Study of lipid in the ear canal in canine otitis externa with Malassezia pachydermatis.
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An epidemiological investigation of 120 canine otitis externa cases in 1,370 dogs was done on the incidence rate, ear pinna shapes, breeds and their relationships. Eighty-five cases (12.6%) in 672 dogs with pendulous ears and 35 cases (5.0%) in 698 dogs with erect ears had otitis externa, and the difference between them was significant (P<0.05). Ninety-five auditory cerumen specimens were cultured for Malassezia pachydermatis (M. pachydermatis) and analyzed for concentrations of major fatty acids. Although rates of cases positive for M. pachydermatis in both ear pinna shapes were almost the same, i.e. 55.2% in the pendulous group and 53.6% in the erect group, the average total fatty acid level of the pendulous ear group was significantly (P<0.05) higher than that in the erect ear group after dismissing extraordinary levels in the Siberian husky. Isolated M. pachydermatis strains were examined for the effects of fatty acid supplementation on their growth. The majority of the strains utilized fatty acids and grew faster in fatty acid supplemented broth. These results suggest that M. pachydermatis, the predominant causative agent of canine otitis externa, prefers the auditory canal of dogs with lipid-rich earwax and grows fast, but growth strongly depends upon the canine breed. (+info)
Attachment of Malassezia pachydermatis to the ear dermal cells in canine otitis externa.
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To investigate the predominance of Malassezia pachydermatis (M. pachydermatis) as a causative agent of canine otitis externa, ear cerumen samples were observed for adhesion of M. pachydermatis to the cornified epithelial cells by light and electron microscopes. The yeasts appeared not to adhere to the cornified epithelial cells directly, but they seemed to exist in the proximity of the epithelial cells with an electron opaque halo-like space around them. Polysaccharide and lipid staining techniques were conducted to identify the substances existing in that space. Lipid substances, not saccharides, were observed around the yeasts and the cornified epithelial cells. These results suggested that in the canine ear canal malassezia yeast attachment to the cornified epithelial cells is mediated by lipids. (+info)
A quasi-randomised controlled trial of water as a quick softening agent of persistent earwax in general practice.
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BACKGROUND: Earwax is a common problem in general practice. The incidence of complaints owing to earwax in general practice in the Netherlands is 39.3 per 1000 patients. AIM: To determine the feasibility of a strategy using water as a quick dispersant for persistent earwax, compared with the usual strategy using oil as a dispersant for three days in a general practice setting. DESIGN OF STUDY: Practice based, prospective controlled intervention study. SETTING: Forty-two patients (59 ears) in four general practices in the Netherlands. METHOD: Patients with persistent earwax were randomised into an intervention group and a control group. For patients in the intervention group, water drops at body temperature were dropped into the impacted ear and the auditory meatus was blocked with a wet wad of cotton. After the patient had waited for 15 minutes in the waiting room a series of attempts at syringing was completed. Patients in the control group received the usual strategy and were instructed to soften the earwax with oil each night before sleeping and to block the auditory meatus with a wad of cotton, for three days. They were asked to come back after three days for the second attempt of syringing. For both strategies the mean number of syringing attempts (and 95% confidence interval) was calculated and compared by testing the difference between the means using a t-test for independent samples. All ears in which the wax was still persistent after another five syringing attempts were given the value of 6 in the calculations. RESULTS: The mean number of syringing attempts needed per patient in the intervention group was 3.0 (95% CI = 2.4 to 3.6) and for the control group, the mean was 2.4 (95% CI = 1.7 to 3.1). The difference between means (0.6, 95% CI = 0.3 to 1.5) was not statistically significant (P = 0.18). CONCLUSION: A patient with persistent earwax can stay in the waiting room following the initial series of five attempts at syringing, with water instilled in the ear canal. After 15 minutes, the earwax is removed as easily as in the usual strategy using oil instilled for three days. The strategy using water as a dispersant for persistent earwax is quick and more convenient for the patient. (+info)
Effectiveness of ear syringing in general practice: a randomised controlled trial and patients' experiences.
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BACKGROUND: Ear syringing is a common procedure performed for a variety of symptoms in primary care. Reports of its effectiveness vary considerably and no randomised controlled trials (RCTs) have been performed. AIM: To estimate the effect of ear syringing on hearing thresholds and on symptoms leading to ear syringing in general practice. DESIGN OF STUDY: Randomised single-blind controlled trial. Before-and-after self-assessments of symptoms. SETTING: Patients from three general practices in the Bristol area attending twice-weekly clinics dedicated to ear syringing over a 12-week period. METHOD: Patients were randomly assigned to have their hearing tested before and after ear syringing, or twice before ear syringing. Changes in hearing threshold were measured by pure tone audiometry (PTA). All patients completed sef-assessment forms of symptoms using Likert scales before, and one week after, ear syringing. RESULTS: Hearing threshold improved by 10 dB or more in 34% (95% confidence interval [CI] = 21% to 47%) of the intervention group and 1.6% of control group (number needed to treat = 3.1, 95% CI = 2.2 to 5.2, P<0.001). The levels of improvement in the intervention group ranged between 15 dB and 36 dB. The symptoms that most commonly improved included hearing on the phone, pain, a feeling of blocked ears, and hearing one-to-one. There was a strong relationship between the change thresholds, as measure using PTA, and self-reports of hearing improvement. Secondary analysis was unable to identify predictors of objectively measured improvement. CONCLUSION: Ear syringing improved hearing threshold in a substantial proportion of patients. An even larger proportion reported an improvement in symptoms. It was not possible to predict which patients would benefit. (+info)
Does earwax lose its pathogens on your auriscope overnight?
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OBJECTIVES: To describe the organisms cultured from general practitioners' auriscope earpieces; and to explore general practitioners' perceptions of the possibility of cross infection from contaminated auriscope earpieces and of how their auriscope earpieces are cleaned. DESIGN: Microbiological survey of auriscope earpieces in two general practices and a semistructured questionnaire sent to 105 general practitioners. SETTING: General practitioners served by one district general hospital microbiology laboratory in the north of England. RESULTS: Organisms were cultured from 41 (93%) of 44 auriscope earpieces, of which 14 (32%) carried potential pathogens; four (9%) were heavily contaminated. Of the 85 (81%) general practitioners who responded, 72 (85%) believed that contaminated auriscope earpieces could cause serious infection, 66 (78%) did not clean earpieces between patients, and 70 (82%) thought that patients would mind if they knew that dirty earpieces were used. CONCLUSIONS: Almost a third of auriscope earpieces were contaminated by pathogenic bacteria. Although general practitioners suspected this, most did not ensure that a clean earpiece was used for each patient. (+info)
Itching in the ear canal due to hypocerumenosis. An effective method of treatment.
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Itching of the ear canal, with oozing, edema and cracking of the skin due to absence or insufficiency of wax was treated in more than 200 cases by instructing the patient to massage the ear canal with a cotton tip applicator soaked with a hydrocortisone preparation and inserted a half to three-quarters of an inch beyond the meatus. Some 95 per cent of patients reported good to excellent results in three to four days after the beginning of treatment. In the remainder results were fair. (+info)
Impacted cerumen: composition, production, epidemiology and management.
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In the UK, some 2.3 million people suffer cerumen ('ear wax') problems serious enough to warrant management, with approximately 4 million ears syringed annually. Impacted cerumen is a major cause of primary care consultation, and a common comorbidity in ENT patients, the elderly, infirm and people with mental retardation. Despite this, the physiology, clinical significance and management implications of excessive and impacted cerumen remain poorly characterized. There are no well-designed, large, placebo-controlled, double-blind studies comparing treatments, and accordingly, the evidence surrounding the management of impacted cerumen is inconsistent, allowing few conclusions. The causes and management of impacted cerumen require further investigation. Physicians are supposed to follow the edicts and principles of evidence-based medicine and clinical governance. Currently, in patients with impacted cerumen, the lack of evidence makes this impossible. (+info)
Predictors of hearing loss in school entrants in a developing country.
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BACKGROUND: Hearing loss is a prevalent and significant disability that impairs functional development and educational attainment of school children in developing countries. Lack of a simple and practical screening protocol often deters routine and systematic hearing screening at school entry. AIM: To identify predictors of hearing loss for a practical screening model in school-aged children. SETTINGS AND DESIGN: Community-based, retrospective case-control study of school entrants in an inner city. METHODS: Results from the audiologic and non-audiologic examination of 50 hearing impaired children in randomly selected mainstream schools were compared with those of a control group of 150 normal hearing children, matched for age and sex from the same population. The non-audiologic evaluation consisted of medical history, general physical examination, anthropometry, motor skills, intelligence and visual acuity while the audiologic assessment consisted of otoscopy, audiometry and tympanometry. STATISTICAL ANALYSIS: Multiple logistic regression analysis of significant variables derived from univariate analysis incorporating student t-test and chi-square. RESULTS: Besides parental literacy (OR:0.3; 95% CI:0.16-0.68), non-audiologic variables showed no association with hearing loss. In contrast, most audiologic indicators, enlarged nasal turbinate (OR:3.3; 95% CI:0.98-11.31), debris or foreign bodies in the ear canal (OR:5.4; 95% CI:1.0-36.03), impacted cerumen (OR:6.2; 95% CI:2.12-14.33), dull tympanic membrane (OR:2.2; 95% CI:1.10-4.46), perforated ear drum (OR:24.3; 95% CI:2.93-1100.17) and otitis media with effusion OME (OR:14.2; 95% CI:6.22-33.09), were associated with hearing loss. However, only parental literacy (OR:0.3; 95% CI:0.16-0.69), impacted cerumen (OR:4.0; 95% CI:1.66-9.43) and OME (OR:11.0; 95% CI:4.74-25.62) emerged as predictors. CONCLUSION: Selective screening based on the identification of impacted cerumen and OME will facilitate the detection of a significant proportion of hearing impaired school entrants. (+info)