Chronic Otitis in Cats: Clinical management of primary, predisposing and perpetuating factors.

PRACTICAL RELEVANCE: Chronic otitis can be one of the most frustrating diseases to manage for a small animal practitioner. While it occurs less commonly in the cat than the dog, it is no less challenging. The purpose of this review is to discuss the common and uncommon causes of chronic otitis in the cat within the clinical framework used for diagnosis and treatment. The focus is on diseases that affect the ear canal, rather than those restricted to the pinnae. CLINICAL CHALLENGES: Otitis is multifactorial, which complicates management. A common clinical mistake is to focus solely on treating the infection present. Only by addressing all factors will a clinician successfully control chronic otitis. For the purposes of this review, the authors have adopted the established model of separating primary, predisposing and perpetuating causes of otitis. Primary factors are those that directly cause otitis (inflammation); predisposing factors are those that put the patient at risk for development of otitis; and perpetuating factors are those that result in ongoing clinical signs of otitis or that prevent clinical resolution. AUDIENCE: This review is aimed at veterinarians who treat cats and particularly those with an interest in feline dermatology and otology. EQUIPMENT: While many practitioners rely on a hand-held otoscope, a video-otoscope can be very helpful for the diagnosis and treatment of chronic otitis. EVIDENCE BASE: This review presents up-to-date information regarding the diagnosis and treatment of chronic otitis in cats, with emphasis on the most recent peer-reviewed literature.

Efficacy assessment of PEV2 phage on Galleria mellonella larvae infected with a Pseudomonas aeruginosa dog otitis isolate.

Pseudomonas (P.) aeruginosa is the most frequently isolated Gram-negative bacteria in dog otitis. Antimicrobial resistance is particularly prevalent in P. aeruginosa and phage therapy represents a promising alternative therapeutic strategy. The aim of this study was to assess the efficacy of the PEV2 phage against a clinical P. aeruginosa isolate from a canine otitis using a Galleria (G.) mellonella larvae model. The genomic DNA of PAV237 P. aeruginosa isolate was sequenced and analysed. In a first main experiment, the efficacy of PEV2 phage against PAV237 was assessed at different multiplicities of infection (MOI) (50,000, 5000, 500, 50) by analyzing the larvae survival rate during 4 days. In a second experiment, the bacterial and phage titer evolutions were assessed depending on two MOIs (50,000, 5000). No significant survival increase was observed with PEV2 therapy in the infected larvae groups. The generated Kaplan-Meier curves showed that the rate of alive larvae was significantly higher in the non-infected larvae compared to the infected-treated ones irrespective of phage MOIs. An increase of the phage titer was observed at 24 and 48 h post-inoculation (HPI) with both MOIs and the P. aeruginosa titers were lower with MOI 50,000 and 5000 compared to the infectivity control at 24 and 48 HPI. Even if an ineffectiveness of the PEV2 phage was observed on the larvae survival, PEV2 is active against P. aeruginosa in this model and PEV2 replication is correlated with a lower bacterial proliferation in the phage treated larvae.

Recurrent polyp formation with Candida tropicalis infection and otitis in a dog.

To describe a case of a recurrent Candida tropicalis otitis externa, media and interna in a dog with an ear polyp. A 9-year-old Irish Setter was presented with 2 episodes of otitis sinistra, left-sided vestibular syndrome and Horner syndrome 7 months apart. At the first episode a benign ear polyp was extracted and Candida tropicalis cultured from the left middle ear. The neurological signs disappeared within 7 days, the Candida infection was more difficult to treat. Seven months later, a polyp was found in the ear again and cytology was consistent with Candida tropicalis. A unilateral left total ear canal ablation with lateral bulla osteotomy was performed and a middle ear culture confirmed Candida tropicalis. Treatment led to resolution of clinical signs. Candida tropicalis, an emerging pathogen, should be considered in cases of recurrent yeast otitis and may be difficult to treat.

Un protocolo de investigación para la realización de un ensayo controlado aleatorizado que compare la acción de la homeopatía y la alopatía en la otitis media aguda y su recurrencia en niños / A research protocol for conducting a randomized controlled trial comparing the action of homeopathy and allopathy in acute otitis media and its recurrence in children

Antecedentes: la otitis media aguda (OMA) es una de las infecciones agudas más comunes en niños. La prescripción no juiciosa de antibióticos puede provocar un aumento de los casos resistentes a antibióticos. La Homeopatía puede proporcionar un tratamiento más seguro y más eficaz. Objetivo: anteriormente, un estudio piloto realizado por el Consejo Central de Investigación en Homeopatía (CCRH) en 80 pacientes, en un solo centro, mostró resultados de no inferioridad. Este estudio se realizará para corroborar los hallazgos anteriores. Métodos: será un ensayo controlado (con brazo paralelo), aleatorizado, de diseño abierto y de no inferioridad, que se realizará en niños de 2 a 12 años de edad, con una otitis media aguda. El ensayo incluirá 240 niños, de los que cada participante será seleccionado de forma aleatoria para recibir un medicamento homeopático individualizado, o bien, un medicamento alopático sintomático. En caso de que un niño no muestre una mejoría ≥50% con el tratamiento asignado en el día tres, recibirá un antibiótico. Los niños de ambos grupos serán tratados / seguidos durante 1 año para verificar la recurrencia, si la hay. Los parámetros principales serán los cambios en la Escala de examen de la membrana timpánica (Tympanic Membrane Examination Scale, TMES) y la escala Otitis media aguda-severidad de los síntomas (Acute Otitis Media-Severity of Symptoms, AOM-SOS), así como el tiempo para mejorar el dolor a través de la Escala de dolor de caras revisada (Facial Pain Scale-Revised) entre los grupos, y la recurrencia a un año (número de episodios, intensidad y duración) de la OMA en ambos grupos. Discusión: El estudio consolidará los hallazgos observados durante un estudio piloto realizado por el CCRH en Jaipur, India. Se propone que se compare el papel de la Homeopatía individualizada frente a la alopatía en el tratamiento de la OMA y que se evalúe su papel en el control de las recidivas. (AU)

Rhabditis spp., in the Espírito Santo, State of Brazil and evaluation of biological control.

The objectives of this study were to describe occurrences of Rhabditis spp. causing parasitic otitis in dairy cattle of Gir breed in the state of Espírito Santo, southeastern Brazil, and to evaluate the biological control of this nematode using the nematophagous fungi Duddingtonia flagrans (AC001) and Monacrosporium thaumasium (NF34). After nematode detection and collection, three groups were formed: two groups that were treated, respectively, with the fungal isolates; and a control group, without fungus. The treatments were as follows: (a) Petri dishes containing the culture medium 2% water agar (WA) + 250 nematodes + AC001; (b) Petri dishes containing 2% WA + 250 nematodes + NF34; and (c) Petri dishes containing only 2% WA + 250 nematodes. After seven days at 27 °C the treatments with fungi were able to capture and destroy the nematodes, with percentages of 82.0% (AC001) and 39.0% (NF34) in relation to the control group. The results demonstrate the occurrence of Rhabditis spp. after animals physical examination and that there was efficacy of the in vitro predatory activity of both fungal isolates. Thus, these results are important because they can assist in future in vivo control of this nematode in cattle.

Rhabditis spp, in the Espírito Santo, State of Brazil and evaluation of biological control / Rhabditis spp, no Espírito Santo, estado do Brasil e avaliação do controle biológico

Abstract The objectives of this study were to describe occurrences of Rhabditis spp. causing parasitic otitis in dairy cattle of Gir breed in the state of Espírito Santo, southeastern Brazil, and to evaluate the biological control of this nematode using the nematophagous fungi Duddingtonia flagrans (AC001) and Monacrosporium thaumasium (NF34). After nematode detection and collection, three groups were formed: two groups that were treated, respectively, with the fungal isolates; and a control group, without fungus. The treatments were as follows: (a) Petri dishes containing the culture medium 2% water agar (WA) + 250 nematodes + AC001; (b) Petri dishes containing 2% WA + 250 nematodes + NF34; and (c) Petri dishes containing only 2% WA + 250 nematodes. After seven days at 27 °C the treatments with fungi were able to capture and destroy the nematodes, with percentages of 82.0% (AC001) and 39.0% (NF34) in relation to the control group. The results demonstrate the occurrence of Rhabditis spp. after animals physical examination and that there was efficacy of the in vitro predatory activity of both fungal isolates. Thus, these results are important because they can assist in future in vivo control of this nematode in cattle.

Resumo Os objetivos neste estudo foram descrever ocorrências do nematódeo Rhabditis spp., causando otite parasitária em bovinos leiteiros da raça Gir no estado do Espírito Santo, sudeste do Brasil, e avaliar o controle biológico desse nematódeo utilizando os fungos nematófagos Duddingtonia flagrans (AC001) e Monacrosporium thaumasium (NF34). Após a detecção e coleta dos nematódeos, três grupos foram formados: dois grupos que foram tratados com os isolados fúngicos, respectivamente; e um grupo controle, sem fungos. Os tratamentos foram os seguintes: (a) placas de Petri contendo o meio de cultura 2% ágar de água (WA) + 250 nematoides + AC001; (b) placas de Petri contendo 2% de WA + 250 nematoides + NF34; e (c) placas de contendo apenas 2% de nematódeos WA + 250. Após sete dias a 27 °C os tratamentos com fungos foram capazes de capturar e destruir os nematódeos, com porcentagens de 82,0% (AC001) e 39,0% (NF34) em relação ao grupo controle. Os resultados demonstram a ocorrência de Rhabditis spp., no Estado do Espírito Santo e a eficácia da atividade predatória in vitro dos isolados fúngicos utilizados. Assim, esses resultados são importantes, pois podem auxiliar no controle alternativo in vivo de Rhabditis spp. em bovinos com otite parasitária.

Infections of the Ear.

Infections of the ear are a common presentation to an acute care environment. In this article, the authors aim to summarize the most common presentations, and diagnostic and treatment options for typical infections of the ear. This article is geared toward the emergency physician, urgent care provider, and primary care provider who will likely be the initial evaluating and treating provider to assist them in determining what treatment modalities can be managed in a clinic and what needs to be referred for admission or specialty consultation.

Honey as a Treatment in Otorhinolaryngology: A Review by Subspecialty.

OBJECTIVES: To provide an up-to-date review of honey's effectiveness and potential applications in otorhinolaryngology. METHODS: A literature search of the online databases PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted. RESULTS: Sixty-three studies were identified within head and neck surgery (n = 23, 36%); pediatric otolaryngology (n = 18, 29%); rhinology, sinus, and skull base surgery (n = 11, 17%); otology (n = 6, 10%), facial plastic and reconstructive surgery (n = 3, 5%); and laryngology (n = 2, 3%). Studies included 6 meta-analyses, 44 randomized control trials, 5 case reports, and 8 animal models or in vitro studies. Of 55 clinical studies, 50 reported Level 1 evidence (prospective randomized control trials), and 5 reported Level 4 evidence (case series). The evidence level by subspecialty was: head and neck surgery (Level 1 n = 23), pediatrics (Level 1 n = 18), rhinology (Level 1 n = 7, level 4 n = 1), otology (Level 1 n = 1, Level 4 n = 3), facial plastics and reconstructive surgery (Level 4 n = 1), and laryngology (Level 1 n = 2). CONCLUSIONS: Honey can be used for a variety of otolaryngology conditions. The highest quality meta-analyses support oral honey for prevention and treatment of oral mucositis in cancer patients, cough associated with upper respiratory infection in children, and pain control after tonsillectomy. Further research will likely justify broader applications.

Clinical care of children with primary ciliary dyskinesia.

INTRODUCTION: Primary ciliary dyskinesia (PCD) is a rare heterogeneous disorder, usually inherited as an autosomal recessive condition but X-linked inheritance is also described. Abnormal ciliary function in childhood leads to neonatal respiratory distress in term infants, persistent wet cough, bronchiectasis, chronic rhinosinusitis, and hearing impairment; approximately 50% of patients have situs inversus. There is a paucity of evidence for treating PCD, hence consensus guidelines are predominantly influenced by knowledge from cystic fibrosis (CF). Extrapolation of evidence from other diseases is inappropriate since differences in pathophysiology, morbidity and prognosis risk treatment failure and lack of adherence. Areas covered: Review authors searched PubMed and Cochrane databases for publications relating to management of children with PCD. Because of the paucity of data, we emphasise the need for well-designed clinical trials with PCD patients rather than reliance on evidence from other diseases. Expert commentary: The evidence for treatment of PCD is poor, and management is often extrapolated from studies of patients with CF or chronic rhinosinusitis. However, much work is underway to improve the situation and international consortia and networks are conducting well-designed projects to inform the management of children with PCD.

Detecção e tratamento de otite por Rhabditis blumi em bovinos da região Norte do Brasil / Detection and treatment of otitis by Rhabditis blumi in cattle of northern Brazil

O presente estudo teve como objetivo descrever a ocorrência de otite parasitária causada por Rhabditis blumi em bovinos leiteiros de raça Gir de uma fazenda da região Norte do Brasil. Foram coletadas amostras de 42 bovinos por swab e lavado dos condutos auditivos externos (CAE). Ao exame clínico, 9,5% (4/42) dos bovinos apresentavam sintomatologia nervosa, como leve a moderada rotação da cabeça, apatia, flacidez dos lábios e ptose palpebral unilateral, alopecia das regiões da cabeça e cupim, causados pelo desconforto e prurido da região auricular, alteração na mastigação e acúmulo de alimento na cavidade oral. Adicionalmente, 71,4% (30/42) dos abovinos mostraram a presença do parasita no cerúmen dos condutos auditivos. À análise microscópica do material do saco conjuntival foi observado presença do parasita em 90% (9/10) dos bovinos avaliados. Os 30 bovinos positivos para Rhabditis spp. foram distribuídos aleatoriamente em três grupos de 10 animais: (G1) Bovinos controle, (G2) Bovinos tratados com ivermectina 1% pour on e (G3) Bovinos submetidos a lavado dos condutos auditivos externos (CAE). Cada tratamento foi repetido três vezes com intervalo de sete dias. No G1 os 10 bovinos mantiveram-se infectados durante todo o estudo. No G2 20% dos bovinos foram negativos após os dois primeiros tratamentos, porém, mostraram-se positivos na terceira avaliação. No G3 todos os bovinos mantiveram-se positivos, sendo observada apenas diminuição da carga parasitária. A identificação por análise molecular por meio de fragmentos amplificados da expansão D2/D3 do 28S rDNA confirmou a presença apenas da espécie Rhabditis blumi nos animais. Baseado nas observações clínicas, morfológicas e moleculares pode-se relatar o primeiro caso de R. blumi em bovinos da raça Gir no Estado do Pará, através da compra de animais oriundos de áreas onde a otite parasitária tem sido diagnosticada, principalmente de Minas Gerais, para formar animais mestiços (Gir x Holandês). Desta forma ressalta-se a importância do exame clínico prévio dos animais a serem transferidos para outras propriedades ou regiões. Este relato também parece ser o primeiro sobre a presença de R. blumi no saco conjuntival de bovinos. O tratamento com ivermectina no G2 não surtiu melhora clínica dos bovinos.(AU)

This study aimed to describe the occurrence of parasitic otitis caused by Rhabditis blumi in dairy cattle of the Gir race from a farm in northern Brazil. Forty-two samples were collected from cattle by swab washed from the external auditory canal (EAC). On clinical examination, in 71.4% (30/42) of the cattle the parasite was found in the cerumen of the ear canal, along with alopecia of head and hump caused by discomfort and itching of the auricular region. At microscopic analysis of material from the conjunctival sac the parasite was found in 90% (9/10) of the evaluated cattle. In addition, 9.5% (4/42) of the cattle showed nervous symptoms, such as mild to moderate rotation of the head, apathy, flaccid lips and unilateral ptosis, change in chewing and food accumulation in the oral cavity. Thirty cattle positive for Rhabditis spp. were randomly divided into three groups of 10 animals each: (G1) Cattle Control, (G2) Cattle treated with ivermectin 1% pour-on, and (G3) Cattle undergoing wash of the external auditory canal (EAC). Each treatment was repeated three times with intervals of seven days. In G1, 10 cattle remained infected throughout the study. In G2, 20% of the cattle were negative after the first two treatments, however were positive at the third evaluation. In G3, all cattle remained positive, but with decrease in parasite load. Identification by molecular analysis of amplified fragments through the expansion D2/D3 28S rDNA confirmed the presence of only Rhabditis blumi. Based on clinical, morphologic and molecular examination, it appears to be the first report of the occurrence of R. blumi infection in Gir cattle in the State of Pará, due to the purchase of cattle from areas where parasitic otitis has been diagnosed, as from Minas Gerais, to produce crossbred animals (Gir x Holstein). This emphasizes the importance of prior clinical examination by the veterinary service in order to transfer only healthy animals to other properties or regions. This appears also to be the first report on R. blumi infection of the conjunctival sac in cattle. Treatment with ivermectin in G2 did not produce clinical improvement.(AU)

Fusobacterium necrophorum otitis and mastoiditis in infants and young toddlers.

There is an increased recovery of Fusobacterium necrophorum from cases of otitis media and mastoiditis in the pediatric population. These infections may be highly severe, causing local osteomyelitis, bacteremia, and Lemierre's syndrome. The severity and difficulties in providing optimal treatment for these infections may be especially difficult in this age group due to immunological immaturity and delayed presentation. In this review of literature, we present and analyze the clinical presentation, management, and outcome of otic infections caused by F. necrophorum in infants and young toddlers less than 2 years old. Search in Pubmed was conducted for reported cases in the English literature for the time period of the last 50 years. Twelve well-described cases were retrieved with F. necrophorum otitis and mastoiditis and complications reported in all cases. Treatment included both intravenously with antimicrobial agents (beta lactams plus metronidazole) and mastoidectomy. Lemierre's syndrome and Lemierre's syndrome variants developed in 60 % of the patients. Dissemination of the infection as distal osteomyelitis and septic shock were also reported. The outcome was favorable in all the cases. Otitis and mastoiditis infections in children less then 2 years old are invasive infections, and severe complications can occur.

Fusobacterial head and neck infections in children.

Fusobacterium species are increasingly recognized as a cause of head and neck infections in children. These infections include acute and chronic otitis, sinusitis, mastoiditis, and tonsillitis; peritonsillar and retropharyngeal abscesses; Lemierre syndrome; post-anginal cervical lymphadenitis; and periodontitis. They can also be involved in brain abscess and bacteremia associated with head and neck infections. This review describes the clinical spectrum of head and neck fusobacterial infection in children and their management.

Integrated community case management of childhood illness in Ethiopia: implementation strength and quality of care.

Ethiopia has scaled up integrated community case management of childhood illness (iCCM) in most regions. We assessed the strength of iCCM implementation and the quality of care provided by health extension workers (HEWs). Data collectors observed HEWs' consultations with sick children and carried out gold standard re-examinations. Nearly all HEWs received training and supervision, and essential commodities were available. HEWs provided correct case management for 64% of children. The proportions of children correctly managed for pneumonia, diarrhea, and malnutrition were 72%, 79%, and 59%, respectively. Only 34% of children with severe illness were correctly managed. Health posts saw an average of 16 sick children in the previous 1 month. These results show that iCCM can be implemented at scale and that community-based HEWs can correctly manage multiple illnesses. However, to increase the chances of impact on child mortality, management of severe illness and use of iCCM services must be improved.

[The swimmer's otitis. An up to date and prevention options]. / L'otite del nuotatore. Attualità e proposta preventiva.

The swimmer's otitis or acute otitis externa, is a pathology that often occurs in those who practice swimming at a competitive level. The same problem often occurs in the summer with the attendance of swimming pools and bathing areas. A survey made in the United States in 2007 confirms the dynamics of the onset of this pathology, because the contamination of fungi and bacteria in the waters of the swimming pools and the sea cause the inflammation of the epithelium of the auditory canal. To face this issue, in addition to a correct diagnosis, and the necessary and appropriate therapies, it may follow the use of these medicinal preparations. The first one (A) is protective-acting, the second one (B) is characterized as a preventive, hygroscopic, moistening, antiseptic and antimycotic-acting solution. Swimmers who have been using the two (pre-and post) preparations daily for about a year have reported sporadic episodes of otitis. However, there is no doubt that these two compounds deserve a meticulous clinical trial in order to confirm their preventive and therapeutic potentials in external acute otitis.

Clinical characteristics of pediatric granular myringitis.

OBJECTIVE: To determine the clinical characteristics of children with granular myringitis. STUDY DESIGN: Case series with chart review of children with granular myringitis. SETTING: Tertiary care children's hospitals in Delaware and Florida. SUBJECTS AND METHODS: From July 1, 2006, to June 30, 2011, 15 patients were identified with granular myringitis based on International Classification of Diseases, Ninth Revision code 384.1 (10 male, 5 female; 10 left-sided, 5 right-sided). RESULTS: Average age at onset was 10 years (range, 4-18 years). Average length of symptoms was 21 months (range, 3-48 months). Thirteen of the 15 patients (87%) had myringotomy tube placement prior to diagnosis of myringitis, and 11 had a previous perforation (73%). Eleven myringoplasties were performed on 8 (53%) patients prior to the onset of granular myringitis (5 fascia, 2 fat, 2 cartilage, 1 paper patch, and 1 at an outside hospital that was unknown). A total of 27 otolaryngologic surgical procedures were done on 14 of 15 patients. Ten patients (67%) had audiometry performed, and 6 (40%) had ear cultures. Medical treatment included ciprofloxacin and dexamethasone otic drops in all patients, oral antibiotics in 4 patients, and additional topical agents in 8 patients. Two patients had laser resurfacing, and 1 patient had surgical curettage. Five patients had long-term remission, 8 had intermittent remission, and 2 had no remission of their symptoms. CONCLUSION: Granular myringitis is a chronic, recalcitrant disease typically preceded by myringotomy and tube placement or myringoplasty/tympanoplasty. Medical and surgical intervention is varied and often does not lead to permanent resolution of the disease.

Beneficial effects of probiotics in upper respiratory tract infections and their mechanical actions to antagonize pathogens.

Probiotics are live micro-organisms with beneficial effects on human health, which have the ability to counteract infections at different locations of the body. Clinical trials have shown that probiotics can be used as preventive and therapeutic agents in upper respiratory tract infections (URTIs) and otitis. Their mechanical properties allow them to aggregate and to compete with pathogens for nutrients, space and attachment to host cells. Consequently, they can directly antagonize pathogens and thus exert beneficial effects without directly affecting the metabolism of the host. An overview of the probiotics with such traits, tested up to date in clinical trials for the prevention or treatment of URTIs and otitis, is presented in this review. Their mechanical properties in the respiratory tract as well as at other locations are also cited. Species with interesting in vitro properties towards pharyngeal cells or against common respiratory pathogens have also been included. The potential safety risks of the cited species are then discussed. This review could be of help in the screening of probiotic strains with specific mechanical properties susceptible to have positive effects in clinical trials against URTIs.