An exploration of recorded otological manifestations in South African children with HIV/AIDS: A pilot study.

CONTEXT: The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a pandemic currently presenting as one of South Africa's largest health challenges. Within the pediatric population, hearing plays a vital role in appropriate speech, language and scholastic development; therefore, unidentified and untreated otologic manifestations require exploration in this population. AIM: The current study aimed to identify recorded otological manifestations in pediatric patients with HIV/AIDS attending an HIV/AIDS clinic in Johannesburg. METHOD: A qualitative retrospective record review design was adopted where data were collected from 100 medical records from a pediatric HIV/AIDS clinic in a public hospital in Johannesburg. Data were analyzed using qualitative statistical measures. RESULTS: Findings revealed that almost half (43%) of the sample presented with otological manifestations. Otitis media 15 (15%) and otorrhea 15 (15%) were the most common manifestations. A few (only 7%) of the participants with otological manifestations were referred to Audiologists and/or Ear, Nose and Throat Specialists (ENTs) for assessment and management. CONCLUSIONS: Current findings raise important implications for the clinical assessment and management of pediatric patients with HIV/AIDS, for the role of all team members, and for the importance of early detection and intervention of these manifestations in this population group where speech-language development is still occurring and where successful learning at school is still key.

Canal Wall-Down Mastoidectomy plus Meatoplasty for Extensive Verruca Vulgaris in the Ear Canal and Mastoid Bone.

Verruca vulgaris is commonly seen on the hands, feet, and face, but rarely in the external auditory canal. We report the case of a 57-year-old woman with a huge papillary mass filling the entire external auditory canal, with destruction of the posterior canal wall and excavation into the mastoid bone. We performed en bloc resection of the whole region affected by verruca vulgaris, including the external auditory canal, mastoid skin, and tympanic membrane using canal wall-down mastoidectomy plus meatoplasty. There was no evidence of recurrence 12 months postoperatively. Complete surgical removal by mastoidectomy is a promising option for wide-spread verruca vulgaris in the external auditory canal.

Shope Fibroma in the External Ear Canal of a Domestic Rabbit.

A 5-y-old, intact, 2.5-kg female domestic rabbit was presented because of blood spatter on the wall of its cage and the toenails of its right hind limb. Physical examination revealed a red, gelatinous mass that spanned the width of the right vertical ear canal. Radiographic images revealed a soft-tissue opacity at the base of the right ear, which was superimposed over the tympanic bulla and extended to the pinna. A CT scan revealed that the soft-tissue mass was within the vertical and horizontal portions of the right external ear canal and extended to the level of the tympanic membrane, with no bony involvement. An incisional biopsy of the mass and subsequent histopathology revealed heterophilic inflammation with bacteria, necrosis, and no evidence of neoplasia. The patient died during anesthesia for removal of the mass at 1 mo after the initial presentation. Necropsy with histopathology of the mass was consistent with Shope fibroma virus in light of the presence of typical intracytoplasmic eosinophilic inclusions. Electron microscopy of paraffin-embedded tissue revealed electron-dense intracytoplasmic structures within neoplastic cells consistent with the diagnosis of Leporipoxvirus. To our knowledge, this report is the first description of Shope fibroma virus invading the external ear canal of a domestic rabbit. Given the results of this case, Shope fibroma should be considered in rabbits presenting with abnormal tissue in the ear canal.

Ear, nose and throat (ENT) involvement in zoonotic diseases: a systematic review.

INTRODUCTION: Zoonoses are infections transmitted from animal to man, either directly (through direct contact or contact with animal products) or indirectly (through an intermediate vector, such as an arthropod). The causative agents include bacteria, parasites, viruses, and fungi. The purpose of this review is to make an accurate examination of all zoonotic diseases that can be responsible of ear, nose, and throat (ENT) involvement. METHODOLOGY: A PubMed search was performed combining the terms (otorhinolaryngology OR rhinology OR laryngology OR otology OR mastoiditis OR otitis OR sinusitis OR laryngitis OR rhinitis OR pharyngitis OR epiglottitis OR dysphonia OR ear OR larynx OR nose OR pharynx) with each one of the etiological agents of zoonoses for the period between January 1997 and August 2012 without language restrictions. RESULTS: A total of 164 articles were selected and examined. Larynx was the most commonly involved ENT organ, followed by oral cavity, pharynx, and neck. Bacteria were the most representative microorganisms involved. Nose and major salivary glands were affected most frequently by protozoa; paranasal sinus, oral cavity, ear, neck, nerves and upper airway by bacteria; and larynx by fungi. CONCLUSIONS: ENT symptoms and signs may be present in many zoonotic diseases, some of which are also present in industrialized countries. Most zoonotic diseases are not commonly encountered by ENT specialists. Appreciation of the possible occurrence of these diseases is important for a correct microbiological approach, which often requires special culture media and diagnostic techniques.

Verruca vulgaris of tympanic membrane treated with topical immunotherapy.

Verruca vulgaris is a common skin disease caused by human papillomavirus (HPV) infection, but it rarely involves the tympanic membrane. The current treatments for verruca are usually destructive and irreversible, should not be performed universally; the most relevant therapy will be variable subject to disease location, severity, and the patient's immune status. In this report, we demonstrated a case with verruca vulgaris of tympanic membrane, who had topical immunomodulatory agent treatment successfully with well-preserved hearing, and who has no any recurrence up to now for 3 years. In clinical, to cure verruca on the vulnerable tympanic membrane without hearing sequela is a dilemma, and there is no any treatment guideline due to its rarity. Topical immunomodulatory agent with high selectivity, showed great competence on this occasion and verified its practicability in treating verruca on unapproachable area, or where bearing vital functions; the convenient out-patient-based application also ensures good compliance. However, it does need longer duration and higher costs than the other routine treatment modalities.

[Viral infection and ear diseases].

The association of viral infection to ear disease has triggered a great deal of interests. In the present paper, we provide a critical review of the viral hypothesis of ear diseases. Detection of viral antigen and antibody or RNA and DNA in the patients serum, endolymphatic fluid or surgical pathology specimens reveals that virus may have relevance to certain kinds of ear diseases, such as Meniere's disease, idiopathic sudden sensorineural hearing loss, otosclerosis. Bell's palsy and otitis media. The most appealing is the herpesvirus, which can cause latent infection in the neurons, and its reactivation may be the mechanism of recurrent attacks of ear diseases. Currently, antiviral drug treatment plus supportive therapy are the most effective managements dealing with viral infection. Although antiviral vaccine will become a promising preventive strategy in the future.

Use of PCR to estimate the prevalence of Equus caballus papillomavirus in aural plaques in horses.

Aural plaques occur on the skin of the medial surface of the pinnae of horses. In this study the presence of Equus caballus papillomavirus (EcPV)-3 and -4 DNA was assessed in 45 such plaques using a 'touchdown' PCR. Papillomaviruses (PVs) were detected in 62.3% (28/45) of samples: EcPV-3 and -4 DNA in 8.89% (4/45) and 37.78% (17/45) of samples, respectively, with 15.56% (7/45) of samples exhibiting co-infection. Viral DNA was not detected in 37.78% (17/45) of samples, suggesting the possible existence of other equine PVs. Neither EcPV-3 nor -4 were detected in negative control skin. This study is the first to evaluate the prevalence of these two viruses in equine aural plaques.

Hallazgos otoneurológicos en pacientes portadores de VIH y neurosífilis / Otoneurological findings in HIV and neurosyphilis coinfected patients

Introducción: El virus de la inmunodeficiencia humana (VIH) y el Treponema pallidum comparten mecanismos de transmisión y tienen la potencialidad de cambiar el curso de la otra enfermedad. Entre el 1% y 13% de los pacientes infectados con VIH presentan serología positiva para sífilis o desarrollan la enfermedad durante la evolución. Ambas pueden causar un variado número de alteraciones cocleovestibulares. Objetivo: Describir los hallazgos otoneurológicos en pacientes infectados con VIH y con presentación de neurosífilis durante la evolución de su enfermedad. Material y método: Estudio transversal observacional en 10 pacientes VIH positivos con episodios de neurosífilis de la Unidad de Infectología del Hospital Sótero del Río. Se realizó consulta otorrinolaringológica y examen funcional del octavo par con video-óculo-nistagmografía. Resultados: Sesenta por ciento de los pacientes infectados con VIH y neurosífilis presentó síntomas cocleovestibulares, de los cuales todos presentaron alteraciones audiométricas, 50%% de la muestra, además, presentó alteraciones vestibulares de características periféricas. El síntoma más frecuente fue la hipoacusia (50%%). La alteración audiométrica más frecuente fue la hipoacusia sensorioneural bilateral asimétrica. No se observó predominancia de algún tipo de alteración vestibular. Ningún paciente presentó alteraciones centrales. Conclusión: La evaluación otorrinolaringológica debiera considerarse como de rutina para disminuir la discapacidad generada por patología otoneurológica en estos pacientes.

Introduction: The human immunodeficiency virus (HIV) and Treponema pallidum share transmission mechanisms and have the potentiality of changing one another courses. Between 1 and 13%% of HIV infected patients present positive serology for syphilis or develop this disease during the evolution of the HIV. Both can cause a wide range of cochleovestibular manifestations. Aim: To describe otoneurological findings in HIV patients with episodes of neurosyphilis during the course of the disease. Material and method: Observational transversal study with 10 HIVpositive patients with episodes of neurosyphilis registered in the Infectology Unit of Sótero del Río Hospital. They went under otolaryngologic consult and functional testing of vestibulochoclear nerve with videonystagmography. Results: 60%% of evaluated patients had cochleovestibular symptoms, all of them with audiometric alterations. 50% of the sample also showed vestibular abnormalities (peripheral disorders). The commonest symptom was hearing loss (50%%). The most frequent audiometric alteration was asymmetric bilateral neurosensorial hearing loss. We did not observe any kind of vestibular variation predominance. No patient presented central vestibular disease. Conclusions: The otolaryngologic evaluation should be considered as a routine exam to diminish the disability generated in these patients because of the acquired otoneurological disease.

Severe ear chondritis due to cowpox virus transmitted by a pet rat.

We describe a case of cowpox virus infection leading to severe acute inflammation and chondritis of the outer ear, complicated by local necrosis and facial cellulitis. Secondary lesions occurred on a finger and the abdomen. Apart from scarring, outcome was favorable after repeated surgical excision of necrotic tissue.

'Orf on the ear', in a patient with Guillain-Barré Syndrome.

We report a case of orf on an ear in a patient admitted to hospital following the onset of Guillain-Barré syndrome. While the underlying causes of Guillain-Barré syndrome are not completely understood, immune stimulation appears to play a key role in pathogenesis. Any association between orf infection and Guillain-Barré syndrome has not been documented. A 22-year-old male sheep farmer, who was previously fit and well, presented to his local hospital with a 2-day history of distal upper and lower limb paraesthesia and weakness. He was transferred to a tertiary hospital where the diagnosis of Guillain-Barré syndrome was confirmed. History revealed that he had experienced a mild respiratory illness 3 weeks prior to presentation and an inflamed nodular lesion over his left ear, which had appeared 2 weeks prior to admission. Differential diagnoses of orf, atypical mycobacterial infection, subcutaneous mycosis and a squamous cell carcinoma were considered. Histopathology from a biopsy of the lesion was consistent with orf, which was confirmed by polymerase chain reaction testing. This case is of interest for two reasons: orf has not been described in association with Guillain-Barré syndrome, and orf on the ear is uncommon.

Epstein-Barr virus-positive Hodgkin lymphoma-like earlobe lymphoid infiltrate: case report.

Hodgkin lymphoma (HL) is a malignancy of the lymph system usually occurring on the lymph nodes. A 57-year-old Japanese woman presented with the chief complaint of an enlarging tumor of the left ear. An excisional biopsy was taken, and histological examination showed a mixed infiltration of cells, including Reed-Sternberg cells and their mononuclear forms against a background of small lymphocytes. Reed-Sternberg cells were CD15, CD20, CD30, Ki-67, MUM-1, CD45, EMA, and Epstein-Barr virus-encoded small RNA was detected by in situ hybridization. We diagnosed this tumor as a skin infiltration with a lymphocyte-rich classical HL pattern. Skin involvement of HL is most often a secondary phenomenon representing a rare late manifestation of disease dissemination; however, we could not detect any evidence of systemic lesion for 6 months after the initial presentation. A case of HL only involving the skin was reported by several past reports, which termed it primary cutaneous HL. But, it is still controversial whether HL initially occurs on the skin because a diagnostic gray zone exists between HL, some non-HL entities, and nonneoplastic lymphoid infiltrates. Clinical and histological features of this case suggest that the skin will become a primary site of HL.

Ear, nose and throat manifestation of viral systemic infections in pediatric patients.

OBJECTIVE/METHODS: An exhaustive review of literature was performed to investigate available data and evidences regarding pediatric otolaryngologic manifestations of viral systemic infections. RESULTS/CONCLUSIONS: Modern otolaryngologists should be familiar with viral systemic infections since many have head and neck manifestations. Cooperation between otolaryngologist, paediatrician and virologist can be considered and excellent tool in diagnosis and treatment of these diseases in particular when complications occur.

Effects of the neuraminidase inhibitor zanamavir on otologic manifestations of experimental human influenza.

Middle ear pressure (MEP) abnormalities are frequently observed during influenza virus infection and may serve as surrogate markers for the risk of otitis media. MEP abnormalities were evaluated in adult volunteers who were inoculated with influenza A/Texas/36/91(H1N1) or B/Yamagata/88 virus and given the antiviral zanamivir (GG167) intranasally as prophylaxis or early treatment in randomized, double-blind, placebo-controlled trials. In the influenza A prophylaxis studies, 15% of 61 zanamivir recipients versus 61% of 33 placebo recipients showed significant MEP abnormalities (P < .01). In the influenza A early treatment trial, 32% of 31 infected zanamivir recipients versus 73% of 26 infected placebo recipients developed MEP abnormalities (P < .01). In the influenza B prophylaxis trial, 16% of 25 zanamivir versus 44% of 9 placebo recipients showed abnormalities (P = .09). These findings indicate that the neuraminidase inhibitor zanamivir, which is effective in reducing experimental influenza illness, provides protection against the development of MEP abnormalities.