in 1 procedure was 2 (range 1-7; SD, 1.3). CONCLUSIONS: The tested device is an effective and safe device for the evacuation of cerumen. It can be used by general practitioners, pediatricians, and audiologists.


Assuntos
Cerume , Irrigação Terapêutica/instrumentação , Adolescente , Adulto , Idoso , Meato Acústico Externo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
7.
Am Fam Physician ; 98(8): 525-529, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30277727

RESUMO

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.


Assuntos
Cerume , Ceruminolíticos/normas , Ceruminolíticos/uso terapêutico , Perda Auditiva/diagnóstico , Perda Auditiva/terapia , Irrigação Terapêutica/normas , Zumbido/diagnóstico , Zumbido/terapia , Currículo , Educação Médica Continuada , Humanos , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Estados Unidos
9.
J Laryngol Otol ; 132(9): 840-841, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30099978

RESUMO

BACKGROUND: External auditory canal exostoses are known to occur in patients who engage in cold-water sports. Although the majority of patients with exostosis remain asymptomatic, larger lesions can cause wax impaction, conductive hearing loss and predispose to recurrent otitis externa. OBJECTIVE: A novel technique is described of using a piezo saw to excise exostoses that are symptomatic. The piezo saw is used to perform various procedures, but its use in removing exostoses has not been described in the literature. CONCLUSION: Excision of exostoses of the ear canal using a piezo saw is a safe technique and patients have a speedy recovery. This paper describes a new technique for removing exostoses.


Assuntos
Meato Acústico Externo/cirurgia , Neoplasias da Orelha/cirurgia , Exostose/cirurgia , Piezocirurgia/instrumentação , Assistência ao Convalescente , Cerume/metabolismo , Meato Acústico Externo/patologia , Neoplasias da Orelha/patologia , Exostose/patologia , Perda Auditiva Condutiva/etiologia , Humanos , Otite Externa/complicações , Dor Pós-Operatória/complicações , Recidiva , Zumbido/complicações , Resultado do Tratamento
10.
Cochrane Database Syst Rev ; 7: CD012171, 2018 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-30043448

RESUMO

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.


Assuntos
Cerume , Meato Acústico Externo , Higiene , Tensoativos/uso terapêutico , Adulto , Antipirina/uso terapêutico , Benzocaína/uso terapêutico , Peróxido de Carbamida , Carbonatos/uso terapêutico , Criança , Clorobutanol/uso terapêutico , Colina/análogos & derivados , Colina/uso terapêutico , Ácido Dioctil Sulfossuccínico/uso terapêutico , Combinação de Medicamentos , Etanolaminas/uso terapêutico , Humanos , Peróxidos/uso terapêutico , Soluções Farmacêuticas/uso terapêutico , Óleos Vegetais/uso terapêutico , Potássio/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Salicilatos/uso terapêutico , Cloreto de Sódio/uso terapêutico , Ureia/análogos & derivados , Ureia/uso terapêutico , Água
11.
Cochrane Database Syst Rev ; 7: CD004326, 2018 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-30040120

RESUMO

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.


Assuntos
Cerume/efeitos dos fármacos , Solventes/administração & dosagem , Detergentes/administração & dosagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Seringas
12.
Int J Audiol ; 57(9): 703-706, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29869562

RESUMO

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.


Assuntos
Audiologistas/tendências , Cerume , Padrões de Prática Médica/tendências , Irrigação Terapêutica/tendências , Audiologistas/educação , Estudos Transversais , Luvas Cirúrgicas/tendências , Desinfecção das Mãos/tendências , Pesquisas sobre Serviços de Saúde , Comunicação em Saúde/tendências , Humanos , Projetos Piloto , Estudos Prospectivos , Medição de Risco , África do Sul , Irrigação Terapêutica/efeitos adversos
13.
J Mycol Med ; 28(2): 396-398, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29673769

RESUMO

Fungal otitis (otomycosis) is a common infection encountered by otolaryngologists. Nevertheless, its management can be challenging because of its high recurrence rate and of the limited therapeutic options. A 45-year-old woman suffered from recurrent otomycosis. The ineffectiveness of successive antibiotic cures and repeated topical treatments with nystatin and then with econazole cream led to perform microbiological analyses. Culture of ear swab grew Aspergillus niger. The use of a 1% voriconazole sterile solution previously validated for treatment of eye infections was considered after ensuring the absence of known ototoxic effects of the antifungal and of the excipients. The patient was advised to apply locally this voriconazole solution daily for 14 days (3 drops, 3-4 times a day). Full recovery was obtained at the end of the treatment, and no relevant side effects were noticed. More than one year after completion of therapy, there was no recurrence. Our observation shows that voriconazole 1% solution is an interesting option for treating otomycosis which failed to respond to usual therapeutic options. Further prospective studies are now warranted to confirm these findings.


Assuntos
Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergillus niger/efeitos dos fármacos , Otomicose/tratamento farmacológico , Voriconazol/uso terapêutico , Administração Tópica , Antifúngicos/administração & dosagem , Cerume/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Nistatina/uso terapêutico , Otomicose/microbiologia , Estudos Prospectivos , Resultado do Tratamento , Voriconazol/administração & dosagem
14.
Med Hypotheses ; 114: 19-22, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29602456

RESUMO

Cholesteatoma is an ear disease based on a locally destructive noncancerous conglomerate of epidermis and keratin debris. Abnormal growth of stratified keratinized squamous epithelium in the temporal bone causes destruction of the outer and middle ear, potentially leading to hearing impairment, facial palsy, vertigo, lateral sinus thrombosis, and intracranial complications. Although cholesteatoma is effectively treated by surgical resection (mastoidectomy), the lack of effective and nonsurgical therapies potentially results in fatal consequences, establishing the need for a comprehensive investigation of cholesteatoma pathogenesis. Although its etiology is still being debated, interestingly, we found that the trend associated with the 538G allele frequency of the adenosine triphosphate-binding cassette transporter C11 (ABCC11) gene, the determinant of wet-type earwax, and ethnic groups was similar to that between the incidence of cholesteatoma and ethnic groups (countries). The incidences of cholesteatoma in Europe (Denmark, Finland, and Scotland) are higher than in East Asia (Japan), and the frequencies of the ABCC11 538G allele in African, American, and European (Finland and Scotland) populations are higher than those in East Asian populations (Japan). Additionally, a single-nucleotide polymorphism in the ABCC11 gene (rs17822931, 538G > A; Gly180Arg) is closely related to earwax morphotypes. While earwax is often beneficial to ear health, it is sometimes harmful in cases where it causes hearing impairment. Based on independent findings of associations between ABCC11 and the physiological environment of the auditory canal, we hypothesize a possible link between ABCC11, earwax, and the incidence of cholesteatoma.


Assuntos
Transportadores de Cassetes de Ligação de ATP/genética , Cerume , Colesteatoma/complicações , Colesteatoma/genética , Alelos , Comorbidade , Frequência do Gene , Genótipo , Humanos , Incidência , Modelos Teóricos , Polimorfismo de Nucleotídeo Único
16.
Am J Vet Res ; 79(3): 333-341, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29466046

RESUMO

OBJECTIVE To determine the pharmacokinetics of florfenicol, terbinafine, and betamethasone acetate after topical application to canine auricular skin and the influence of synthetic canine cerumen on pharmacokinetics. SAMPLE Auricular skin from 6 euthanized shelter dogs (3 females and 3 neutered males with no visible signs of otitis externa). PROCEDURES Skin adjacent to the external opening of the ear canal was collected and prepared for use in a 2-compartment flow-through diffusion cell system to evaluate penetration of an otic gel containing florfenicol, terbinafine, and betamethasone acetate over a 24-hour period. Radiolabeled 14C-terbinafine hydrochloride and 3H-betamethasone acetate were added to the gel to determine dermal penetration and distribution. Florfenicol absorption was determined by use of high-performance liquid chromatography-UV detection. Additionally, the effect of synthetic canine cerumen on the pharmacokinetics of all compounds was evaluated. RESULTS During the 24-hour experiment, mean ± SD percentage absorption without the presence of synthetic canine cerumen was 0.28 ± 0.09% for 3H-betamethasone acetate, 0.06 ± 0.06% for florfenicol, and 0.06 ± 0.02% for 14C-terbinafine hydrochloride. Absorption profiles revealed no impact of synthetic canine cerumen on skin absorption for all 3 active compounds in the gel or on skin distribution of 3H-betamethasone acetate and 14C-terbinafine hydrochloride. CONCLUSIONS AND CLINICAL RELEVANCE 3H-betamethasone acetate, 14C-terbinafine hydrochloride, and florfenicol were all absorbed in vitro through healthy auricular skin specimens within the first 24 hours after topical application. Synthetic canine cerumen had no impact on dermal absorption in vitro, but it may serve as a temporary reservoir that prolongs the release of topical drugs.


Assuntos
Betametasona/farmacocinética , Cerume , Cães/metabolismo , Naftalenos/farmacocinética , Pele/efeitos dos fármacos , Tianfenicol/análogos & derivados , Administração Cutânea , Animais , Cerume/química , Cromatografia Líquida de Alta Pressão/veterinária , Feminino , Géis , Masculino , Pele/metabolismo , Absorção Cutânea/efeitos dos fármacos , Terbinafina , Tianfenicol/farmacocinética
17.
Ann Otol Rhinol Laryngol ; 127(4): 253-257, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29426243

RESUMO

OBJECTIVE: To investigate associations between age, external auditory canal (EAC) dimensions, and cerumen retention/impaction among persons with Down syndrome (DS). METHODS: This cross-sectional study evaluated EAC dimensions, cerumen retention/impaction, and middle ear status with pneumatoscopy after extraction in 130 persons with DS. Descriptive and inferential statistics correlated age, presence of impacted/retained cerumen, and EAC diameter. RESULTS: Of 260 ears in 67 males and 63 females with average age of 9.48 years, 72.3% (188) had EAC of ≤4 mm. Those ≤1 year were 4.97 times more likely to have cerumen problems than those >1 year (95% CI, 1.45-17.02, P = .011). The odds of having cerumen problems with an EAC diameter of ≤4 mm were 3.31 times higher than with a diameter of 5 mm (95% CI, 1.46-7.50, P = .004), and odds of having cerumen impaction were as much as 6.19 times higher (95% CI, 2.38-16.08, P < .001). Male gender and low-lying external ear were also associated with increased odds of cerumen problems. CONCLUSION: There is a high prevalence of cerumen retention/impaction in persons with DS compared to the general Philippine population and a higher prevalence rate for EAC stenosis than elsewhere. A canal diameter of 4 mm and below and age 1 year or less are associated with a significantly higher likelihood of cerumen retention/impaction.


Assuntos
Cerume , Síndrome de Down/epidemiologia , Meato Acústico Externo , Otopatias , Orelha Média , Fatores Etários , Cerume/diagnóstico por imagem , Cerume/fisiologia , Criança , Constrição Patológica , Estudos Transversais , Técnicas de Diagnóstico Otológico , Meato Acústico Externo/patologia , Meato Acústico Externo/fisiopatologia , Otopatias/diagnóstico , Otopatias/epidemiologia , Otopatias/fisiopatologia , Orelha Média/patologia , Orelha Média/fisiopatologia , Feminino , Humanos , Masculino , Filipinas/epidemiologia , Fatores de Risco
18.
Int J Pediatr Otorhinolaryngol ; 103: 133-136, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29224754

RESUMO

OBJECTIVES: To determine the prevalence of chronic ear disease in HIV+, highly active anti-retroviral therapy (HAART)-treated children and compare this to the prevalence in healthy children of similar age living in a similar setting. INTRODUCTION: From previous clinical work in Ethiopia, we suspected that chronic middle ear disease was common both in the general pediatric population and especially among children with HIV/AIDS. Few studies have examined the prevalence of chronic ear disease in HIV + children, particularly in those treated with HAART. METHODS: Full examination of the head and neck was performed by otolaryngologists. This including cleaning of cerumen, otoscopy and microscopic otoscopy when needed. Patient's medical records were reviewed. Presence or absence of tympanic membrane (TM) perforation (unilateral or bilateral), tympanosclerosis, TM atrophy, otorrhea and/or cholesteatoma was documented. RESULTS: 112 HIV+ and 162 healthy (HIVU) children were included. Prevalence of TM perforations was 17% in the HIV + infected versus 3% in the HIVU (Fisher's-Exact-Test; OR: 7.2, 95% CI 2.5-20, p-value <0.0001). Presence of unilateral TM perforations was 12% in the HIV + population and 2% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 2.0-22, p-value 0.002). The presence of bilateral perforations was 4% in the HIV + population and 1% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 1.1-42, p-value 0.088). In the HIV + cohort, 2% were diagnosed with cholesteatoma compared to 0% in the HIVU population (95% CI HIV+ 0.002-0.06; HIVU 0.0-0.02) and 8% of HIV + subjects had active middle ear discharge, compared to 0% in the HIVU population (95% CI HIV+ 0.04-0.1; HIVU 0.0-0.02). Neither tympanosclerosis nor tympanic membrane atrophy was more frequent in the HIV + population compared to the HIVU population. Persistent or recurrent TM perforation was not more frequent in children with prior tympanoplasty in the HIV + population compared to the HIVU population. CONCLUSION: TM perforations are significantly more common in HAART-treated HIV + children than in healthy, age-matched HIVU population. Otorrhea and cholesteatoma were found only in the HIV + cohort.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Otopatias/epidemiologia , Infecções por HIV/complicações , Adolescente , África ao Sul do Saara/epidemiologia , Terapia Antirretroviral de Alta Atividade/métodos , Cerume , Criança , Pré-Escolar , Doença Crônica , Otopatias/complicações , Otopatias/cirurgia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Otoscopia , Prevalência , Membrana Timpânica
19.
Biochem Med (Zagreb) ; 27(3): 030503, 2017 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-29180914

RESUMO

Cerumen or earwax is an emerging bio-fluid in clinical diagnosis that has been very little exploited during the past decades in spite of its high diagnostic potential. It is highly abundant in diagnostic biomarkers such as genetic material, lipids, proteins, chemical elements, internal and external metabolites (e.g. hormones, volatile organic compounds, amino acids, xenobiotics etc.) reaching earwax from the blood circulation. Thus, it is able to reflect not only physiology, pathophysiology of the human body but can also detect recent and long term exposure to environmental pollutants, without the need of invasive blood tests and in the same time overcoming many disadvantages faced by using other diagnostic biological fluids. This review discusses the biology, functions, chemistry of earwax, past and current approaches for the study of its chemical composition, emphasizing how a detected variation in its composition can offer information of high clinical value, which can be useful in diagnosis of many diseases such as metabolic disorders and tumours as well as in forensic applications. It also presents details about techniques of sample collection, storage, and analysis. Moreover, it highlights concerns about the use of earwax for diagnostic purposes, which should be addressed to make earwax diagnostics a reality in the future.


Assuntos
Cerume/metabolismo , Biomarcadores/química , Biomarcadores/metabolismo , Cerume/química , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/metabolismo , Humanos , Metabolômica , Doença de Parkinson/diagnóstico , Doença de Parkinson/metabolismo , Proteômica
20.
Am J Audiol ; 26(3S): 426-429, 2017 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-29025012

RESUMO

Purpose: Technology and connectivity advances are demonstrating increasing potential to improve access of service delivery to persons with hearing loss. This article demonstrates use cases from community-based hearing screening and automated diagnosis of ear disease. Method: This brief report reviews recent evidence for school- and home-based hearing testing in underserved communities using smartphone technologies paired with calibrated headphones. Another area of potential impact facilitated by technology and connectivity is the use of feature extraction algorithms to facilitate automated diagnosis of most common ear conditions from video-otoscopic images. Results: Smartphone hearing screening using calibrated headphones demonstrated equivalent sensitivity and specificity for school-based hearing screening. Automating test sequences with a forced-choice response paradigm allowed persons with minimal training to offer screening in underserved communities. The automated image analysis and diagnosis system for ear disease demonstrated an overall accuracy of 80.6%, which is up to par and exceeds accuracy rates previously reported for general practitioners and pediatricians. Conclusion: The emergence of these tools that capitalize on technology and connectivity advances enables affordable and accessible models of service delivery for community-based ear and hearing care.


Assuntos
Acesso aos Serviços de Saúde , Perda Auditiva/diagnóstico , Testes Auditivos/métodos , Visita Domiciliar , Otite Média/diagnóstico , Otoscopia/métodos , Serviços de Saúde Escolar , Smartphone , Audiologia , Automação , Cerume , Criança , Assistência à Saúde , Otopatias/diagnóstico , Humanos , Processamento de Imagem Assistida por Computador , Programas de Rastreamento , Tecnologia , Gravação em Vídeo
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