Colesteatoma del conducto auditivo externo: Experiencia de 5 años Hospital del Salvador / External ear canal cholesteatoma: 5-year experience Hospital del Salvador

Introducción: El colesteatoma del conducto auditivo externo (CCAE) es una estructura quística revestida por epitelio escamoso estratificado queratinizado que tiene la capacidad de invadir y erosionar localmente al hueso temporal. Su incidencia es de 0,19 a 0,3/100.000 habitantes siendo 60 veces menos frecuente que el de oído medio. Objetivo: Describir las características epidemiológicas, clínicas, imagenológicas y tratamiento de los pacientes diagnosticados con CCAE en el Servicio de Otorrinolaringología Hospital del Salvador. Material y Método: Se presenta una serie de ocho casos clínicos recopilados durante el período 2017 y 2021. Se realizó revisión de fichas clínicas, biopsias y tomografías computadas de oídos (TC oídos). Se describen los hallazgos y tratamiento efectuado. Resultados: El promedio de edad fue de 65,6 años, correspondiente a 5 mujeres y 3 hombres con presencia de tabaquismo y diabetes en la mitad de los casos. Los síntomas y signos más frecuentes fueron otalgia e hipoacusia seguido de otorrea. 7 pacientes se presentaron con tímpano íntegro y el compromiso de la pared inferior del conducto se evidenció en 6 de 8 pacientes. La TC oídos mostró erosión ósea del conducto, con o sin compromiso de estructuras adyacentes, en todos los casos y el diagnóstico histológico fue efectuado en el 100% de los pacientes. Se privilegió el tratamiento conservador mediante curaciones óticas periódicas asociado a ácido salicílico al 3% y/o antibióticos tópicos en 6/8 pacientes. Conclusiones: El CCAE es una entidad poco frecuente sin signos ni síntomas patognomónicos por lo que el diagnóstico histológico junto con el estudio imagenológico es perentorio. El tratamiento conservador es una alternativa terapéutica válida que ofrece buenos resultados en pacientes con adecuada adherencia al tratamiento y posibilidad de seguimiento estricto.

Introduction: External ear canal cholesteatoma (EECC) is a cystic structure lined by keratinized stratified squamous epithelium that has the ability to locally invade and erode the temporal bone. Its incidence is 0.19 to 0.3 / 100,000 habitants, being 60 times less frequent than that of the middle ear. Aim: To describe the epidemiological, clinical, imaging and treatment characteristics of patients diagnosed with EECC in the Hospital del Salvador ENT department. Material and Methods: A series of eight clinical cases collected during the period 2017 and 2021 is presented. A review of clinical records, biopsies and computed tomography of the ear (ear CT) was carried out. The findings and treatment carried out are described. Results: The average age was 65.6 years corresponding to 5 women and 3 men with the presence of smoking and diabetes in half of the cases. The most frequent symptoms and signs were earache and hearing loss followed by otorrhea. 7 patients presented with an intact eardrum and compromise of the inferior wall of the canal was evidenced in 6 of 8 patients. Ears CT showed bone erosion of the canal with or without compromise of adjacent structures in all cases and the histological diagnosis was made in 100% of the patients. Conservative treatment with periodic ear dressings associated with 3% salicylic acid and / or topical antibiotics was favored in 6/8 patients. Conclusion: EECC is a rare entity without pathognomonic signs or symptoms, therefore the histological diagnosis together with the imaging study is peremptory. Conservative treatment is a valid therapeutic alternative that offers good results in patients with adequate adherence to treatment and the possibility of strict follow-up.

Research on effect of pulsatile external auditory canal irrigation on foreign bodies in children / 中国实用护理杂志

Objective:To explore the methods to improve the success rate of external canal foreign body washing and reduce the incidence of adverse reaction in children (≤14 years old).Methods:This study was a randomized controlled trial. A total of 60 pediatric patients with ear canal foreign bodies who were admitted to the otolaryngology-head and neck surgery clinic of Shengjing Hospital Affiliated to China Medical University from January 2021 to May 2022 were selected. The patients were divided into the experimental group and the control group by the random number table method, with 30 cases in each group. The experimental group were treated with pulsatile external auditory canal irrigation method, while the control group were treated with the conventional ear canal flushing method. The success rate of flushing, the flushing time, the incidence of adverse reactions and satisfaction of the patient's family were compared between the two groups.Results:The success rate of flushing was 80.0% (24/30) in the experimental group and 46.7% (14/30) in the control group, with statistically significant difference ( χ2= 7.18, P <0.05). The flushing time was (140.80 ± 44.48) s in the experimental group and (296.60 ± 82.79) s in the control group, with statistically significant difference ( t=9.08, P <0.05). The incidence of adverse reactions was 23.3% (7/30) in the experimental group and 63.3% (19/30) in the control group, with statistically significant difference ( χ2=9.77, P<0.05). The satisfaction of the patient's family was 93.9% (28/30) in the experimental group and 36.7% (11/30) in the control group, with statistically significant difference ( χ2=21.17, P<0.05). Conclusions:The pulsatile external auditory canal irrigation method can improve the success rate of ear canal foreign body flushing, shorten the flushing time and reduce the adverse reactions. The need for surgery and hospitalization due to ear canal foreign body, the suffering of patients and the corresponding cost can be decreased accordingly. The new treatment showed clear advantages clinically and should be widely applied.

Pleomorphic adenoma of the external auditory canal

ABSTRACT Pleomorphic adenoma (PA) of the external auditory canal (EAC) is a rare clinical entity with a few cases reported in the literature. The clinical diagnosis of these lesions can be formidable due to their rarity and unusual location. This tumor occurs at various other anatomical locations apart from the major salivary glands. A 30-year-old female presented with a two-year history of a gradually enlarging and painless mass in the left external auditory canal. The tumor was excised, and histopathological and immunohistochemical evaluation revealed a mixed tumor with both epithelial and stromal components of different proportions, recognized and classified today by the World Health Organization (WHO) as a pleomorphic adenoma. The post-operative course was uneventful, and at the 10-month follow-up, no recurrence of the pleomorphic adenoma was noted. We highlight the histological features and the immunohistochemical profile of the tumor and review the literature on glandular neoplasms of the EAC and their recent classification, emphasizing on the histogenesis, clinical presentations, and microscopic features of the tumor. In addition, we aim to discuss vital features in differentiating these tumors from other tumors of the external auditory canal to enable clinicians and pathologists to recognize this uncommon benign neoplasm.

Dermal cylindroma of the external auditory canal

ABSTRACT External auditory canal (EAC) cylindroma is a rare tumor that mainly presents as a painless mass over the lateral aspect of the ear canal. They have been designated under different nomenclatures in the literature, and controversies persist about their etiology and histogenesis. Moreover, a clinical diagnosis of EAC cylindroma is often challenging because of their rarity and a close resemblance with other adnexal benign and malignant tumors. None of the previous authors have extensively reviewed the dermal cylindroma of the EAC. We provide an extensive review involving PubMed and Google Scholar and report by Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. A total of 8 cases are included in the current study. The mean age is 55.13 years. There are six females and two males. The left and right ear are involved in 62.50% and 37.50% of cases, respectively. The most common sign/symptom is painless mass (50%). Five authors reported a primary lesion (62.50%), while the remaining 3 reported a recurrent tumor (37.50%). Benign versus malignant cylindroma is reported in 87.50% and 12.50% of cases, respectively. All, except one case, reported a solitary swelling. Surgical excision was employed in all the cases. Primary defect closure versus defect closure with local/distant skin graft /flap is utilized in 37.50% and 62.50% of cases, respectively.

Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

Patrones de resistencia en agentes bacterianos involucrados en otitis caninas en Medellín, Colombia, durante 2019: análisis retrospectivo / Patterns of resistance in bacterial agents involved in canine otitis at Medellín, Colombia, during 2019: retrospective analysis

RESUMEN Dentro de los agentes patógenos en los procesos otíticos bacterianos, se destacan microorganismos como Staphylococcus pseudintermedius, Pseudomona auriginosa, Proteus mirabi-lis, Escherichia coli, Corynebacterium spp., Enterococcus spp. y Streptococcus spp., para los cuales se ha descrito resistencia frente a los antibióticos empleados para combatirlos. En Colombia son pocos los reportes acerca de la resistencia antibiótica de microorganismos causantes de otitis. Por ello, el objetivo de esta investigación fue determinar los agentes bacterianos más frecuentemente aislados en infecciones otíticas de caninos remitidas a un laboratorio veterinario de Medellín durante el 2019 y su resistencia a antibióticos. Para llevarlo a cabo, se realizó un estudio descriptivo transversal retrospectivo. Se analizaron los resultados de los antibiogramas realizados a partir de cultivos bacterianos en muestras óticas remitidas a un laboratorio de referencia de la ciudad de Medellín. Además, se efectuó un análisis de frecuencias para la muestra total. Se encontró que los principales microorganismos bacterianos aislados fueron Staphylococcus pseudintermedius, Pseudomona auriginosa, Proteus mirabili y Staphylococcus aureus. La gentamicina fue el medicamento que mayor porcentaje de resistencia presentó y la cefalexina el que menos resistencia presentó. Se pudo concluir que el Staphylococcus pseudintermedius está presente en más del 60% de los casos de otitis bacteriana. Adicionalmente, se observó una variación de la resistencia presentada por los microorganismos en el tiempo. Estos presentaron mayor resistencia ante los antibióticos aminoglucósidos.

ABSTRACT Among the pathogens in bacterial otic processes, microorganisms such as Staphylococcus pseudintermedius, Pseudomona auriginosa, Proteus mirabilis, Escherichia coli, Corynebac-terium spp., Enterococcus spp., and Streptococcus spp. stand out, for which resistance to antibiotics has been described employed to combat them. In Colombia there are few reports about the antibiotic resistance of microorganisms that cause otitis. For that reason, the purpose of this study was to determine the bacterial agents most frequently isolated from canine ear infections and their resistance to antibiotics from samples of ear secretions sent to a veterinary laboratory in Medellín during 2019. In order to do that, an cross-sectional, retrospective descriptive study was done. The results of the antibiograms performed from bacterial cultures obtained from ear samples sent to a reference laboratory in the city of Medellín were analyzed. A frequency analysis was carried out for the total sample. It was found that the main isolated bacterial microorganisms were Staphylococcus pseudintermedius, Pseudomona auriginosa, Proteus mirabili and Staphylococcus aureus. Gentamicin was the drug with the highest percentage of resistance and cephalexin the one with the least resistance. It was possible to conclude that Staphylococcus pseudintermedius is linked in more than 60% of cases of bacterial otitis and the resistance presented by microorganisms varies over time. The group of aminoglycosides antibiotics was the one which microorganisms are manifesting more percentage of resistance.

Dehiscencia timpánica (foramen de Huschke): a más de 300 años de su primera descripción / Tympanic dehiscence (Huschke's foramen): more than 300 years after its first description

RESUMEN: La dehiscencia timpánica o Foramen de Huschke se considera un rasgo craneal morfológico menor, hipostósico, no estocástico, transitorio, ubicado en la placa timpánica del hueso temporal, cuya expresión se considera fisiológica hasta los 5 años de edad. La mención de este rasgo en la literatura es escasa, generando controversias entre de los anatomistas que la han descrito. El epónimo Huschke, anatomista alemán, quien ha sido mencionado como el primero en observarla en 1844. Sin embargo, existen antecedentes de que dicha característica ósea fue previamente descrita por otros autores casi 200 años antes. La actual denominación, dehiscencia timpánica, fue dada en 1878 por Bürkner, siendo aceptada hasta el día de hoy. El objetivo de este artículo es realizar un análisis histórico de la descripción morfológica de la dehiscencia timpánica en la literatura anatómica especializada.

SUMMARY: Tympanic dehiscence or Huschke's Foramen is considered a minor, hypostosic, non-stochastic, transitory morphological cranial feature, located in the tympanic plate of the temporal bone, whose expression is considered physiological up to 5 years of age. The mention of this feature in the literature is scarce, generating controversy among the anatomists who have described it. The eponymous Huschke, a German anatomist, who has been mentioned as the first to observe it in 1844. However, there is a history that this bone characteristic was previously described by other authors almost 200 years earlier. The current name, tympanic dehiscence, was given in 1878 by Bürkner, being accepted until today. The objective of this article is to carry out a historical analysis of the morphological description of tympanic dehiscence in specialized anatomical literature.

Estudio anatómico de la dehiscencia timpánica (foramen de Huschke) en la población arqueológica de Tutuquén, Región del Maule, Chile / Anatomical study of tympanic dehiscence (foramen of Huschke) in the archaeological population of Tutuquén, Maule Region, Chile

RESUMEN: La dehiscencia timpánica o Foramen de Huschke (FH) se considera un rasgo craneal morfológico menor, hipostósico, no estocástico, transitorio, ubicado en laplaca timpánica del hueso temporal, cuya expresión se considera fisiológica hasta los 5 años de edad, denominándose como persistente su presencia a mayor edad. La mención de este rasgo en la literatura anatómica se presenta de manera escasa, debido a una muy baja presencia en poblaciones modernas, situación que cambia al estudiar poblaciones arqueológicas. El propósito de este estudio es describir la expresión del foramen de Huschke en una población arqueológica de Chile central. Fueron analizados 27 huesos temporales obtenidos de los restos óseos de la población del Monumento Arqueológico Cementerio Tutuquén, los cuales están depositados en el Museo Regional de Rancagua, Chile. Se evaluó presencia y ubicación del foramen, sexo, temporalidad y rango etáreo para cada muestra incluida. El FH se presentó en un 77,78% de los temporales, siendo 47,62% restos masculinos, 28,57% femeninos y 23,81% de sexo indeterminado. La totalidad de los restos de niños y subadultos presentaron FH, mientras que en adultos su expresión disminuye hasta un 68,42%. La ubicación fue un 38,10% en cuadrante inferomedial, 33,33% superolateral, 23,81% superomedial, 4,71% central. No se encontraron FH de ubicación inferolateral. El único temporal observable del período 10.000 AP (antes del presente, 1950) presentó FH, mientras que, en el período 7.000 AP se presentó en 6/7 temporales y en 14/19 temporales del período 1.000 AP. Los datos aportados complementan el conocimiento anatómico del proceso de osificación del hueso timpánico y la expresión de la dehiscencia timpánica como rasgo morfológico menor desde el estudio de poblaciones arqueológicas.

SUMMARY: The tympanic dehiscence or Foramen of Huschke (FH) is considered a transient minor, hypostosic, non-stochastic cranial feature, located in the tympanic plate of the temporal bone. Its expression is considered physiological until the age of five, and its presence is constant after that. This characteristic is seldom mentioned in anatomical literature since it is infrequent in modern populations. However, there is a difference when archaeological populations are studied. The purpose of this study is to describe the expression of the Huschke foramen in an archaeological population of central Chile. For this analysis, 27 temporal bones were obtained from human skeletal remains of the Tutuquén Cemetery Archaeological Monument. Presence and location of the foramen, sex, time period and age range were evaluated for each sample. The FH occurred in 77.78% of the temporal bones, with 47.62% male, 28.57% female and 23.81% of undetermined sex. All children and subadults presented FH, while in adults it decreased to 68.42%. The location was 38.10% in the inferomedial quadrant, 33.33 % superolateral, 23.81% superomedial, 4.71% central, and no FH was found at the inferolateral position. The only temporal bone identified in the 10,000 BP (before the present 1950) presented FH, while in the 7,000 BP period, it presented in 6/7 temporal bones and in the 1000 BP period, it was found in 14/ 19 temporal bones. The data provided complements anatomical knowledge of the tympanic bone ossification process, and in archaeological population studies, tympanic dehiscence presents as a lesser morphological characteristic.

Identification of Malassezia species as part of normal skin and ear canal microbiota in horses / Identificación de especies de Malassezia como microbiota normal en piel y canal auditivo externo de equinos / Identificação de espécies de Malassezia como microbiota normal em pele e canal auditivo externo de cavalos

Abstract Background: The yeasts of the genus Malassezia are considered part of the normal skin microbiota in humans and animals. In horses, several species of the genus Malassezia have been reported in different areas of the skin and ear canal. Objective: Isolate, characterize and identify the different species belonging to the genus Malassezia isolated from the ear canal and skin of equine patients with no dermatological lesions that were referred to the large animal clinic of veterinary teaching hospital at the National University of Colombia. Methods: 22 horses were evaluated and sampled. Eighty-two samples were obtained by swabbing either the ear canals (left and right), skin areas of prepuce, mammary gland and inguinal region. The samples were examined by cytological evaluation and were cultured on modified Dixon's agar and phenotypic and molecular identification were performed for yeast colonies. Results: Fourteen yeast isolates were obtained from the 82 samples. Biochemical identification determined that 50% (n=7) were Malassezia spp., 35.7% (n=5) were identified as Candida spp. and 14.3% (n=2) as Cryptococcus spp.. Using molecular tests, the Malassezia species were M. slooffiae (28.6%) and M.nana (57.1%); only one isolate was classified as Trichosporo asahii. Conclusion: M.nana and M. slooffiae were identified as part of the normal ear canal and skin microbiota in the evaluated horses. The observed prevalence of Malassezia spp. was 18.2% (n=4/22) in this study sample.

Resumen Antecedentes: Las levaduras del género Malassezia hacen parte de la microbiota normal cutánea de humanos y animales. En equinos se han reportado diferentes especies de Malassezia aisladas de varias regiones de piel y canal auditivo externo. Objetivo: Aislar, caracterizar e identificar las especies del género Malassezia spp. a partir de canal auditivo externo y piel de equinos sin lesiones dermatológicas, remitidos a la Clínica de Grandes Animales de la Facultad de Medicina Veterinaria y de Zootecnia de la Universidad Nacional de Colombia. Metodología: Se evaluaron 22 equinos, a partir de los cuales se obtuvieron 82 muestras entre hisopados de canal auditivo externo (izquierdo y derecho) y diferentes regiones de piel (prepucio, glándula mamaria e ingle). Las muestras fueron procesadas mediante examen directo y cultivo en agar Dixon modificado. A partir de los aislamientos en los que se observaron colonias morfológicamente compatibles con Malassezia spp. se realizó la identificación fenotípica y molecular. Resultados: De las 82 muestras procesadas se obtuvieron 14 aislamientos de levaduras, de las cuales mediante identificación bioquímica el 50% (n=7) correspondió a Malassezia spp., el 35,7% (n=5) a Candida spp., y el 14,3% (n=2) a Cryptococcus spp. Luego mediante pruebas moleculares se identificaron las especies del género Malassezia como: M. slooffiae (28,6%) y M . nana (57,1%); y un aislamiento correspondió a Trichosporon asahii. Conclusión: Se logró identificar las especies M.nana y M. slooffiae como microbiota normal de la piel y el canal auditivo en los equinos evaluados. La prevalencia de Malassezia spp. para la población evaluada fue de 18,2% (n=4/22).

Resumo Antecedentes: As leveduras do gênero Malassezia fazem parte da microbiota cutânea normal de humanos e animais. Em cavalos, diferentes espécies de Malassezia isoladas de várias regiões da pele e do canal auditivo externo foram reproduzidas. Objetivo: Isolar, caracterizar e identificar as espécies do gênero Malassezia spp. do canal auditivo externo e pele eqüinos sem lesões cutâneas, referiu-se à Clínica de Grandes Animais da Faculdade de Medicina Veterinária e Zootecnia da Universidade Nacional da Colômbia. Métodos: 22 equinos foram avaliadas a partir dos quais 82 amostras a partir de esfregaços do canal auditivo externo (esquerda e direita) e diferentes regiões da pele (prepúcio, glândula mamaria e virilha) foram obtidos. As amostras foram processadas por exame direto e cultura em ágar Dixon modificado. Dos isolados nos quais as colônias foram observadas morfologicamente compatíveis com Malassezia spp. identificação fenotípica e molecular foi realizada. Resultados: Das 82 amostras processadas 14 isolados de levedura, que foram obtidos por identificação bioquímica de 50% (n=7) correspondia a Malassezia spp., 35,7% (n=5) a Candida spp., e 14,3% (n=2) para Cryptococcus spp.. Em seguida, usando o teste molecular espécie Malassezia foram identificadas como M. slooffiae (28,6%) e M . nana (57,1%); e um isolamento correspondia a Trichosporon asahii. Conclusão: As espécies M.nana e M. slooffiae foram identificadas como microbiota de pele normal e do canal auditivo nos equídeos avaliados. A prevalência de Malassezia spp. para a população avaliada foi 18,2% (n=4/22).

Resolução cirúrgica de pólipo inflamatório em ouvido médio de felino através da técnica de avulsão e tração por abordagem lateral: relato de caso / Surgical resolution of feline middle ear inflammatory polyp by lateral approach traction and avulsion technique: case report

O objetivo desse trabalho foi descrever um caso de pólipo inflamatório em ouvido médio de um felino e sua resolução cirúrgica através da avulsão e tração da massa após abordagem lateral. Um felino, fêmea, de 2 anos de idade, foi atendido no Hospital Veterinário Professor Sylvio Barbosa Cardoso, apresentando prurido intenso, dor e secreção fétida em região auricular. Pelo exame físico foi possível observar um nódulo em região de ouvido médio esquerdo. Associado a isso, o animal apresentava “headtilt” (inclinação da cabeça para o lado afetado). Foram solicitados exames hematológicos, radiografia de crânio e citologia da massa. O animal foi encaminhado para cirurgia de extirpação da massa. Foi feita uma incisão na pele sob o canal auditivo vertical palpável. A cartilagem foi liberada até o nível da junção entre as cartilagens auricular e anular. Com o auxílio de um fórceps, o pólipo foi agarrado e delicadamente girado até ser completamente extirpado de sua origem. A cartilagem e o subcutâneo foram fechados com material de sutura monofilamentar 4-0 e a pele foi fechada em um padrão de sutura subdérmica usando o mesmo material. A peça foi encaminhada para exame histopatológico, pelo qual confirmou-se a suspeita de pólipo inflamatório, através da observação de epitélio colunar ciliado. Utilizando a técnica cirúrgica TALA (avulsão e tração após abordagem lateral) foi possível obter melhora do quadro clínico do animal referido, rápida recuperação pós-cirúrgica e sem nenhuma complicação decorrente da técnica. Essa técnica, portanto, se mostrou satisfatória, melhorando significativamente a qualidade de vida do animal.

The aim of this study was to describe a case of inflammatory polyp in the middle ear of a cat and its surgical resolution through avulsion and mass traction after lateral approach. A female feline, two year old, was admitted at the Hospital Veterinário Professor Sylvio Barbosa Cardoso, presenting intense itching, pain and fetid discharge in the ear region. Physical examination revealed a nodule in the left middle ear region. Associated with this, the animal presented head tilt (inclination of the head to the affected side). Hematological examinations, skull radiography and mass cytology were requested. The animal was referred for polyp removal surgery. A skin incision was made under the palpable vertical ear canal. The cartilage was released to the level of the junction between the auricular and annular cartilages. With the help of a forceps, the polyp was grasped and gently rotated until completely removed from its origin. The cartilage and subcutaneous tissue were closed with 4-0 monofilament suture material and the skin was closed in a subdermal suture pattern using the same material. The piece was referred for histopathological examination, which confirmed the suspicion of inflammatory polyp by observing ciliated columnar epithelium. Using the TALA surgical technique (avulsion and traction after lateral approach) it was possible to obtain improvement of the clinical 3 picture of the referred animal, rapid postoperative recovery and without any complications resulting from the technique. This technique therefore proves satisfying, significantly improving the quality of life of the animal

Resolução cirúrgica de pólipo inflamatório em ouvido médio de felino através da técnica de avulsão e tração por abordagem lateral: relato de caso / Surgical resolution of feline middle ear inflammatory polyp by lateral approach traction and avulsion technique: case report

O objetivo desse trabalho foi descrever um caso de pólipo inflamatório em ouvido médio de um felino e sua resolução cirúrgica através da avulsão e tração da massa após abordagem lateral. Um felino, fêmea, de 2 anos de idade, foi atendido no Hospital Veterinário Professor Sylvio Barbosa Cardoso, apresentando prurido intenso, dor e secreção fétida em região auricular. Pelo exame físico foi possível observar um nódulo em região de ouvido médio esquerdo. Associado a isso, o animal apresentava "headtilt" (inclinação da cabeça para o lado afetado). Foram solicitados exames hematológicos, radiografia de crânio e citologia da massa. O animal foi encaminhado para cirurgia de extirpação da massa. Foi feita uma incisão na pele sob o canal auditivo vertical palpável. A cartilagem foi liberada até o nível da junção entre as cartilagens auricular e anular. Com o auxílio de um fórceps, o pólipo foi agarrado e delicadamente girado até ser completamente extirpado de sua origem. A cartilagem e o subcutâneo foram fechados com material de sutura monofilamentar 4-0 e a pele foi fechada em um padrão de sutura subdérmica usando o mesmo material. A peça foi encaminhada para exame histopatológico, pelo qual confirmou-se a suspeita de pólipo inflamatório, através da observação de epitélio colunar ciliado. Utilizando a técnica cirúrgica TALA (avulsão e tração após abordagem lateral) foi possível obter melhora do quadro clínico do animal referido, rápida recuperação pós-cirúrgica e sem nenhuma complicação decorrente da técnica. Essa técnica, portanto, se mostrou satisfatória, melhorando significativamente a qualidade de vida do animal.

The aim of this study was to describe a case of inflammatory polyp in the middle ear of a cat and its surgical resolution through avulsion and mass traction after lateral approach. A female feline, two year old, was admitted at the Hospital Veterinário Professor Sylvio Barbosa Cardoso, presenting intense itching, pain and fetid discharge in the ear region. Physical examination revealed a nodule in the left middle ear region. Associated with this, the animal presented head tilt (inclination of the head to the affected side). Hematological examinations, skull radiography and mass cytology were requested. The animal was referred for polyp removal surgery. A skin incision was made under the palpable vertical ear canal. The cartilage was released to the level of the junction between the auricular and annular cartilages. With the help of a forceps, the polyp was grasped and gently rotated until completely removed from its origin. The cartilage and subcutaneous tissue were closed with 4-0 monofilament suture material and the skin was closed in a subdermal suture pattern using the same material. The piece was referred for histopathological examination, which confirmed the suspicion of inflammatory polyp by observing ciliated columnar epithelium. Using the TALA surgical technique (avulsion and traction after lateral approach) it was possible to obtain improvement of the clinical 3 picture of the referred animal, rapid postoperative recovery and without any complications resulting from the technique. This technique therefore proves satisfying, significantly improving the quality of life of the animal.

Congenital microtia with aural atresia or stenosis accompany with first branchial cleft anomaly: report of 5 cases / 中华耳鼻咽喉头颈外科杂志

Objective@#To summarize the experience of the diagnosis, treatment and effects of the cases with coexistence of first branchial cleft anomaly(FBCA) and microtia with congenital aural atresia or stenosis(external auditory canal stenosis, EACS).@*Method@#This was a retrospective study. The clinical data of 5 patients with microtia and EACS in Beijing Tongren Hospital of Capital Medical University from October 2015 to March 2018 were collected, including 3 males and 2 females, aged from 5 to 28 years. The clinical characteristics, imaging findings, treatment methods and effects of 5 patients were analyzed.@*Result@#The 5 cases were all coexistence of EACS and FBCA, three of who associated with cholesteatoma of external auditory canal. CT showed external auditory canal stenosis with soft tissue shadow, sometimes gas or bone septum found inside, filling in the external auditory canal, combined with canal bone destruction irregularly. All patients underwent surgical resection of FBCA, 3 patients accompanied by cholesteatoma resection and canalplasty. The postoperative follow-up ranged from 10 to 39 months, and no recurrence of infection was observed.@*Conclusions@#EACS and FBCA both result from maldevelopment of the first branchial cleft. These two malformations, FBCA and EACS with or without cholesteatoma, can occur simultaneously, in which situation CT shows external auditory canal stenosis with soft tissue shadow inside. These patients underwent surgical resection of FBCA combined with cholesteatoma resection with good result.

Contralateral Occlusion Test (COT): the effect of external ear canal occlusion with aging / Teste de Oclusão Contralateral (TOC): o efeito da oclusão do canal auditivo externo com a idade

ABSTRACT Purpose This study aimed to evaluate the effects of complete external ear canal occlusion on hearing thresholds with aging. The goal was to decide which tuning fork is more appropriate to use for the contralateral occlusion test (COT), in individuals of different ages. Methods Forty-two normal hearing subjects between 21 and 67 years were divided into three age groups (20-30 years, 40-50 years, and 60-70 years). Participants underwent sound field audiometry tests with warble tones, with and without ear canal occlusion. Each ear was tested with the standard frequencies (250, 500, 1000, and 2000 Hz). The contralateral ear was suppressed by masking. Results Hearing thresholds showed an increase as the frequency increased from 20.85 dB (250 Hz, 20-30 years group) to 48 dB (2000 Hz, 60-70 years group). The threshold differences between occlusion and no occlusion conditions were statistically significant and increased ranging from 11.1 dB (250 Hz, 20-30 years group) to 32 dB (2000 Hz, 20-30 years group). We found statistically significant differences for the three age groups and for all evaluations except to 500 Hz difference and average difference. The mean hearing loss produced by occlusion at 500 Hz was approximately 19 dB. We found no statistically significant differences between right and left ears and gender for all measurements. Conclusion We conclude that the use of the 512 Hz tuning fork is the most suitable for COT, and its use may allow clinicians to distinguish mild from moderate unilateral conductive hearing loss.

RESUMO Objetivo O objetivo deste estudo foi avaliar o efeito da oclusão completa do canal auditivo externo nos limiares auditivos, em indivíduos de idades distintas, para apurar qual o diapasão mais adequado na realização do teste de oclusão contralateral (TOC). Método 42 indivíduos normo-ouvintes (21-67 anos) foram divididos em três grupos etários (20-30, 40-50 e 60-70 anos). Os participantes foram avaliados com testes de audiometria tonal liminar em campo livre, com e sem oclusão completa do canal auditivo externo. Cada ouvido foi testado para as frequências 250, 500, 1000 e 2000 Hz. No ouvido contralateral, foi realizado mascaramento, para evitar a ocorrência de audição contralateral. Resultados Verificou-se aumento dos limiares auditivos, diretamente proporcional ao aumento da frequência (desde 20.85 até 48 dB). A diferença nos limiares auditivos entre a condição de oclusão e de não oclusão foi estatisticamente significativa em todas as frequências e aumentou de forma diretamente proporcional com a frequência (desde 11.1 até 32 dB). Foram também encontradas diferenças estatisticamente significativas para os três grupos etários, em todos os parâmetros, exceto na diferença a 500 Hz e na diferença total média. A perda auditiva média resultante da oclusão aos 500 Hz foi de 19 dB. Não se encontraram diferenças estatisticamente significativas entre o ouvido direito e o esquerdo, e entre o gênero. Conclusão A utilização do diapasão de 512 Hz é a mais adequada para o TOC. A sua utilização pode permitir aos clínicos, em ambiente de consulta e de forma rápida, a distinção entre perda condutiva de grau leve a moderada.

A comparison between penlight and otoscopic examination of the ear canal and tympanic membrane among grade 1 students

BACKGROUND@#In the Philippines, screening for ear problems especially in children at entry to school is usually undertaken by school nurses and teachers who typically do not have specialized instrumentation. The penlight has recently been employed as screening method in determing the possibilities of ear problems in public school communities. This study attempts to determine the accuracy of the penlight as an alternative method for screening to assess the common external ear abnormalities among Grade 1 students in an elementary school.@*OBJECTIVES@#1. To compare the result of otologic examination using the penlight versus otoscopy in determining of common pediatric ear problems. 2. To determine the sensitivity, specificity and predictive values of penlight examination in the screening of ear canal and tympanic membrane for abnormal conditions among Grade 1 students.@*METHODS@#Otologic examination with the use of a penlight was carried out by the tranined nurse in ears of Grade 1 students and the results compared with those obtained from otoscopy done by an otolaryngologist. Presence of ear conditions such as cerumen, discharge, foreign body, tympanic membrane visualization, and an overall assessment were recorded in an Excel file. The examiners were both blinded with the findings.@*RESULTS@#Ninety-four students (188 test ears) with a median age of 6 years, ranging from 5 to 10 years, and a 1:1 sex distribution were included in the study. The result showed an excellent agreement (P<.001) between the penlight and otoscopic examination. The sensitivity and specificity were of 98.6% and 100%, respectively. The PPV is nearly 100% and NPV of 95.2% and and overall accuracy of 98.94%.@*CONCLUSIONS@#There is an excellent agreement between the nurse‘s findings and otolaryngologist‘s findings in examining the ear canal and tympanic membrane. The penlight has on overall accuracy of 98.94%, in identifying cerumen, discharge, foreign body and visualizing the tympanic membrane. Thus, this study shows that with trained nurse in otologic examination, the penlight is an effective screening in identifying common ear problem among children.

Cistomatose ceruminosa em felino Persa: relato de caso / Feline ceruminous cystomatosis in a Persian cat: a case report

Neste trabalho, os autores relatam o caso de um gato Persa, macho, de cinco anos e meio de idade, atendido na Cidade do Rio de Janeiro apresentando nódulos auriculares diagnosticados por histopatologia como cistomatose ceruminosa. Por tratar-se de uma afecção pouco comum, de etiologia desconhecida e fácil resolução, os autores objetivaram divulgá-la, descrevendo os principais sinais clínicos e tratamentos. Como terapia, foi realizadaa excisão cirúrgica dos cistos com bisturi elétrico e não houve recidiva nos últimos três anos. Sugere-se que os cistos benignos podem malignizar, além de dificultarem o asseio do conduto auditivo levando ao acúmulo de cerúmen e, consequentemente, a infecções secundárias (otite externa) por proliferação microbiana.

In this case report the authors describe the presence of nodules in the concave pinna of a five years-old male Persian cat brought to veterinary clinic care in Rio de Janeiro in 2015, diagnosed by histopathology as ceruminous cystomatosis. As it is an uncommon disorder of unknown etiology and easy treatment, the authors aim to elucidate the main clinical signs associated and treatment used. The ablation of cysts was performed withan electric bistoury and no recurrency was reported within three years. It is suggested that benign cysts can progress to malignancy, besides, lesions can disrupt normal self-cleaning of the auditory canal leading to secondary otitis externa by microbial proliferation.

Influencia auditiva de la pared posterosuperior del conducto auditivo externo, en la hipoacusia de conducción postimpanomastoidectomía / Hearing influence of the posterior ear canal wall, in the conductive hearing loss after tympanomastoidectomy

RESUMEN Introducción: El tratamiento de la otitis media crónica (OMC) colesteatomatosa es quirúrgico, cuyo objetivo es erradicar la enfermedad, evitar complicaciones y prevenir recurrencias. El gold standard es la timpanomastoidectomía con canal wall down (TCWD). Estudios en cadáver han definido que TCWD disminuye la audición 1-5 dB en frecuencias <1.000 Hz y 0-10 dB entre 1.000 y 3.000 Hz. De aquí nuestro interés por definir la influencia acústica de la pared posterosuperior del conducto auditivo externo (CAE). Objetivo: Determinar en cuantos decibeles se corrige la audición al reconstituir pared posterior del CAE pos-TCWD. Material y método: Trabajo experimental. A pacientes pos-TCWD se reconstituye de manera transitoria la pared posterior del CAE, realizándose audiometría pre y posprocedimiento. Resultados: 23 pacientes (25 oídos), promedio 48,8 años (18-72 años). En 96% existió una diferencia favorable al reconstruir la pared posterior, presentando una mejoría auditiva entre 1,2 y 10,6 dB (4,2 ± 2,8 dB). En frecuencias <1.000 Hz la mejoría fue de 6,0 dB (p <0,001), entre 1.000-3.000 Hz fue 2,6 dB (p <0,001) y >3.000 Hz no hubo diferencia. Considerando PTP de vía aérea la mejoría fue 4,6 dB (p <0,001). Conclusión: Nuestro estudio demuestra que existe mejoría auditiva en la gran mayoría de oídos evaluados al reconstituir la pared posterosuperior del CAE, alcanzando 6 dB en frecuencias <1.000 Hz y 2,6 dB en frecuencias medias. Si consideramos los PTP de vía aérea la mejoría es de 4,6 dB en presencia de pared posterior.

ABSTRACT Introduction: Cholesteatomas treatment is surgical and the goals are complete resection of it, to prevent complications and recurrences. The gold standard operative technique is canal wall down tympanomastoidectomy (CWDT), which reduces the recurrence rate lower than 2%. Studies on human temporal bones have defined that CWDT causes a decrease of 1 to 5 dB at frequencies below 1000 Hz and 0 to 10 dB between 1000 and 3000 Hz. Aim: To determine how many decibels the hearing is improved by reconstituting the posterior wall of the ear canal (EC) in patients after CWDT. Material and method: Experimental study. In patients after CWDT, the posterior wall of EC was reconstructed temporarily. Audiometry was performed before and after the procedure. Results: 23 patients were enrolled (25 ears evaluated). Average age 48.8 years (range 18 to 72 years). In 96% of the ears there was a difference after the procedure with a hearing improvement of 4.2 ± 2.8dB. In frequencies below 1000 Hz, hearing improvement was 6.0 dB (p<0.001), between 1000-3000 Hz, the improvement was 2.6 dB (p<0.001) and >3000 Hz there was no difference. When considering the airway-conduction pure tone average (PTA), the difference was a 4.6 dB improvement (p<0.001). Conclusions: Our study shows that there is a hearing improvement in the vast majority of ears that were evaluated by reconstituting the posterior wall of the EC, reaching a gain of 6 dB at frequencies <1000 Hz and 2,6 dB at mid frequencies. Considering the airway PTA, the improvement is 4.6 dB in the presence of posterior canal wall.

Comparative analysis of two methods for the treatment of ear mycosis with pevison / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare two administration methods of triamcinolone acetonide cream for the treatment of ear mycosis with pevison. METHODS Eighty-six cases diagnosed as the external auditory canal fungal infections with tympanic membrane perforation were randomly divided into observation group and control group, with 43 cases in each group. All the selected patients were positive in the external auditory meatal secretions fungus detection test, fungi and secretions of the external auditory canal are thoroughly cleaned under the endoscope. After ear canal cleaning, the obervation group was treated with Pevisone smeared on gelatin sponge which was evenly placed on the external auditory canal with fungal infection. The control group was treated with Pevisone smearing on external auditory canal by the patients themselves, twice a day. Two groups of patients come to the hospital every 3 days for review. After 2 weeks of treatment, the patients were followed up for 3 months, and the clinical efficacy of each group was compared. RESULTS The observation group was cured in 39 cases(90.7％), effective in 2 cases(4.7％), and ineffective in 2 cases(4.7％), The total efficiency rate is 95.3％.1 case recurred at 3 months of follow-up(2.4％). While in the control group, it was cured in 26 cases(60.5％), effective in 1 cases(2.3％), and ineffective in 16 cases(37.2％), the total efficiency rate is 62.8％.9 cases recurred at 3 months of follow-up(31.0％). The effect of the observation group was significantly higher than that of the control group(x2=14.508, P<0.05). CONCLUSION The ear endoscope can be used to remove the external auditory canal fungus thoroughly and has good visibility. Treating external auditory canal fungi disease with tympanic membrane perforation with gelatin sponge coated with triamcinolone acetonide cream has better clinical efficacy.

Clinicopathologic features and prognosis of adenoid cystic carcinoma of external auditory meatus / 中华病理学杂志

Objective@#To investigate clinicopathologic features and prognosis of adenoid cystic carcinoma (ACC) involving external auditory meatus.@*Methods@#The clinical presentation and follow-up data of 63 patients with ACC of external auditory canal were collected from January 2006 to February 2017 at PLA General Hospital and Hainan Branch of PLA General Hospital. The clinicopathologic features and prognostic factors of external auditory canal ACC were analyzed.@*Results@#(1) There were 28 males and 35 females and the average age of the first diagnosis was 48.9 years (22-81 years). The tumors showed cribriform pattern in 35 cases (15 cases of late stage), tubular pattern in 14 cases (8 cases of late stage), and solid pattern in 14 cases (9 cases of late stage). Cases with solid pattern was relatively more frequent than that of cribriform pattern and tubular pattern, but the difference was not statistically significant (P>0.05). (2) The average follow-up time was 62.4 months (2-228 months) in the 57 available cases. Among the 33 cases with recurrence, 18 cases had local recurrence and 15 cases had distant metastasis. The mean recurrence time was 40.6 months (2-204 months). Nine patients died of ACC: 2 cases in early stage (died at 48 and 102 months after the first treatment), 7 cases in late stage and 57 with (died at 9, 30, 32, 60, 72, 94 and 228 months). (3) Among the 37 patients with perineural invasion, there were 21 cases of cribriform pattern, 4 cases of tubular pattern and 12 cases of solid pattern; the number of cases in early stage and late stage were 15 and 22, respectively; and the differences were statistically significant (P<0.05). In addition, 31 cases had otalgia among the 37 patients with perineural invasion, where differences were not significant (P>0.05). (4) Thirty of 45 cases with tumor resection or partial resection of temporal bone had recurrence, whereas 3 of 12 cases of tumor combined with superficial lobectomy of parotid gland had recurrence. The difference was statistically significant (P<0.05). Postoperative adjuvant radiotherapy was given in 19 cases, including 7 cases of early stage (2 cases of recurrence), and 12 cases of late stage (8 cases of recurrence), among which there was no significant difference (P>0.05).@*Conclusions@#ACC occurring in external auditory canal frequently recurs. Superficial parotid lobectomy at the first operation is necessary to prevent tumor recurrence. Postoperative adjuvant radiotherapy has certain curative effect on patients with early stage tumor, but it does not affect the recurrence rate. Patients at late stage are more prone to perineural invasion than those in early stage. In addition, cribriform and solid patterns are more common that tubular pattern, and there is no significant correlation between perineural invasion and otalgia.

A Case of Contrast Enhanced Cystic Mass of External Ear Canal Diagnosed as Engorged Hard Tick

A 58-year-old female complained earfullness and otalgia and came to the clinic. Dark gray colored cystic mass obstructing the left ear canal was observed during the endoscopic exam. Contrast enhanced CT image showed an oval shape soft tissue lesion in the mid part of the external auditory canal with a homogenous increased contrast uptake. The mass was removed under microscopic view at outpatient clinic. While dissecting the mass in the ear canal, a pod like structure was visualized. The external organism was densely adherent to the skin and turned out to be an engorged hard tick. Considering the final diagnosis, contrast uptake observed in the CT scan implicates the patient communication of blood between host and parasite. This unique image finding differs from a benign mass lesion in the ear canal was one of the differential diagnosis points for the lesion. This article is reporting the case of tick bite in the ear canal with a rare CT scan finding.

Ear canal collapse prevalence and associated factors among users of a center of prevention and rehabilitation for disabilities / Prevalência e fatores associados ao colabamento do meato acústico externo entre usuários de um centro de prevenção e reabilitação de deficiências

ABSTRACT Purpose: to investigate the prevalence of the ear canal collapse when using supra-aural earphones and to verify if this event is influenced by sex, age, color of the skin and prominent ear. Methods: the collapse was assessed by a visual inspection after the positioning of a detached cushion, pressured against the external ear. Results: a total of 436 individuals, aged 3 to 97 years, participated in the study. Ear canal collapse was observed in 11.4% of the subjects, being mostly bilateral (90.0%). The prevalence ranged from 6.3% to 36.6% across age groups. Males, aged 65 years or above and presence of prominent ear were independently identified as associated factors for the occurrence of ear canal collapse (p<0.05). Despite a higher prevalence for those self-identified as white skinned when compared to non-whites, the difference was not statistically significant. Conclusion: the ear canal collapse, when supra-aural earphones are used, is more likely to occur in men, in elderly people, and among those with prominent ears. The prevalence of the event in this population raises the necessity of a careful examination, previous to any evaluation using supra-aural earphones.

RESUMO Objetivo: investigar a prevalência do colabamento do meato acústico externo quando utilizados fones supra-aurais e verificar se a ocorrência deste evento é influenciada pelos fatores sexo, idade, cor da pele e orelha em abano. Métodos: a pesquisa do colabamento foi conduzida de forma padronizada por meio do posicionamento de um coxim avulso, pressionado contra o pavilhão auricular. Resultados: participaram do estudo 436 indivíduos, com idade entre 3 e 97 anos. Foi observado colabamento do meato acústico externo em 11,4% dos indivíduos, apresentando-se de forma bilateral em 90,0% dos casos. A prevalência variou de 6,3% a 36,6% entre os grupos etários. Sexo masculino, idade igual ou superior a 65 anos e presença de orelha em abano foram identificados, independentemente, como fatores associados à ocorrência do evento (p<0,05). Apesar da prevalência do colabamento ser maior entre os que referem pele de cor branca, a diferença não foi estatisticamente significante, comparando-se com os não brancos. Conclusão: o colabamento do meato acústico externo, quando utilizados fones supra-aurais, é um evento com maior ocorrência entre homens, idosos e aqueles que apresentam orelha em abano. A prevalência do evento nessa população alerta para a necessidade de uma cuidadosa verificação, prévia a qualquer avaliação com fones supra-aurais.