Subject(s)
Ear Diseases , Hemorrhage , Skull Fracture, Basilar , Humans , Ear Diseases/diagnosis , Ear Diseases/diagnostic imaging , Ear Diseases/etiology , Hemorrhage/diagnosis , Hemorrhage/diagnostic imaging , Hemorrhage/etiology , Skull Fracture, Basilar/diagnosis , Skull Fracture, Basilar/diagnostic imaging , Skull Fracture, Basilar/etiology , Ear, Middle/diagnostic imaging , Male , Adolescent , Otoscopy , Accidental Falls , Hearing Loss/etiologyABSTRACT
OBJECTIVE: To examine the otologic and neurotologic symptoms, physical examination findings, and imaging features secondary to hematologic malignancies. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases, including PubMed, Scopus, and CINAHL, were searched for articles including patients with otologic manifestations of leukemia, lymphoma and multiple myeloma. Data collected included patient and study demographics, specific hematologic malignancy, timing and classification of otologic symptoms, physical examination findings, imaging features and methods of diagnosis. Pooled descriptive analysis was performed. RESULTS: Two hundred seventy-two articles, of which 255 (93.8%) were case reports and 17 (6.2%) were case series, reporting on 553 patients were identified. Otologic manifestations were reported on 307 patients with leukemia, 204 patients with lymphoma and 42 patients with multiple myeloma. Hearing loss and unilateral facial palsy were the most common presenting symptoms for 111 reported subjects with leukemia (n = 46, 41.4%; n = 43, 38.7%) and 90 with lymphoma (n = 38, 42.2%; n = 39, 43.3%). Hearing loss and otalgia were the most common presenting symptoms for 21 subjects with multiple myeloma (n = 10, 47.6%; n = 6, 28.6%). Hearing loss and unilateral facial palsy were the most common otologic symptoms indicative of relapse in subjects with leukemia (n = 14, 43.8%) and lymphoma (n = 5, 50%). CONCLUSION: Hearing loss, facial palsy, and otalgia might be the first indication of a new diagnosis or relapse of leukemia, lymphoma, or multiple myeloma. Clinicians should have a heightened level of suspicion of malignant etiologies of otologic symptoms in patients with current or medical histories of these malignancies.
Subject(s)
Hematologic Neoplasms , Humans , Hematologic Neoplasms/complications , Hearing Loss/etiology , Lymphoma/complications , Multiple Myeloma/complications , Ear Diseases/etiology , Facial Paralysis/etiology , Leukemia/complicationsABSTRACT
BACKGROUND: Cocaine is one of the most used recreational drugs. Whilst medical uses exist, chronic recreational nasal use of cocaine is associated with progressive destruction of the osseocartilaginous structures of the nose, sinuses and palate - termed cocaine-induced midline destructive lesions. CASE REPORT: A 43-year-old male with a history of chronic cocaine use, presented with conductive hearing loss and unilateral middle-ear effusion. Examination under anaesthesia revealed a completely stenosed left Eustachian tube orifice with intra-nasal adhesions. The adhesions were divided and the hearing loss was treated conservatively with hearing aids. Whilst intra-nasal cocaine-induced midline destructive lesions are a well-described condition, this is the first known report of Eustachian tube stenosis associated with cocaine use. CONCLUSION: This unique report highlights the importance of thorough history-taking, rhinological and otological examination, and audiometric testing when assessing patients with a history of chronic cocaine use. This paper demonstrates the complexity of managing hearing loss in such cases, with multiple conservative and surgical options available.
Subject(s)
Cocaine-Related Disorders , Eustachian Tube , Humans , Male , Adult , Eustachian Tube/pathology , Cocaine-Related Disorders/complications , Constriction, Pathologic/chemically induced , Cocaine/adverse effects , Hearing Loss, Conductive/etiology , Hearing Loss, Conductive/chemically induced , Otitis Media with Effusion/etiology , Ear Diseases/chemically induced , Ear Diseases/etiology , Chronic DiseaseABSTRACT
Symptoms of temporomandibular disorders (TMD) could be present as otologic symptoms like earache and dizziness in some patients. In most cases, these symptoms are not recognized because otolaryngologists fail to diagnose TMD as a source of the problem. This investigation was conducted to evaluate the effect of TMD treatments on the otologic symptoms which after taking history and clinical examinations seemed to be related to TMD. In the present study, the patients who were complaining of otalgia, ear fullness, tinnitus, hearing loss, and dizziness were evaluated by an ear fellow. Forty patients who had no known otologic or other primary causes to explain their symptoms, were referred to the orofacial pain clinic with the possible diagnosis of TMD. If the diagnosis was confirmed by an orofacial pain specialist, a combination of TMD treatments was administered to each case and the patients were followed up. The results showed that following implementation of treatment protocols for TMD, more than 50% of the patients reported complete or partial recovery in the second follow-up (p < 0.05). The most common otologic symptom of the referred cases was earache, and the most common associated complaint was neck pain. All the patients had one or more parafunctional habits. This study showed that TMD treatments were significantly efficient in improving otologic symptoms partially or completely and the authors concluded that for the patients with otolaryngologic unexplained symptoms, an overhaul examination is needed to assess TMD as a possible cause of the patient complaint. It is recommended that in cases with unexplained otologic symptoms, otolaryngologists care more about the neck trigger points (TP) and ask about the patient's parafunctional habits. Otolaryngologists and dentists need to be aware of the risk of developing otologic symptoms caused by these habits or cervical TPs.
Subject(s)
Ear Diseases , Temporomandibular Joint Disorders , Tinnitus , Humans , Ear Diseases/diagnosis , Ear Diseases/etiology , Ear Diseases/therapy , Earache/etiology , Earache/therapy , Dizziness/complications , Tinnitus/complications , Vertigo/complications , Temporomandibular Joint Disorders/therapy , Temporomandibular Joint Disorders/complications , Facial Pain/etiology , Facial Pain/therapyABSTRACT
Acquired stenosis of the external ear canal (ASEEC) is a relatively uncommon condition. Stenosis or narrowing of the external ear canal (EEC) occurs lateral to the tympanic membrane resulting in a skin lined blind canal. Recurrent otorrhea, and conductive hearing loss are typical clinical features. Although ASEEC can be due to different etiologies, a common pathogenesis, namely an inflammatory cascade, has been implicated. Clinical evaluation, audiogram, and Computed tomography (CT scan) form the mainstay of diagnosis. Surgery is the primary modality for treatment. Restenosis is the most common postsurgical complication.
Subject(s)
Ear Canal , Ear Diseases , Humans , Ear Canal/diagnostic imaging , Ear Canal/surgery , Constriction, Pathologic , Ear Diseases/diagnosis , Ear Diseases/etiology , Ear Diseases/surgery , Ear , Hearing Loss, Conductive/diagnosis , Hearing Loss, Conductive/etiology , Hearing Loss, Conductive/surgeryABSTRACT
BACKGROUND: Lyme disease after a tick bite often presents as erythema migrans, yet less frequent variants of this disease, such as Borrelia lymphocytoma, multiple erythema migrans and neuroborreliosis, are also seen occasionally. CASE PRESENTATION: We report a case of a tick-bitten child who first presented with an indistinct macular erythema around the left eye and a more distinct macular erythema on and around the left ear. The next day, she developed a facial palsy. INTERPRETATION: The case was interpreted as facial multiple erythema migrans and Borrelia lymphocytoma on the ear, followed by neuroborreliosis. The diagnosis of lymphocytoma was made from clinical findings and PCR of skin biopsy. She recovered quickly after intravenous ceftriaxone and is now healthy.
Subject(s)
Lyme Disease , Pseudolymphoma , Skin Diseases, Bacterial , Child , Female , Humans , Ear Diseases/etiology , Erythema Chronicum Migrans/etiology , Facial Dermatoses/etiology , Facial Paralysis/etiology , Lyme Neuroborreliosis/etiology , Pseudolymphoma/diagnosis , Tick Bites/complications , Lyme Disease/complications , Lyme Disease/diagnosis , Skin Diseases, Bacterial/diagnosisABSTRACT
OBJECTIVE: Children with cleft palate are at increased risk for Eustachian tube dysfunction (ETD) and conductive hearing loss from chronic otitis media. While it has been proposed that the severity of ETD is related to the severity of cleft palate, data are lacking to support this hypothesis. An improved understanding of the relevance of cleft width may have prognostic value that could inform decisions on the timing of tympanostomy tube placement and choice of tympanostomy tube design. The objective of this study was to assess severity of ETD in children with narrow, moderate, and wide cleft palate, with examination of hearing outcomes, number of tympanostomy procedures, and incidence of otologic complications. METHODS: Retrospective chart review was conducted on 58 patients with primary palatoplasty performed at a single academic medical center from January 1, 2016-December 31, 2019. The primary outcome was the number of otologic procedures performed after the initial palatoplasty. Secondary outcomes included audiometric findings, number of tympanostomy tube placements, presence of effusion at the time of myringotomy, and occurrence of any postoperative otologic complication. Outcomes were compared for patients with narrow (<10 mm), moderate (10-15 mm), and wide (>15 mm) cleft palate. Analysis included consideration of cleft palatal morphology (Veau I - IV), presence of Robin sequence or syndromes, and risk factors for otitis media. RESULTS: Patients with moderate and wide cleft palate underwent higher mean numbers of otologic procedures [narrow: 1.3 (95% confidence interval [CI] 0.9, 1.7); moderate: 1.6 (95% CI 1.1, 2.1); wide: 1.8 (95% CI 1.2, 2.4)]. Moderate and wide cleft palate were less likely to have normal hearing after their first tympanostomy (narrow: 50%, 10/20; moderate: 25%, 6/24; wide: 36%, 5/14). Patients with a wide cleft palate had a shorter median time between first and second tympanostomy procedures (median, IQR; narrow: 27.0, 20.8-35.7; moderate 20.4, 16.3-25.9; wide 17.3, 11.5-23.4). CONCLUSION: Our findings suggest that patients with wider cleft palate may be more susceptible to severe ETD. Further large-scale study may help to allow for more informed and personalized clinical decision making for management of cleft palate, incorporating cleft width for prognosis of risks for persistent middle ear dysfunction.
Subject(s)
Cleft Palate , Ear Diseases , Otitis Media with Effusion , Otitis Media , Child , Humans , Infant , Cleft Palate/complications , Retrospective Studies , Ear, Middle , Ear Diseases/etiology , Otitis Media/complications , Middle Ear Ventilation/adverse effects , Otitis Media with Effusion/surgerySubject(s)
Dermatitis , Ear Diseases , Humans , Dermatitis/diagnosis , Dermatitis/etiology , Ear, External , Ear Diseases/diagnosis , Ear Diseases/etiologyABSTRACT
Background: This study assessed the eustachian tube (ET) function in adult patients with chronic rhinosinusitis (CRS) using tympanometry and nasal endoscope. Materials and Methods: This was a hospital-based cross-sectional study conducted for 9 months. All participants underwent endoscopic evaluation of the pharyngeal end of their ETs, and the middle ear function was assessed using tympanometry. Endoscopic findings were graded based on a validated mucosal inflammatory endoscopic grading scale. Statistical analysis was carried out using SPSS version 24. Results: A total of 102 CRS patients and age- and sex-matched controls were recruited. Tympanograms suggestive of eustachian tube dysfunction (ETD) types B and C were found among 7.8% and 12.8% of the right and left ears of the CRS groups, respectively. Mucosal inflammatory endoscopic grade that is diagnostic of ETD Grades 3 and 4 was found among 24.5% and 38.2% of the right and left ET of CRS cases, respectively. Conclusion: CRS predisposes patients to anatomical and functional impairment of ET. The relationship between tympanometry and mucosal inflammatory endoscopic grading scale in detecting ETD among CRS patients showed a strong relationship. However, a combination of the two will improve the diagnosis of ETD by evaluating the ET function directly and indirectly.
Subject(s)
Ear Diseases , Eustachian Tube , Sinusitis , Adult , Humans , Acoustic Impedance Tests , Cross-Sectional Studies , Nigeria , Sinusitis/complications , Sinusitis/diagnosis , Ear Diseases/diagnosis , Ear Diseases/etiology , Chronic DiseaseABSTRACT
Traumatic conductive hearing loss (TCHL) is most commonly attributed to tympanic membrane perforations, hemotympanum, or ossicular chain disruption. These complications are generally managed conservatively for up to 6 months with good hearing outcomes. We encountered a case of penetrating facial trauma leading to TCHL because of obstructive Eustachian tube dysfunction (OETD), which is not a previously described etiology for OETD and TCHL. A lysis of scar tissue surrounding the Eustachian tube with balloon dilation was performed in our patient, resulting in resolution of conductive hearing loss. In the absence of traditional signs of TCHL, providers should consider OETD as a potential cause of TCHL. We recommend visualization of the Eustachian tube orifice and balloon dilation if clinically indicated.
Subject(s)
Ear Diseases , Eustachian Tube , Facial Injuries , Tympanic Membrane Perforation , Wounds, Penetrating , Humans , Hearing Loss, Conductive , Ear Diseases/etiology , Ear Diseases/diagnosis , Tympanic Membrane Perforation/complications , Hearing Tests , Facial Injuries/complicationsABSTRACT
OBJECTIVE: To compare the incidence and the histopathological aspect of spontaneous and two induced Mongolian gerbils' models of cholesteatoma: External Auditory Canal (EAC) obliteration model and the Auditory Tube (AT) cauterization model. METHODS: Fifty-four ears of 27 animals were divided into EAC obliteration, AT cauterization, and control groups and histologically assessed for cholesteatoma incidence and classification at intervals of 2, 4, 8, and 16 weeks. RESULTS: Cholesteatoma was diagnosed in 30 of the 53 ears evaluated with a significantly higher incidence in groups that received some type of intervention (p<0.0001). It was not possible to histologically distinguish cholesteatomas of the same stage between the study groups. CONCLUSION: Although we observed a significant increase in cholesteatoma incidence with the two methods used when compared to the control group, all developed cholesteatomas were apparently identical from a histological point of view.
Subject(s)
Cholesteatoma, Middle Ear , Cholesteatoma , Ear Diseases , Eustachian Tube , Animals , Disease Models, Animal , Cholesteatoma/complications , Cholesteatoma/pathology , Ear , Ear Diseases/etiology , Ear Canal/pathology , Gerbillinae , Cholesteatoma, Middle Ear/etiology , Cholesteatoma, Middle Ear/pathologySubject(s)
Ear Diseases , Pain , Humans , Ear, External , Syndrome , Ear Diseases/diagnosis , Ear Diseases/etiologyABSTRACT
OBJECTIVE: We aim to compare the modified Veau-Wardill-Kilner push-back technique (VWK) and the Sommerlad intravelar veloplasty (Sommerlad IVVP) in terms of middle ear outcomes and oronasal fistulae frequency in three years old children. METHODS: For this retrospective cohort study, data were collected and anonymized from consecutive patients with cleft palate (with or without cleft lip) who underwent surgery in our hospital between January 2008 and December 2018. Patients with syndromic diagnoses and patients who underwent surgical treatment elsewhere were excluded. We collected data from 101 children (202 ears) regarding middle ear complications at the age of three, including acute otitis media, middle ear effusion, tympanic membrane retraction, tympanic membrane perforation, tympanic membrane atelectasis and chronic otitis media with cholesteatoma. In addition, the presence of oronasal fistulae and the number of ventilation tubes received by the age of three were recorded. RESULTS: The odds of children having a normal middle ear evaluation were 3.07 (95% Confidence interval (95%CI): [1.52, 6.12]; p < 0.05) times higher when children received Sommerlad IVVP compared to modified VWK. With 40.7% compared to 26.7%, a significantly higher incidence of middle ear effusion was present in the modified VWK group compared to Sommerlad IVVP (X2(1) = 4.38, p < 0.05). Furthermore, this group needed significantly more ventilation tube reinsertions (X2(2) = 12.22, p < 0.05) and was found to have a significantly higher incidence of oronasal fistula (53.5% vs. 17.2%, X2(1) = 14.75, p < 0.05). The latter was significantly associated with a higher need for ventilation tube reinsertion (X2(1) = 7.34, p < 0.05). CONCLUSION: This study shows superior middle ear outcomes and fewer oronasal fistulae after Sommerlad IVVP compared to modified Veau-Wardill-Kilner push-back at the age of three.
Subject(s)
Cleft Palate , Ear Diseases , Nose Diseases , Otitis Media with Effusion , Plastic Surgery Procedures , Child , Child, Preschool , Cleft Palate/complications , Ear Diseases/etiology , Humans , Nose Diseases/surgery , Oral Fistula/complications , Oral Fistula/surgery , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVES: Weight loss has been proposed as risk factor for patulous Eustachian tube (PET), however, it has not been well-characterized how this subpopulation responds to standard treatments. This study aimed to evaluate PET symptom improvement in the setting of and absence of rapid weight loss. METHODS: This retrospective case series included patients diagnosed with PET at an academic institution. Demographic characteristics, medical comorbidities, presenting symptoms, treatment, and outcomes of symptom improvement were reviewed. Univariate analysis modeled the likelihood of symptom improvement between rapid weight loss and non-rapid weight loss patients. RESULTS: A total of 124 patients (median age 55 years, 61 % female) were included. At diagnosis, 7 (5.6 %) patients were underweight, 40 (32.3 %) were normal weight, 32 (25.8 %) were overweight, and 45 (36/3 %) were obese. There were 39 (31.5 %) patients who had history of weight loss prior to presentation; of these, 22 (17.7 %) noted rapid weight loss and 17 (13.7 %) had non-rapid weight loss. There were 62 (50.0 %) patients who were recommended conservative treatment, and 62 (50.0 %) who underwent medical and/or surgical treatment. Symptom resolution was achieved in 49 (39.5 %) patients. On univariate analysis, patients with rapid weight loss were significantly more likely to experience improvement (p = 0.006) than non-rapid weight loss. Rapid weight loss patients had a four-fold increased likelihood of symptom improvement compared to non-rapid weight loss patients (OR = 4.8, p = 0.053). CONCLUSIONS: While rapid weight loss and bariatric surgery are reported risk factors for the development of PET, our findings suggest that patients with rapid weight loss are significantly more likely to achieve symptom improvement than non-rapid weight loss.
Subject(s)
Ear Diseases , Eustachian Tube , Otitis Media , Body Mass Index , Ear Diseases/diagnosis , Ear Diseases/etiology , Ear Diseases/therapy , Eustachian Tube/surgery , Female , Humans , Male , Middle Aged , Retrospective Studies , Weight LossABSTRACT
BACKGROUND: Balloon eustachian tuboplasty (BET) is a minimally invasive surgical treatment that is effective and safe for obstructive eustachian tube dysfunction. However, BET complications include excessive widening of the eustachian tube, causing a patulous eustachian tube (PET). Herein, we report a case of PET following BET in a patient who underwent radiation therapy and reviewed the literature on considerations for reducing complications after BET. CASE PRESENTATION: A 63-year-old woman complained of bilateral ear fullness after concurrent chemoradiation therapy for nasopharyngeal lymphoma. BET was performed on the left side because the left-sided serous otitis media persisted. A left-sided PET was performed two weeks after the BET, along with eustachian tube silicone plug insertion on the left side. The patient became asymptomatic immediately after the surgery, with no recurrence reported after a 12-month follow-up period. CONCLUSIONS: To our knowledge, there has been no report of PET following BET in a post-radiation patient, and it was successfully treated via ET silicone plug insertion.
Subject(s)
Ear Diseases , Eustachian Tube , Otitis Media with Effusion , Otitis Media , Female , Humans , Middle Aged , Retrospective Studies , Otitis Media/pathology , Otitis Media with Effusion/surgery , Ear Diseases/etiology , Ear Diseases/surgery , Ear Diseases/pathology , SiliconesABSTRACT
Red Ear Syndrome is an uncommon disorder that can affect all age groups. It is frequently referred to Dermatology as it can present similarly to erythromelalgia. Although the exact pathophysiology is unknown, a common hypothesis suggests a shared pathophysiological background with migraine due to their well-known association. Currently, there are no established treatment guidelines. Delays in accurate diagnosis and commencing optimal treatment can significantly negatively impact on a patients quality of life. We discuss the clinical presentation and response to treatment of a case of Red Ear Syndrome in an 8-year-old boy.
Subject(s)
Ear Diseases , Erythromelalgia , Child , Ear , Ear Diseases/diagnosis , Ear Diseases/etiology , Erythromelalgia/diagnosis , Humans , Male , Quality of Life , SyndromeABSTRACT
The Eustachian tube connects the middle ear and the nasopharynx. It's physiological functions include ventilating and balancing the pressure inside and outside the middle ear, drainage of the middle ear secretions, prevention of retrograde infection, sound suppression and noise suppression. Eustachian tube dysfunction is closely related to the occurrence and development of many diseases. It's etiologyand influencing factors are still unclear. This article reviews the recent research on etiology and related factors of Eustachian tube dysfunction,and strives to make breakthroughs in etiology and mechanism, so as to provide help for clinical intervention.
Subject(s)
Ear Diseases , Eustachian Tube , Otitis Media with Effusion , Otitis Media , Ear Diseases/etiology , Ear, Middle , Humans , NasopharynxABSTRACT
Background: Aural hematomas are not uncommon in ruminants' clinical practice; however, there is a lack of information regarding their management in newborn ruminants, especially for complicated cases with rupture of the hematoma and secondary ear pinna necrosis. Case Description: A 3-day-old orphan goat kid was admitted due to swelling on the left ear pinna and trauma on the right pina caused by biting by other goats. The swelling on the left ear which was located at the convex surface was soft, painless, and fluid-filled, suggestive of aural hematoma located at the convex surface. The right pinna was swollen, bleeding, and extremely painful at palpation. The skin was necrotized at the distal 2/3rd of the convex surface and the 1/2 of the concave surface. Underneath the necrotized skin of the convex surface, blood, and blood clots were trapped, and there was a pocket between the remaining normal skin and the cartilage indicating possible rupture of aural hematoma. The kid was surgically treated under general anesthesia with xylazine and ketamine. The aural hematoma was drained by the convex surface using a Penrose tube after flushing the cavity with 2 mg dexamethasone. The trauma of the right pinna was left to heal by secondary intention after resection of all necrotized, edematous tissues, and blood clots. Post-surgery, the animal was treated with parenteral antibiotic administration and daily application of a topical antiseptic solution. The Penrose tube was removed after 5 days, and the animal recovered uneventfully. Conclusions: The present case indicates that aural hematoma can occur in newborn goat kids secondary to ear pinna biting and might evolve to pinna necrosis. In addition, tube drainage after flushing the cavity with corticosteroids appears to be an effective treatment approach without requiring bandaging post-operatively.
Subject(s)
Ear Auricle , Ear Diseases , Goat Diseases , Animals , Ear Auricle/surgery , Ear Diseases/etiology , Ear Diseases/surgery , Ear Diseases/veterinary , Ear, External , Goat Diseases/drug therapy , Goats , Hematoma/etiology , Hematoma/surgery , Hematoma/veterinaryABSTRACT
To evaluate the incidence and risk factors for aural haematoma in dogs under primary veterinary care in the UK. A cohort study design. Dogs diagnosed with aural haematoma during 2016 were identified from the VetCompass database. Univariable and multivariable logistic regression modelling were used for risk factor analysis. There were 2,249/905,554 dogs diagnosed with aural haematoma during 2016. The estimated one-year incidence risk for aural haematoma was 0.25% (95% confidence interval 0.24-0.26). After accounting for confounding factors, 14 breeds showed increased odds and 20 breeds showed reduced odds of aural haematoma compared with crossbred dogs. Breeds with the highest odds included Bull Terrier (OR 7.42, 95% confidence interval 4.39-12.54), Saint Bernard (OR 7.28, 95% confidence interval 3.58-14.81) and French Bulldog (OR 6.95, 95% confidence interval 5.55-8.70). Increasing age, increasing bodyweight and breeds with V-shaped drop and semi-erect ear carriage also showed increased odds of aural haematoma. Associations between ear carriage within breeds and the risk of aural haematoma suggest that trauma along the line of cartilage folding within V-shaped and semi-erect ears may trigger aural haematoma. New knowledge of key breed predispositions will contribute to improved breed health control strategies.