Current diagnosis and treatment of skull base osteomyelitis / 临床耳鼻咽喉头颈外科杂志

Skull base osteomyelitis is a rare, refractory, and potentially fatal disease primarily caused by otogenic and sino rhinogenic infections. At times, it can mimic neoplasia complicating the diagnosis. With the use of antibiotics, advancements in diagnostic methods, and skull base surgical techniques, the mortality rate has significantly improved. However, the successful diagnosis and treatment of the disease is still challenging due to delayed diagnosis, lengthy treatment course, a tendency for relapse and lack of guidelines. Therefore, this article aims to review the progress in the diagnosis and treatment of skull base osteomyelitis.

Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

Necrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe and rare infectious disease of the external auditory canal (EAC). Without treatment, it may progress to skull base involvement. The bacteria Pseudomonas aeruginosa is the most common causative agent (90% of the cases), and affects immunocompromised subjects, particularly diabetic patients. Severe chronic otalgia, otorrhea, and cranial nerve palsy are the most common clinical presentations. Patients with NOE are frequently referred to neurosurgery because of the neurological impairment and skull base compromise. The definitive diagnosis is frequently elusive, requiring a high index of suspicion. Several laboratorial tests, imaging modalities, and the histologic exclusion of malignancy may be required. An early diagnosis and aggressive treatment reduce morbidity and mortality. We present four NOE cases to illustrate the spectrum of clinical presentation and complementary exams. According to the literature, more effort for early diagnosis and treatment is required, and neurosurgeons play an important role in this task.

Otitis externa difusa infecciosa: revisión de la literatura / Infectious diffuse external otitis: literature review

External otitis (EO) is a skin infection of the external auditory canal (EAC). It's a frequent complaint to the otolaryngologist affecting 10% of the population at least once in their life time. EO is associated with an increased humidity of the EAC, local trauma and allergic skin conditions. The diagnosis is based on clinical symptoms and signs such as earache and positive tragus sign. Infections EO are mostly bacterial infections caused by P. aeruginosa and S. aureus, and in a lower percentage fungal infection by A. niger and C. albicans. Treatment of acute infectious EO is essentially local and should be active against most common agents. The aim of this review is to update the current reality of this common clinical entity in our environment. (AU)

Otoscopia: exame da orelha / Otoscopy: examination of ear

Otoscopia é o exame que permite ao médico avaliar o conduto auditivo e a membrana timpânica, além de diagnosticar enfermidades da orelha externa e da orelha média. A otoscopia, uma boa anamnese e um exame físico completo são fundamentais para o estudo das doenças da orelha. O presente trabalho faz uma revisão da otoscopia e de suas principais afecções.

Otoscopy is the examination of the external auditory meatus and the tympa nic membrane. It is used for the purpose of diagnosing diseases of the external and middle ear. The anmanesis and the clinical examination associated with ear examination (otoscopy) are essential in ear diaseases. The purpose of this study is to review the examination of the ear (otoscopy) and principal disease of the ear.

Otite externa maligna / Malignant external otitis

A otite externa maligna é uma forma rara de infecção necrotizante do meato auditivo externo, cujo diagnostico e tratamento continua sendo um desafio. Neste artigo serão detalhadas as características clínicas e os métodos diagnósticos e terapêuticos atualmente disponíveis para esta doença.

survey of otomycosis in eastern azarbaidjan [Research Center of Tropical and Infectious Diseases, Tabriz University of Medical Sciences]

Otomycosis [Otitis externa] is a fungal infection of the external ear canal with only a few studies about its real frequency in Iran. To evaluate Otomycosis frequency and characteristics in patients with clinical suspicion of external otitis the present study was carried out in eastern Azarbaidjan [North - West of Iran] during 2006-2008. A total of 53 patients were assigned to mycological diagnosis [direct microscopic examination and culture]. Clinical samples of suspected patients were studied for laboratory identification in direct microscopy and cultured in specific mediums for the determination of their causative fungi. Over all 43 fungal isolates [14 male [33%] and 29 female [67%]] were taken from 53 patients suspected of Otomycosis. The mycose was more prevalent in 20-40 years age group in both sexes. The most common pathogen was Aspergillus niger [40 cases], followed by Afumigatus [3 cases] and Candida albicans [2 cases]. In clinical samples of some cases two different fungi were isolated at the same time. Saprophytic molds were the main etiologic agents of Otomycosis, and A. niger was the prime causal agent. Infection in 20-40 age groups had the most prevalence and Otomycosis among females was determined more than males. This study provided useful information on the prevalence, causative agents and health implications of Otomycosis, as an infection grossly eglected in studied environment

Otomycosis: a retrospective study / Otomicoses: um estudo retrospectivo

Otomycosis is a fungal infection of the external ear canal with only a few studies about its real frequence in Brazil. AIM: to evaluate otomycosis frequence and characteristics in patients with clinical suspicion of external otitis. STUDY DESIGN: Retrospective study with transversal cohort (2000-2006). MATERIALS AND METHODS:103 patients were assigned to mycological diagnosis (direct microscopic examination and culture). RESULTS: Otomycosis was diagnosed in 19.4 percent of the patients. Patient age varied from 2 to 66 years (an average of 23.5 years of age), and 60 percent of otomycosis cases were seen in women between 2 to 20 years of age. Chronic otitis, previous antibiotic therapy and the lack of cerumen were predisposing factors; itching, otalgia, otorrhea and hypoacusis were the symptoms reported by the patients. The most frequently isolated species were C. albicans (30 percent), C. parapsilosis (20 percent), A. niger (20 percent), A. flavus (10 percent), A. fumigatus (5 percent), C. tropicalis (5 percent), Trichosporon asahii (5 percent) and Scedosporium apiospermum (5 percent). CONCLUSIONS: Otomycosis is endemic in João Pessoa-PB. Clinical exam and mycological studies are important for diagnostic purposes because otomycosis symptoms are not specific.

Otomicose é uma infecção fúngica do conduto auditivo externo com poucos estudos sobre sua real frequência no Brasil. OBJETIVO: Avaliar a frequência e características das otomicoses em pacientes com suspeita clínica de otite externa. DESENHO DO ESTUDO: Estudo retrospectivo com corte transversal (2000-2006). MATERIAL E MÉTODOS: 103 pacientes foram atendidos para diagnóstico micológico (exame microscópico direto e cultivo). RESULTADOS: Otomicoses foram diagnosticadas em 19,4 por cento dos pacientes. A idade desses pacientes variou de 2 a 66 anos (média de 23,5 anos) e 60 por cento das otomicoses foram observadas em mulheres entre 2 a 20 anos de idade. Otite crônica, antibioticoterapia prévia e ausência de cerume foram os fatores predisponentes e prurido otológico, otalgia, otorreia e hipoacusia os sintomas relatados pelos pacientes. As espécies mais frequentemente isoladas foram C. albicans (30 por cento), C. parapsilosis (20 por cento), A. niger (20 por cento), A. flavus (10 por cento), A. fumigatus (5 por cento), C. tropicalis (5 por cento), Trichosporon asahii (5 por cento) e Scedosporium apiospermum (5 por cento). CONCLUSÃO: Otomicose é endêmica em João Pessoa - PB. O acompanhamento clínico e o diagnóstico micológico são importantes uma vez que a sintomatologia de otomicose não é específica.

Atividade in vitro de antifungicos frente a isolados de Malassezia spp. de animais atendidos no Hospital Veterinário da Unipar / Actividad in vitro de antifúngicos frente a aislados de Malassezia spp. de animales atendidos en el Hospital Veterinario de la UNIPAR / In vitro activity of antifungals against malassezia spp. isolates from animals assisted in the Unipar Veterinary Hospital

A otite externa em cães, na grande maioria das vezes, tem participação de espécies de Malassezia ssp. Fatores predisponentes e perpetuantes tornam esta levedura bastante importante, pois normalmente ocasiona uma otite recidivante. Drogas antifúngicas são amplamente utilizadas, porém a sua eficácia muitas vezes fica aquém do desejado. Considerando estes fatos, este estudo teve como objetivo estudar as concentrações inibitórias mínimas in vitro de cetoconazol e clorexidine, frente a isolados de Malassezia spp. Testes in vitro foram realizados e verificou-se que o cetoconazol necessita de uma menor concentração para inibir o crescimento de Malassezia spp., quando comparado ao clorexidine, mostrando-se mais eficiente.

External otitis in dogs usually present the occurance of species of Malassezia ssp. Predisponent and perpetuating factors make this yeast very important as it usually results in recurrent otitis. Antifungal drugs are largely used, however, their efficacy is usually above the expected. By considering these factors, the minimum inhibitory in vitro concentrations of cetoconazol against Malassezia spp. isolates were studied. In vitro tests were conducted and cetoconazol presented to be more efficient as it demands a lower concentration to inhibit the growth of Malassezia spp. when compared to clorexidine.

La otitis externa en perros, la mayoría de las veces, tiene participación de especies de Malassezia spp. Factores que predisponen y perpetúan esta levadura muy importante, pues normalmente ocasiona una otitis recidivante. Drogas antifúngicas son ampliamente utilizadas, sin embargo su eficacia muchas veces se queda aquende del deseado. Considerando estos hechos, este estudio tuvo como objetivo estudiar las concentraciones inhibitorias mínimas in Vitro de cetoconazol y clorhexidina, frente a aislados de Malassezia spp. Testes in Vitro fueron realizados y se verificó que el cetoconazol necesita de una menor concentración para inhibir el crecimiento de Malassezia spp., cuando comparado al clorhexidina, presentándose más eficiente.

Perfil de isolamento microbiano em cães com otite média e externa associadas / Profile of microorganisms isolated from dogs with associated media and extern otitis

Comparou-se o perfil de isolamento microbiano de amostras coletadas de cães com otite média (OM) e externa (OE) associadas. Sessenta e quatro cães com otite média e externa foram avaliados durante 10 meses. Amostras dos condutos auditivos externos foram coletadas com auxílio de swabs estéreis e aquelas do ouvido médio pela técnica cirúrgica da osteotomia da bula timpânica. Os microrganismos foram cultivados e identificados de acordo com os métodos previamente descritos, e a susceptibilidade a antimicrobianos avaliada pelo método de difusão em ágar estabelecido pelo National Committee for Clinical Laboratory Standards. Bactérias anaeróbias estritas não foram isoladas em qualquer amostra. Todas as amostras de OE mostraram crescimento bacteriano e/ou fúngico. Na OM, a positividade nas culturas foi de 48 por cento. Os microrganismos mais isolados na OE foram: Bacillus sp. (26,9 por cento), M. pachydermatis (22,2 por cento) e S. intermedius (21,7 por cento); na OM foram: S. intermedius (32,5 por cento), S. aureus subsp. aureus (22,5 por cento) e bacilos Gram-negativos não fermentadores (10,0 por cento). Observou-se alguma diferença no perfil de isolamento entre os quadros de OM e OE em 96,7 por cento dos animais. Verificou-se elevada resistência de cepas de S. intermedius à penicilina G, ampicilina, eritromicina, tetraciclina e clindamicina.

The isolation pattern of samples collected from dogs with both media (OM) and extern otitis (OE) was compared. Sixty-four dogs suffering from those conditions were studied over a 10-month period. Samples from the external ear were collected with sterile swabs while those from the middle ear were collected by osteotomy of the tympanic bulla. The microorganisms were cultured and identified according to methods previously described and to the susceptibility of antimicrobials according to the National Committee for Clinical Laboratory Standards agar diffusion test. Anaerobic bacteria were not isolated in any sample. All samples from OE showed bacterial and/or fungal growth. Concerning media otitis, this percentage was 48 percent. The most common microorganisms isolated from OE were Bacillus sp. (26.9 percent), M. pachydermatis (22.2 percent) and S. intermedius (21.7 percent) and those from OM were S. intermedius (32.5 percent), S. aureus subsp. aureus (22.5 percent) and non-fermentative Gram-negative rods (10.0 percent). Some difference was observed in the isolation pattern between media and extern otitis in 96.7 percent of the animals. High resistance rates of S. intermedius strains to penicillin G, ampicillin, erythromycin, tetracycline and clindamycin were found.

Isolation and identification of microorganisms present in 53 dogs suffering otitis externa

La otitis extrema es una enfermedad de etiología multifactorial que comúnmente afecta a los caninos. Representa una patología compleja que se asocia a infecciones causadas por bacterias y levaduras, y que muchas veces no responden a los tratamientos. El objetivo de este estudio fue aislar e identificar los microorganismos patógenos y no patógenos presentes en pacientes con otitis extrema. Esta investigación fue realizada sobre 53 pacientes caninos con otitis extrema que fueron atendidos en el Servicio de Consulta Extrema de la Policlínica Veterinaria de la Universidad del Zulia, los mismos presentaron signos clínicos tales como: eritema del canal auditivo, aumento de las secreciones, dolor, sacudidas constantes de la cabeza y prurito, siendo las secreciones purulentas y el prurito los más resaltantes. Las muestras fueron colectadas de los exudados presentes en la porción horizontal del canal auditivo. Diferentes grupos de bacterias fuerona aisladas en medios de cultivos, presentándose con mayor frecuencia Pseudonoma aeruginosa (22,22%), Proteus mirabilis (13,89%), Staphyloccocus aureus (12,50%), Staphylococcus epidermis (8,33%), Escherichia coli (5,56%) y Staphylococcus coagulada negativa (5,56 %). Por medio de la evaluación citológica se evidenció que Malassezia pachydermatis se encontró presente en un 68,80% de los casos estudiados. Las razas mayormente afectadas fueron Poodle (30,19%), mestizos (26,42%), Cockers spaniel (16,98%) y pastor alemán (9,49%); así mismo se observó mayor incidencia de otitis en caninos entre los 2 y 5 meses de edad (43,40%).

Otitis externa maligna: a propósito de un caso / Malignant external otitis: a purpose case

Se presenta un caso de otitis externa maligna (OEM), patología rara en la infancia que afecta principalmente a pacientes ancianos diabéticos e inmunocomprometidos, causada por la Pseudomona aeruginosa y cuyo diagnóstico precoz con debridamiento local y antibioticoterapia agresiva puede conducir a una evolución favorable. Se trata de un lactante de 5 meses con clínica de otitis externa, en quien se diagnóstica otitis media derecha, recibiendo amoxicilina por 48 horas. La inflamación progresa hacia regiones temporo-parietal derecha y periorbitaria izquierda, consulta al Hospital de Niños José Manuel de Los Ríos ingresando a emergencia en condiciones críticas, siendo trasladado a la unidad de terapia intensiva pediátrica. Inicia antibioticoterapia de amplio espectro. La flogosis progresa a áreas violáceas y necrosis en 24 horas. Se realiza necrectomía temporoparietal derecha. Persiste la clínica de shock séptico a pesar de la terapeútica instalada, con desarrollo de disfunción multiorgánica. Fallece 48 horas después de su ingreso. Los cultivos de secreción ótica, hemocultivo y coprocultivo reportaron Pseudomana aeruginosa. HIV negativo. Estudio hematológico sin alteraciones.

Otitis externa infection in Jordan. Clinical and microbiological features

Aims of this study were to investigate the clinical findings and to identify causative microorganisms and their susceptibility to antibiotics in otitis externa infection. The symptoms and signs, as well as the bacterial and fungal flora from the auditory canal of one hundred and eighty patients [100 males and 80 females], age range from 6 month to 19-years old suffering from acute otitis externa were studied from January 2001 to December 2002. One way ANOVA and Least Significant Difference [LSD] were carried out for statistical analysis. Pain was the most common symptom [97.2%] while, itching and difficulty in hearing were the least common [11.7%]. Pseudomonas aeruginosa [P.aeruginosa] was isolated from [41.7%] which showed the best susceptibility to ciprofloxacin [93.4%], aspergillus species from [19.4%], candida albicans from [10.6%], staphylococcus aureus from [16.1%] which showed the best susceptibility to amikacin and ciprofloxacin [96.5%], proteus mirabilis from [2.8%] which showed the best susceptibility [100%] to amikacin, ciprofloxacin, imipenem and ofloxacin, anaerobic bacteria from [2.2%]; and no bacteria growth was observed in [7.2%]. There was a significant variation relating signs, symptoms and sex in favor of males [P=0.03]. Significant seasonal variation in otitis externa infection was observed [P <0.05]. Pseudomonas aeruginosa was the most frequently isolated pathogenic microorganism, which showed the best susceptibility to ciprofloxacin. Pain was the most common symptom

Estudio microbiológico del tracto respiratorio superior / Microbiological procedures for diagnosis of upper respiratory tract infections

Las infecciones del tracto respiratorio superior son muy comunes, particularmente en niños. Se describen las bacterias que producen faringitis, otitis media aguda y sinusitis aguda y los procedimientos microbiológicos empleados en su identificación.

Malassezia pachydermatis e outros agentes infecciosos nas otites externas e dermatites em cäes / Malassezia pachydermatis and other infectious agents in external otitis and dermatitis in dogs

Malassezia pachydermatis (Pityrosporum canis) faz parte da microbiota da pele e quando ocorrem alteraçöes no microambiente local como aumento da umidade, da temperatura e do substrato, determinando uma elevaçäo do número de células, ocorre a transiçäo da forma comensal para o parasitismo. O objetivo deste trabalho foi determinar a prevalência da infecçäo por M. pachydermatis e outros agentes infecciosos nas otites externas e dermatites de cäes. Foram analisadas 78 amostras de cäes com otite, 36 amostras de cäes com o conduto auditivo normal e 24 com dermatite. Todas as amostras foram submetidas ao exame direto, cultivo em ágar sangue e ágar Sabouraud dextrose, acrescido de cloranfenicol e cicloheximida. Ao exame direto, 50 porcento das amostras de otite e 16,6 porcento das amostras de dermatite apresentaram numerosas células semelhante a M. pachydermatis, enquanto 83,3 porcento das amostras de ouvidos saudáveis apresentaram ausência de células com esta morfologia. M. pachydermatis foi isolada em 25 porcento das amostras do conduto auditivo normal, em 80,7 porcento das amostras de otite e em 37,5 porcento das amostras de dermatite. Foram também isolados das amostras de otite Staphylococcus intermedius, S. aureus, S. epidermidis, Pseudomonas aeruginosa, Proteus sp, Actinomyces sp, Streptococcus sp e Otodectes cynotis e das de dermatite Staphylococcus intermedius, S. aureus, S. epidermis, Microsporum canis, M. gypseum, Trychophyton sp e Demodex canis. M. pachydermatis foi o agente com maior prevalência nas otites externas e dermatites, sendo um agente oportunista que causa otite e dermatite quando há uma alteraçäo do microambiente.

Otite externa / External otitis

Otite externa é uma condiçäo inflamatória que acomete o pavilhäo, conduto auditivo externo e face externa da membrana timpânica. As causas säo infecçöes, reaçöes cutâneas e traumas. Geralmente estäo presentes otalgia, prurido e otorréia. O tratamento consiste em eliminar os fatores predisponentes, propiciar analgesia, higiene e canal e eliminar os microrganismos patogênicos.