Otosyphilis: A Review of the Literature.

The number of cases of syphilis has increased in the United States and in many high-income nations. Otosyphilis is a less recognized complication of syphilis that can lead to irreversible sensorineural hearing loss. Different pathophysiological mechanisms have been proposed to explain hearing loss in otosyphilis. We review the literature on otosyphilis in adults and propose the need for future work in this field to identify better ways to diagnose, treat, and manage this disease. Patients with syphilis should be screened routinely for hearing loss, and all patients with new, sudden, or fluctuating sensorineural hearing loss should be evaluated for syphilis.

In vitro antimicrobial activity of topical otological antimicrobials and Tris-EDTA against resistant Staphylococcus pseudintermedius and Pseudomonas aeruginosa isolates from dogs.

BACKGROUND: The value of susceptibility tests for the selection of topical otological antimicrobial agents is unclear. Laboratories test antibiotic concentrations substantially lower than concentrations supplied in topical formulations. Additionally, microbiological consensus statements are not available for topical antimicrobials. HYPOTHESIS/OBJECTIVES: The primary aim of this study was to measure the minimum inhibitory and bactericidal concentrations of enrofloxacin, gentamicin, marbofloxacin, neomycin, orbifloxacin, polymyxin B and silver sulfadiazine from concentrations available in otological formulations (COF) to 1:59,000 dilution. The secondary aim was to evaluate the effect of Tris-EDTA in conjunction with these antimicrobial agents. METHODS AND MATERIALS: Twenty resistant clinical isolates [Staphylococcus pseudintermedius (n = 10) and Pseudomonas aeruginosa (n = 10)] were tested by broth microdilution using a concentrated inoculum (3.75 × 107 cfu/mL). RESULTS: Concentrations available in otological formulations were at least 26× greater than the MICs for S. pseudintermedius and P. aeruginosa. COFs of polymyxin B and SSD were 27× greater than the MBCs for P. aeruginosa, whereas all other antimicrobial COFs were equal to or less than the MBCs for both organisms. Tris-EDTA significantly reduced the MICs of all antimicrobials, except with SSD for P. aeruginosa, and it significantly increased the MIC of SSD for S. pseudintermedius. CONCLUSIONS AND CLINICAL IMPORTANCE: Further studies are warranted to validate the present results in vivo. COFs are inhibitory and less likely bactericidal, with few exceptions, against resistant strains of these organisms. Tris-EDTA may be advantageous for P. aeruginosa whereas no additional benefit is afforded against S. pseudintermedius. Susceptibility tests may not be useful for the selection of topical otological antimicrobial agents.

[Opportunistic mycoses of ENT organs. Part 1]. / Opportunisticheskie mikozy LOR-organov. Soobshchenie 1.

The present literature review summarizes information about the diseases of the upper respiratory tract and the ears caused by opportunistic fungi. The factors responsible for the increased frequency of opportunistic infections, among which mycosis is the leading one, are given. The exogenous and endogenous risk factors are described. The main pathogens of opportunistic mycotic infections of the ENT-organs are listed. Special attention is given to the mechanism underlying the development of anti-colonial immunity of the upper respiratory tract and the ears and the formation of the antifungal immunity of the macroorganism as a whole. The data on the pathogenetic factors of mycelial and yeast-like micromycetes are presented. The main variants of the pathogenetic mechanisms, such as adhesion, invasive growth, and penetration, behind the formation of the mycotic lesions are considered. These biological properties of the fungi contribute to their ability to cause a wide range of pathological changes - from the superficial lesions of the skin and mucous membranes of the ENT organs to the deep invasive processes. The protective cellular and humoral immune reactions of a macroorganism that develop in response to the introduction of a pathogenic fungus are described. The review lists the main nosological forms of mycosis known to affect the ENT-organs with special reference to the leading role of the yeast-like fungi belonging to the genus Candida in the development of mycotic lesions of these biotopes (64.65%). The most pathogenic species, Candida albicans, prevails in the structure of the yeast-like fungi biome whereas the leading role in the development of mycosis of the ENT organs by micromycetes of mold belongs to the species Aspergillus niger.

Experimental induction of mycotic plaques in the guttural pouches of horses.

Guttural pouch mycosis (GPM) is a rare but potentially life-threatening condition in horses. GPM is caused by a fungal invasion into the mucosal lining of the guttural pouches and, frequently, the associated neurovascular structures. Although several species of fungi have been associated with this disease, Aspergillus spp. appear to be the most common isolated from the guttural pouches. However, it remains unclear which are the predisposing factors leading to the development of the infection. The objectives of the present study were to experimentally reproduce an infection by Aspergillus fumigatus and to follow the natural evolution of the mycosis. Eight guttural pouches from four horses were experimentally infected by endoscopy-guided intrapouch inoculation of A. fumigatus culture. Horses were monitored for clinical signs and development of fungal plaques through endoscopic examination. Mycotic lesions were observed in all the horses and a spontaneous regression was observed within 15-28 days. No development of clinical signs was noticed. In conclusion, we were able to induce the development of mycotic lesions and to observe a natural regression of these lesions without clinical signs.

Neuro-otologic manifestations of tuberculosis. "The great imitator".

OBJECTIVE: To demonstrate the different neuro-otologic clinical presentations of tuberculosis. STUDY DESIGN: Retrospective clinical analysis. RESULT: 83.3% of the cases of ear or central nervous system TB were without concomitant lung disease. 2 cases had primary infection in the central nervous system. The neuro-otologic manifestation was as follows: 85.7% sensorineural hearing loss; 42% polyneuropathy. 71.4% had granulation tissue. 2 had normal otoscopy. In 6 patients the histopathology and Ziehl Neelsen were confirmatory. One case was confirmed by the positive response to treatment with antituberculosis drugs. CONCLUSIONS: Tuberculosis has a wide variety of neurotologic manifestations from chronic otitis media cadres to vestibular, audiological and neurological manifestations as well as a large variability in imaging studies.

Psychosocial outcomes of children with ear infections and hearing problems: a longitudinal study.

BACKGROUND: There is some evidence of a relationship between psychosocial health and the incidence of ear infections and hearing problems in young children. There is however little longitudinal evidence investigating this relationship. This paper used 6-year prospective longitudinal data to examine the impact of ear infection and hearing problems on psychosocial outcomes in two cohorts of children (one cohort recruited at 0/1 years and the other at 4/5 years). METHODS: Data from the Longitudinal Study of Australian Children (LSAC) were analysed to address the research aim. The LSAC follows two cohorts of children (infants aged 0/1 years - B cohort, n = 4242; and children aged 4/5 years - K cohort, n = 4169) collecting data in 2004, 2006, 2008 and 2010. In B cohort at baseline 3.7% (n = 189) of the sample were reported by their parent to have had an ear infection (excluding hearing problems) and 0.5% (n = 26) were reported by their parent to have hearing problems (excluding ear infections). 6.7% (n = 323) of the K cohort were identified as having had an ear infection and 2.0% (n = 93) to have hearing problems. Psychosocial outcomes were measured using the Strengths and Difficulties Questionnaire. Data were analysed using multivariate analysis of variance and logistic regression, reporting adjusted odds ratio and 95% confidence intervals of the association between reported ear infections (excluding hearing problems)/or hearing problems (excluding ear infections) and psychosocial outcomes. RESULTS: Children were more likely to have abnormal/borderline psychosocial outcomes at 10/11 years of age if they had been reported to have ongoing ear infections or hearing problems when they were 4/5 years old. When looking at the younger cohort however, poorer psychosocial outcomes were only documented at 6/7 years for children reported to have hearing problems at 0/1 years, not for those who were reported to have ongoing ear infections. CONCLUSION: This study adds further evidence that a relationship may exist between repeated ear infections or hearing problems and the long-term psychosocial health of children and provides support for a more systematic investigation of these issues.

[Paracoccidioidomycosis of the external ear]. / Paracoccidioïdomycose localisée au pavillon d'une oreille.

BACKGROUND: Paracoccidioidomycosis is a systemic fungal infection common in Latin America. Cutaneous involvement is frequent and usually affects multiple sites, being most frequently associated with lesions of the oropharyngeal mucosa. The cutaneous form on its own is rare. PATIENTS AND METHODS: We report a case of paracoccidioidomycosis isolated from the ear of a 43-year-old immunocompetent man. The lesion consisted of a partially ulcerated plaque on the auricle of the left ear. Direct examination, histopathological examination and PCR revealed the presence in the skin lesion of yeasts identified as Paracoccidioides brasiliensis. DISCUSSION: The sites of paracoccidioidomycosis on the ear can be confused with other tropical diseases frequently found in the Amazon region such as leishmaniasis, leprosy and lobomycosis. The absence of any other cutaneous sites in this case raised the question of whether the lesion was of primary or secondary origin.

Reproducibility of a semiquantitative method to assess cutaneous cytology.

BACKGROUND: Cutaneous cytology is used in veterinary dermatology to assess bacteria and yeast on the skin surface and in the ears for diagnostic purposes and to monitor treatment success. A number of methods were used in reported studies to quantify micro-organisms on cytology, but evaluation of the intra- and interobserver reliability of the methods is rare. OBJECTIVE: The aim of this study was to evaluate the intra- and interobserver reliability of a semiquantitative cytology assessment method frequently used in practice. METHODS: A total of 60 experienced and inexperienced veterinarians and veterinary students were asked to evaluate 10 glass slides and 18 photographs of cutaneous cytology twice. Cocci, rods, yeast, neutrophilic and eosinophilic granulocytes and macrophages were graded from 0 to 4+. RESULTS: The intra-observer reproducibility for evaluating the slides in the experienced group was 84.3%; in the inexperienced group it was 82.6%. For the photographs, the intra-observer reproducibility was 92.1% in both groups. The interobserver reproducibility for evaluating the slides was 81.6 and 81.0% in the experienced and inexperienced group, respectively; corresponding values for the photographs were 91.0 and 90.0%. There was no significant difference between different participants or between the first and second evaluation by each participant for any of the parameters graded. CONCLUSION AND CLINICAL IMPORTANCE: Based on these results, this semiquantitative method of grading can be recommended for evaluating and monitoring of antimicrobial therapy in daily practice.

[ENT]. / ORL.

We selected once more from about 15000 abstracts published in 2011 a couple of papers focused on general practice. Regarding the ear, we will discuss the role of nasal corticoids in Eustachian tube dysfunction, the treatment of vestibular neuronitis, the role of the bone-anchored hearing aid, or the vestibular implant. Regarding the nose, the influence of tobacco on sinus surgery, the treatment of staphylococcus cases, and the role of neuronavigation. Regarding the throat, head and neck region, our focus was on potential new treatments of the future that might change our approach, and on the correlations between food and cancer.

Prevalence of otomycosis in Ibadan: a review of laboratory reports.

Otomycosis has typically been described as fungal infection of the external auditory canal with infrequent complications involving the middle ear. Because of the dearth of data on the prevalence of Otomycosis in this environment and increased rate of immunosuppression, this study was aimed at finding the prevalence and fungal etiological agents responsible for this condition. Aretrospective review of the laboratory reports of ear swabs of patients that presented with signs and symptoms suggestive of fungal infections of the ear like otorrhoea, otalgia and aural fullness were done. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae and fruiting bodies under microscopy. The swabs were cultured on the Sabouraud Dextrose agar kept at room temperature (27-30 degrees C). Fungi growth occurred within 48 hours to 3 weeks. The data collected were analyzed with the aid of SPSS version 12.0 computer software. Level of significance was set at p<0.05. A total of 53 patients with documented diagnosis of otomycosis were included in the analysis and consisted of 31 (58.5%) females and 22 (41.5%) males. The ages at diagnosis ranged from 2 to 68 years (Mean: 28.9 yrs; Median: 30.0 yrs). Otalgia and otorrhoea were the most common symptoms, followed by hearing loss and aural fullness. The prevalence of otomycosis among the patients in this hospital was 39.6%. Candida albicans was the most common fungal isolate in these patients as it occurred in 28.3% (15/53). Other isolates in order of frequency were Aspergillus fumigatus (5.7%), A. niger (1.9%), Penicillium spp. (1.9%) and Mucor spp.(1.9%). Candida albicans was also the most common fungus identified in all age group. There was no statistical significance associated between age of presentation and types of fungi isolated (p = 0.054). Even though, there was no statistical significance between sex and fungi isolated (p > 0.05), it was noted that all the fungi were commonly isolated from female gender irrespective of their age. Candida albicans and Aspergillus species were the most commonly identified fungal pathogens of otomycosis in U.C. H., Ibadan, Nigeria. High index of suspicion should be demonstrated by General practitioners and Otorhinolaryngologists. Patients' specimens should be sent to the laboratory as early as possible for prompt diagnosis.

A rare case of tympanostomy tube otorrhea: Pigmentiphaga.

Tympanostomy tube otorrhea (TTO) is a common complication of tympanostomy tubes. The most common bacteria associated with TTO include Haemophalis influenza, Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. We present the first case of a 9 year-old female with a history of 22q11 syndrome, hemifacial microsomia, Tetralogy of Fallot, and hearing aid dependence with left-sided profound sensorineural and right-sided moderate conductive hearing loss who presented with TTO caused by the bacteria Pigmentiphaga daeguenesis/kulla, a gram-negative bacteria often found in soil. This patient's otorrhea did not respond to typical otic antibiotic formulations, but was ultimately treated successfully with intramuscular ceftriaxone. We describe the natural history, presentation and management for a case of TTO caused by a rare bacteria from the genus Pigmentiphaga.

Current management of upper respiratory tract and head and neck infections.

The objective of this study is to present the antimicrobial management modalities of treating upper respiratory tract (URT) and head and neck infections. This article discusses the current antimicrobial treatment strategies of URT and head and neck infections. The increasing antimicrobial resistance of many bacterial pathogens has made the treatment of URT and head and neck infections more difficult. This review summarizes the aerobic and anaerobic microbiology and antimicrobials therapy of acute and chronic URT and head and neck infections. These infections include dental (gingivitis, periodontitis, necrotizing ulcerative gingivitis, and periodontal abscess), acute and chronic otitis media, mastoiditis and sinusitis, pharyngo-tonsillitis, peritonsillar, retropharyngeal and parapharyngeal abscesses, suppurative thyroiditis, cervical lymphadenitis, parotitis, siliadenitis, and deep neck infections including Lemierre syndrome. In conclusion, the proper management of these infections requires an accurate clinical and bacteriological diagnosis.

Not 'just' a foreign body in the ear canal.

Foreign bodies are commonly seen by the Ear, Nose and Throat emergency team with cotton wool being the most common aural foreign body seen in the adult population. Most complications secondary to aural foreign bodies described in the literature are minor and rarely require any surgical intervention. Here, we present two cases with impacted cotton wool as aural foreign bodies which resulted in suppurative labyrinthitis and osteomyelitis causing profound sensorineural hearing. These cases highlight the importance of considering aural foreign bodies in the differential diagnosis in those presenting with unilateral symptoms as significant complications, although rare, can occur, particularly in those with delayed diagnosis.

Sensorineural hearing loss due to secondary syphilis.

We present a case of sudden sensorineural hearing loss occurring as a complication of secondary syphilis. Syphilis affecting the inner ear, or otosyphilis, is well described in historical literature, but has rarely been reported in recent times. However, following the resurgence of syphilis in the UK, unusual manifestations such as otosyphilis are likely to be seen increasingly commonly.

Ototopical antifungals and otomycosis: a review.

There has been an increase in the prevalence of otomycosis in recent years. This has been linked to the extensive use of antibiotic eardrops. Treatment of otomycosis is challenging, and requires a close follow-up. We present a review of the literature on otomycosis, the topical antifungals most commonly used, and discuss their ototoxic potential. Candida albicans and Aspergillus are the most commonly identified organisms. Antifungals from the Azole class seem to be the most effective, followed by Nystatin and Tolnaftate.

[Auricular sporotrichosis. Atypical case report simulating bacterial cellulitis]. / Esporotricosis del pabellón auricular. Comunicación de un caso atípico simulando una celulitis bacteriana.

Sporotrichosis is the most common subcutaneous or implantation mycosis in Mexico. The case of a preauricular cutaneous-fixed sporotrichosis simulating atypical bacterial cellulitis is reported in an elderly patient with no history of trauma. The biopsy showed a suppurative granuloma with scarce yeast. Sporothrix schenckii was identified in the culture and confirmed by molecular biology. She was treated with itraconazole and a clinical and mycological cure was obtained. The case of atypical presentation is presented, coming from a semi-arid zone with extreme weather.

Pneumococci responsible for invasive disease and discharging ears in children in Sydney, Australia.

The serotypes and molecular clones of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) responsible for invasive pneumococcal disease (IPD) and discharging ears in metropolitan New South Wales were characterized to form a baseline prior to introduction of the heptavalent conjugate pneumococcal vaccine in Australia. Pneumococci isolated between 1 July 2000 and 30 June 2003 in Sydney from children <15 years were tested for antibiotic susceptibilities and serotyped. Penicillin-nonsusceptible pneumococci were typed by multilocus sequence typing and BOX PCR. During this period, 97 (13.9 %) of 698 pneumococci from IPD that were serotyped were penicillin-nonsusceptible. Of 607 pneumococci from discharging ears, 157 (26.1 %) were penicillin-nonsusceptible. Serotype 14 was the predominant serotype responsible for IPD and serotype 19F predominated from discharging ears. The heptavalent vaccine serotypes accounted for 613 (87.8 %) of all invasive isolates and 420 (69.8 %) of all isolates from discharging ears. Representatives of the major international clones were present among the PNSP. The majority of serotypes and clones that showed penicillin-nonsusceptibility are present within the vaccine. Serotype switching was also noted to have occurred prior to introduction of the vaccine. This study provides a characterization of the pneumococcal serotypes associated with IPD and discharging ears that will be useful for detecting potential selective effects of the vaccine. This surveillance should be continued, as it will be important to monitor the frequency and distribution of serotypes in the post-vaccine era.