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The purpose of this study is to describe challenges in diagnosis and treatment of otologic fungal infections.; 2) Methods: Case series and literature review 3) Results: Three patients treated at Louisiana State University Health Sciences Center – Shreveport between November 2020 – November 2023 were identified with complicated fungal otitis externa requiring detailed radiologic and histopathologic workup to aid in diagnosis and management. 4) Conclusion: Diagnosis of otologic fungal infection is often complex due to similar presentation of more common pathogens, overlapping features among common fungal specimens, and limitations of available diagnostic methods. Patient factors, including diabetes with poor glycemic control, may further complicate this challenging disease. High index of clinical suspicion, collaboration between multidisciplinary teams is essential to differentiate between common and uncommon fungal ear infections. A combination of mechanical debridement, topical and/or systemic therapy, and longitudinal follow-up with otolaryngology and infectious disease teams is required for successful treatment. [ABSTRACT FROM AUTHOR]

A significant change in the seasonal patterns of ear infections has been observed due to the modification of aquatic leisure habits, also altering the etiology of the most frequently causing otitis in its various forms of presentation. This work aims to become the largest series documenting ear infections by this bacterium, carrying out a characterization and considering the possibility that the mechanism of action occurs both through contact with contaminated waters and colonization of the middle ear. [ABSTRACT FROM AUTHOR]

Otitic Hydrocephalus (OH) is one of the most significant life-threatening complications of otological infections. Given their low prevalence and non-specific ear symptoms, this complication requires a high index of suspicion for diagnosis. In this case report, we aim to provide an analysis of OH and describe common clinical signs and symptoms, treatment options, morbidity and mortality. [ABSTRACT FROM AUTHOR]

Ear disease in children are a major public health problem in developing countries and if left untreated, it may result in various social and psychological problems for affected children. Among all ear diseases, ear infections are a common but treatable cause of morbidity in children. Long term consequences of persistent severe ear infection can result in speech development disorders, poor academic and educational development and overall lower quality of life. Most of ear diseases leading to hearing loss are preventable if diagnosed and treated early. A cross sectional study was conducted in Government Rural Primary School students, 2160 students in Patiala district of Punjab state in India with aim to study the prevalence of ear disease and associated hearing loss in students and their relationship with socioeconomic status. The data was collected, compiled and analysed statistically. [ABSTRACT FROM AUTHOR]

Background: Chronic suppurative Otitis Media is a common ear infection in India. Canaloplasty done with tympanoplasty helps to remove bony overhangs and provide complete visibility of fibrous annulus of tympanic membrane. Aim: 1. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty with canaloplasty. 2. To determine the hearing outcome in chronic otitis media (mucosal type) patients undergoing type 1 tympanoplasty without canaloplasty. 3. To compare the hearing outcome in the above mentioned 2 groups of patients. Materials and Methods: 56 patients of 15–60 years of age with mucosal type of Chronic otitis media, with central dry perforation and intact ossicles were included in our study. They were divided into group 1 (type 1 tympanoplasty + canaloplasty) and group 2 (type 1 tympanoplasty without canaloplasty), on alternate basis. AC, BC, Air bone gap avg was assessed via pure tone audiometry at 4 frequencies preoperatively and postoperatively at 3rd and 6th month, % closure of ABG average was calculated. Results: Type 1 tympanoplasty along with canaloplasty has better hearing improvement in pure tone audiometry compared to type 1 tympanoplasty alone, as % closure of ABG at postoperative 3rd and 6th month holds significant. Conclusion: The canaloplasty provides better surgical exposure via removing bony overhangs, aids in excellent functional outcome in the form of % closure of ABG. Hence canaloplasty is added as an adjunct to routinely performed aural surgeries to enhance hearing outcome. [ABSTRACT FROM AUTHOR]

The term chronic suppurative otitis media (CSOM) refers to middle ear infections lasting more than three months that lead to perforated tympanic membrane. Low socioeconomic strata of the society are more likely to have the disease in developing countries. There have been many studies focusing on the bacterial flora of CSOM, but little is known about the mycological aspects, which have become increasingly important over the last few decades. The present study was aimed to speculate the presence of fungal flora responsible for the cases of CSOM among patients who attended the Ear, Nose, and Throat Department of our hospital a tertiary care center. This retrospective study was conducted in a tertiary care centre after taking the approval of the protocol review committee and institutional ethics committee. Total 100 Patients of chronic otitis media were included with no history using ear drops for last one week and using two sterile swab without touching the external auditory canal, discharge was taken from middle ear and placed in sterile container and sent for potassium hydroxide (KOH) mount and observed. The age ranged from 18 months to 87 years and the mean age was 37.27+/- 12.59 years. The study population of male is 42 (41.6%) and female is 59 (58.4%). Distribution of KOH positivity observed for 33 (32.7%) and KOH negative for the study population of 68 (67.3%). When antibacterial treatment does not seem to relieve persistent otorrhea, otologists should suspect mycotic otitis media probable cause. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the anatomical relationships between the structures adjacent to the cartilaginous portion of the ear canal in children with Work type I congenital branchial cleft anomalies (CFBCAs) and to develop new classifications and surgical strategies. Methods: Retrospective analysis was performed on 50 children with Work type I CFBCAs admitted between December 2018 and December 2022. Results: Among the 50 children, total parotidectomy was performed on 49 sides. In 44 cases (88%), the main body of the lesion was closely associated with the cartilage of the inferior ear canal wall. Among these cases, the lesions in 40 cases occurred within the space enclosed by the dorsal inferior wall cartilage, mastoid process, and parotid gland, while in the remaining four cases, the lesions were located between the anterior inferior wall cartilage and parotid gland. Based on the preoperative imaging observations, clinical manifestations, and intraoperative findings, the cases were classified into 6 subtypes (a to f) including 21 cases (42%) of Type Ia (inferior wall of EAC), 7 cases (14%) of Type Ib (bottom wall of EAC), 12 cases (24%) of Type Ic (posterior–inferior wall of EAC), 4 cases (8%) of Type Id (anterior–inferior wall of EAC), 4 cases (8%) of Type Ie (anterior ear wall of EAC), and 2 cases (4%) of Type If (isolated from parotid). Conclusion: Surgical intervention is the only treatment for first branchial cleft anomalies and a comprehensive understanding of the classifications will help with the precise localisation and excision of the lesions. [ABSTRACT FROM AUTHOR]

The aim of this study is to determine the ototoxicities of boric acid in alcohol (BAA) and Castellani solutions by means of distortion product otoacoustic emission (DPOAE). A total of 28 rats were randomly divided into four groups, each group consisting of 7 animals. Then, 0.1 mL Castellani solution, 0.1 mL BAA (4% boric acid solution prepared with 60% alcohol), 0.2 mL (40 mg/mL) gentamicin and 0.2 mL saline were dropped to right outer ear canals of rats in groups 1, 2, 3 and 4 respectively, twice a day, for 14 days. DPOAE values obtained on days 0 and 14 were statistically compared for the values obtained at 750–8000 Hz frequencies. A statistically significant decrease was found on day 14 compared to day 0 values in Castellani group at all frequencies (p < 0.05). In BAA group, there was a statistically significant decrease between frequencies 1500 and 8000 Hz on day 14 (p < 0.05).We found that Castellani and BAA were ototoxic. BAA and Castellani solutions should be avoided in patients with tympanic membrane perforations, ventilation tubes and open mastoid cavities. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the benefit of educational video on parental knowledge, attitude and practice about risk factors of middle ear infection in children. An educational video was developed in English with information on anatomy of the ear, signs and symptoms, risk factors, consequences, prevention, and management related to ear infections. A KAP (Knowledge, attitude and practice) questionnaire was also developed comprising of 33 questions. Parents were requested to fill the questionnaire online and after watching the educational video they were asked to fill the same questionnaire after 1 month. 61 parents responded to both pre questionnaire and post questionnaire. In knowledge domain, thirty five parents gave correct answers to more than sixty percent of questions in the pre questionnaire and fifty six parents gave correct answers to more than sixty percent of the question in the post questionnaire. In attitude domain, all sixty one parents gave correct answers to more than sixty percent of questions in the pre questionnaire. In practice domain, twenty six parents gave correct answers to more than sixty percent of questions in the pre questionnaire and forty nine parents gave correct answers to more than sixty percent of the question in the post questionnaire after watching the educational video. Using the test of proportion, there was statistically significant difference in scores in pre questionnaire and post questionnaire in knowledge and practice domain. In the present study, there was statistically significant improvement in parents overall knowledge and practice about middle ear infection after watching the educational video. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of with tympanostomy tubes (TT) on infrared tympanic membrane thermometer (ITMT) results and to provide a systematic review of ITMT results in non-naïve tympanic membranes. Study design: Original prospective blinded case series and systematic literature review. Settings: A single tertiary university-affiliated medical center. Methods: ITMT measurements of patients with unilateral TT and contralateral naïve control ear were randomly conducted by a single investigator blinded to the TT side before and after cerumen was removed from the external auditory canals. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Google Scholar" on comparable published cases was performed. Results: The mean paired differences (95% confidence interval [CI]) between ventilated and non-ventilated ears before and after cerumen removal were 0.08 ºC/0.14 ºF (−0.04 to 0.19 ºC/− 0.07º–0.34º) and 0.62 ºC/1.12 ºF (0.04–0.25 ºC/0.07–0.45 ºF), respectively (P < 0.001 and P = 0.01, respectively). Conclusion: These findings support the validity and accuracy of ITMT in the setting of ventilated ears. [ABSTRACT FROM AUTHOR]

The tympanic membrane (TM) undergoes a number of pathological changes in middle ear disease which can be detected by a video-otoendoscope. Middle ear disease is also accompanied by changes in middle ear pressure which can be assessed by tympanometry. The objectives of this study were to find the correlation between video-otoendoscopy and tympanometry in acute middle ear infections and to deduce which of the two is more efficient and reliable for early diagnosis. 75 patients with AOM or OME were included over 1 year where each patient was followed for 21 days. Detailed history and clinical examination with videootoendoscope and tympanometry was done on each visit. Each TM was graded using OMGRADE scale. Symptoms and clinical findings consistent with acute otitis media were given a clinical score (CO Score). The results were collected and correlation between video-otoendoscopy and tympanometry was determined and their individual sensitivity, specificity and diagnostic accuracy was calculated. The sensitivity, specificity and diagnostic accuracy for tympanometry and video-otoendoscopy was calculated individually for each of the 4 visits and positive correlation between the 2 was found. Our study showed that tympanometry had a higher overall sensitivity than video-otoendoscopy. While, video-otoendoscopy showed a higher specificity than Tympanometry. Otoendoscopy is good for ruling out AOM/OME but cannot rule out persisting Middle Ear Effusion and Tympanometry is a better tool for detecting MEE but cannot differentiate well between AOM and OME. We found that tympanometry plus otoendoscopy together greatly increase the chances of detecting AOM and OME thus improving diagnostic accuracy, reducing financial costs associated with over or mis-diagnosis. [ABSTRACT FROM AUTHOR]

Cholesteatoma is a potentially serious complication of chronic ear infections and requires surgical intervention for definitive management. Long-term complications include a frequent need for repeat surgical intervention for disease recurrence, and techniques to improve efficacy of single-stage surgery are an important area of continued research. This study investigates a novel application of the photosensitizer immune conjugate (PIC) cetuximab-benzoporphyrin derivative (Cet-BPD) for in vitro localization of human cholesteatoma tissue, coupled with an in vivo safety study for middle ear application of Cet-BPD in a murine model. In fresh human cholesteatoma tissues, Cet-BPD demonstrates selective localization to the hyperplastic squamous cell tissue associated with cholesteatoma, without localizing to other tissues such as middle ear mucosa. Applied to the murine middle ear, Cet-BPD does not demonstrate any deleterious effect on murine hearing when assessed by any of auditory brainstem response (ABR) thresholds, distortion product otoacoustic emission thresholds, or ABR wave I amplitudes. These findings demonstrate the technical promise and encouraging safety profile for the use of PICs for intraoperative localization and treatment of cholesteatoma. [ABSTRACT FROM AUTHOR]

Disorders of the long arm of chromosome 11 (11q) are rare and involve various chromosomal regions. Patients with 11q disorders, including Jacobsen syndrome, often present with a susceptibility for bacterial and prolonged viral and fungal infections partially explained by hypogammaglobulinemia. Additional T lymphocyte or granular neutrophil dysfunction may also be present. In order to evaluate infectious burden and immunological function in patients with 11q disorders, we studied a cohort of 14 patients with 11q deletions and duplications. Clinically, 12 patients exhibited prolonged and repetitive respiratory tract infections, frequently requiring (prophylactic) antibiotic treatment (n = 7), ear-tube placement (n = 9), or use of inhalers (n = 5). Complicated varicella infections (n = 5), chronic eczema (n = 6), warts (n = 2), and chronic fungal infections (n = 4) were reported. Six patients were on immunoglobulin replacement therapy. We observed a high prevalence of low B lymphocyte counts (n = 8), decreased T lymphocyte counts (n = 5) and abnormal T lymphocyte function (n = 12). Granulocyte function was abnormal in 29% without a clinical phenotype. Immunodeficiency was found in patients with terminal and interstitial 11q deletions and in one patient with terminal 11q duplication. Genetically, FLI1 and ETS1 are seen as causative for the immunodeficiency, but these genes were deleted nor duplicated in 4 of our 14 patients. Alternative candidate genes on 11q may have a role in immune dysregulation. In conclusion, we present evidence that inborn errors of immunity are present in patients with 11q disorders leading to clinically relevant infections. Therefore, broad immunological screening and necessary treatment is of importance in this patient group. [ABSTRACT FROM AUTHOR]

Purpose: To report our experience of a sequence of events that resulted in an iatrogenic cholesteatoma originating from the external auditory canal (EAC) years after tympanoplasty that had included a tympanomeatal flap. Methods: Data on the presentation and pathogenesis of iatrogenic cholesteatomas arising from misplaced tympanomeatal flaps during tympanoplasty without mastoidectomy were retrieved from the patients' medical records and analyzed. Results: Five patients were identified with cholesteatomas involving the EAC. They all had recurrent ear infections and varying degrees of conductive hearing loss. Each patient's past surgical history included one or more tympanoplasties in which an ipsilateral tympanomeatal flap had been raised. None had undergone a mastoidectomy. Two patients presented with small cholesteatomas that had developed over an average of 6.5 years after surgery. Three patients had large cholesteatomas that had developed over an average of 33.7 years after surgery. Clinical presentations and imaging studies suggested a misplaced tympanomeatal flap as the most likely source of cholesteatoma. Conclusion: Tympanomeatal flap misplacement may cause iatrogenic cholesteatoma formation originating from the EAC during tympanoplasty even without mastoidectomy. These cholesteatomas can grow substantially before becoming symptomatic as they extend to and through the mastoid. They may not affect the sound conduction system until late in the course of the disease. Meticulous replacement of tympanomeatal flaps and exercising a high index of suspicion postoperatively can reduce the incidence of this complication. [ABSTRACT FROM AUTHOR]

Aggressive behaviors in those with intellectual disability (ID) and autism (ASD) have been linked to a variety of factors including ID level, age, sex, psychiatric disorders, and medical conditions but these factors have not been studied, in large samples, in terms of how they affect the stimuli that trigger aggression. In this survey of 2243 adults, four triggers of aggression associated with frustration, discomfort, change in the physical/social environment, and defensive reactions were analyzed for their relation to ID level, ASD, age, sex, number of psychiatric diagnoses, sleeping problems, seizures, visual impairment, ear infections and gastrointestinal problems. All four triggers were associated with increasing number of psychiatric disorders, with frustration, discomfort, and change intolerance commonly linked to sleeping problems and ASD. Implications for assessment and intervention are discussed. [ABSTRACT FROM AUTHOR]

Multi component tympanometry is not widely used in clinics due lack of evidence supporting its usefulness. The present study was undertaken to investigate the efficacy of multicomponent tympanometry for 1000 Hz probe tone in detecting middle ear pathology. Data were collected from 20 ears of 10 participants with no history of middle ear pathology (Group I) and 39 ears of 26 participants (Group II) with history of middle ear infection or ear-pain or blocking sensation. Single component tympanometry for 226 Hz probe tone and Susceptancec and Conductance tympanograms for 1000 Hz probe tone was carried out on all the participants. Results revealed normal tympanogram for both the probe tones for all the participants of Group I. It was observed that 53.84% of the ears could be identified as having middle ear pathology using 226 Hz probe tone whereas the percentage of correct identification increased to 94.87% when 1000 Hz probe tone was used. They are in accordance with the concept that subtle changes in the middle ear which cannot be detected by 226 Hz tympanogram can be identified using 1000 Hz multicomponent tympanogram. These findings highlight the efficiency of 1000 Hz probe tone in detecting mass dominant middle ear pathology. [ABSTRACT FROM AUTHOR]

Chronic suppurative otitis media in almost any form can disrupt the integrity of ossicular chain. Various materials have been used for ossicular substitution or reconstruction, including both biologic and alloplastic materials. Teflon piston is now the most widely used prosthesis for reconstruction of the ossicular chain in cases of otosclerosis. The oto-surgeons are still confronted with problems of ossicular reconstruction regarding the surgical procedure to be done, type of graft to be selected especially in low and poor socioeconomic population. Thus, there is a need felt to comprehensively and holistically evaluate the outcome of ossiculoplasty using Autograft ossicle versus Allograft ossicle (Teflon). Total 64 patients of chronic suppurative otitis media with no active ear infection and air–bone–gap of more than 15 dB were admitted for surgery and divided into two groups according to material used for ossiculoplasty as group A (Autograft) and group B (Allograft). Patients were evaluated at 3 and 6 months post-operatively using audiogram. In both Group A and B, the average pre-operative AC was 40.62 dB (SD 9.65) and 39.37 (SD 10.53) respectively. In 3 months there was a change of 8.83% from 40.62 dB to 37.03 dB in Group-A (p < 0.109, not statistically significant) and 13.10% change from 39.37 dB to 34.21 dB in Group-B (p < 0.049, statistically significant) whereas at 6 months, air conduction improved by 14.22% in Group-A (p < 0.01, statistically significant) and by 21.81% in Group-B (p < 0.001, highly statistically significant). Post-operatively at 3 months, improved AB gap was 62.5% in Group-A and 68.75% in Group-B patients. Post-operative AB gap at 6 months, improvement was seen in 78.12% in Group-A while it was 81.25% in Group-B patients. Alloplastic Teflon ossicle appears to be a good alternative for ossicular reconstruction where autologous incus is not available or disease precludes its use. [ABSTRACT FROM AUTHOR]

Objectives: The main purpose of the current study was to investigate nasal mucociliary clearance time (NMC) in patients with Vitamin-D deficiency.Methods: A total of 55 patients with Vitamin-D deficiency and 32 controls were evaluated. NMC time was measured with subjective saccharine test and compared between study and control groups. In addition, NMC time was re-evaluated after Vitamin-D replacement protocol in patients with Vitamin-D deficiency.Results: The mean 25(HO)Vitamin-D levels were 14.32 ± 4.23 ng/mL (7-24.6) and 29.38 ± 7.05 ng/mL (25-53.8) in study and control groups, respectively (p < 0.001). The mean NMC time was 11.15 ± 3.05 (6.3-17.6) and 8.40 ± 2.33 (6-13.2) in study and control groups, respectively (p < 0.001). The mean 25(HO)Vitamin-D level after the replacement protocol was 33.38 ± 10.03 and the mean NMC time was 9.56 ± 2.54 (p < 0.001).Conclusion: The mean NMC time was significantly increased in patients with Vitamin-D deficiency which can be corrected after Vitamin-D replacement protocols. The prolonged mucociliary clearance might be one of the pathophysiologic pathways at increased upper respiratory tract infections, and sinonasal and ear infections in patients with Vitamin-D deficiency. [ABSTRACT FROM AUTHOR]

Chronic suppurative otitis media, with and without cholesteatoma, frequently results in disruption of the ossicular chain. The present study was designed to compare the outcome using autologous ossicle and titanium prosthesis in two groups of suitable patients presenting with chronic suppurative otitis media for middle ear reconstructive surgeries. A prospective study done from July 2012 to December 2013, at Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur (Rajasthan). The target group included patients with chronic suppurative otitis media admitted and planned for reconstructive middle ear surgery. The study group patients among the target group requiring certain ossicular reconstruction. The patients included were patients with CSOM with or without cholesteatoma in which there was ossicular discontinuity. The patients were divided in two groups A and B. In group A patients autologous incus was used and in group B titanium prosthesis either TORP or PORP was used for ossicular replacement. Out of 340 patients as target group, 88 patients were included in study group. Further 88 patients of study group, 51 patients were included in group A; rest 37 patients were included in group B. In group B patients partial ossicular replacement platinum prosthesis was used in 31 patients while in rest 6 patients a total ossicular replacement prosthesis was used. Out of 88 patients, 79 were primary cases and 9 were revision cases. Pre and post operative air bone gap were noted. Pre operatively both of the groups were identical in relation to air–bone gap. The postoperative air–bone gap was calculated as the difference between postoperative air conduction and preoperative bone conduction. On comparison of preoperative and post-operative hearing results there was improvement in air conduction threshold and air bone gap in both the groups. Post operatively difference in air bone gap closure between group A and group B was found statistically significant (P value = 0.032) suggesting better hearing outcomes after using titanium ossicular replacement prosthesis. On comparing partial or total ossicular replacement prosthesis no significant difference was found for the audiological outcome (P = 0.434). Various prognostic factors were also noted for air bone gap closure. Titanium ossicular replacement prosthesis have better outcome, and no significant difference found in audiological outcome for TORP and PORP. [ABSTRACT FROM AUTHOR]

The infectious and inflammatory diseases of the central nervous system (CNS) including the brain and spine can present with a wide spectrum of clinical symptoms, locations, and appearance. The purpose of this exhibit is to review the different patterns of their presentations, to illustrate their imaging characteristics and techniques, and to discuss their clinical features and pathology so that the correct diagnosis can be made and prompt intervention can be initiated on a timely fashion. [ABSTRACT FROM AUTHOR]

Dispersal of bacteria from a biofilm in the middle ear, serving as a bacterial reservoir, could explain the recurrent and chronic nature of chronic suppurative otitis media (CSOM). The objective of this study is to investigate if the same strains of bacteria could be detected in repeated episodes of otorrhea in CSOM. In a prospective case series at a primary healthcare clinic in Nuuk, Greenland, patients with more than 14 days of otorrhea were included consecutively. Samples for culturing and biofilm analysis were taken at enrollment and at any subsequent episode with otorrhea. Participants were treated with daily saline irrigation and Ciprofloxacin eardrops for 7-14 days. Biofilm was identified in otorrhea in 81% (17/21) of participants at enrollment. Multispecies infections dominated with Non-typeable Haemophilus Influenzae (NTHI), Staphyloccocus aureus, and anaerobes being the most frequent pathogens. After the initial treatment, 19 (90%) had dry ears. Median observation period was 140 days (range 14-280) where 13 participants had one or more recurrences. Median time to first recurrence was 60 days (range 14-197). Among the 13 with recurrence, three individuals had the same genotype of bacteria at a subsequent episode. Another two had the same phenotype (NTHI). The remaining eight had new multispecies infections. We confirmed a high rate of biofilm in CSOM. However, the clinical implication might be of minor importance when treating with irrigation and antibiotic eardrops, as recurrent episodes of otorrhea were dominated by new pathogens in each episode. [ABSTRACT FROM AUTHOR]

Baha has proven performance and advantages for patients with aural atresia or chronic ear drainage. Being a per cutaneous osseo integrated implant the skin around the fixture is in contact with a foreign body that leads to chronic inflammatory reaction and complications such as skin irritation and overgrowth occur frequently. Challenges that are faced during Baha surgery include those during candidate selection, work up, anesthesia related as well as intra-operative and post operative complications. Ours was a retrospective and observational study where case records of 10 patients who underwent Baha surgery in the Department of E.N.T during the time period from January 2010 to June 2013 were reviewed. Here, the candidates were advised Baha either for congenital external ear deformity or single sided deafness. Out of 10 patients, who underwent Baha implantation, 8 underwent single staged Baha implant and two patients had two staged implant owing to bone thickness <3 mm behind temporo-parietal suture line on HRCT Temporal bone. The complications observed were skin infection (Holgers grade 2) around the site of implant in two patients, skin overgrowth due to more thickness of scalp (Holgers grade 4) in one of the patient. The patient had to undergo revision surgery to replace the abutment. And one of the patients underwent failure of osseointegration and was re-implanted later. Proper surgical technique and post operative wound care play an important role in avoiding complications. [ABSTRACT FROM AUTHOR]

To evaluate the shift in epidemiological and complication profiles of chronic suppurative otitis media (CSOM) over two decades in a resource-limited economy. A retrospective analysis of the prevalence of CSOM and its complications in tertiary health institution a over a period of 2 years were compared between 203 cases seen in 2009 and December 2010 (present era); and 343 cases seen in 1990 and 1991 (previous era). Data were collected on the demographic characteristics of the patients, age of onset of otorrhoea, the disease type, laterality and complications of CSOM. The prevalence of CSOM significantly reduced from 9 % in the previous era to 5.1 % in the present era ( P < 0.0001). The mean age of the recent group was 27.6 ± 19.3 years, and was 21.6 ± 18.2 years in the previous group. ( P = 0.009). Although both group had peak age prevalence at 11-20 years, recent group saw more significant adult population >20 years of age ( P ≤ 0.001). More significant cases of cholesteatoma were documented in the recent group (3.4 %) than previous era (0.9 %) ( P = 0.02). Although no significant change was noted regarding the rates of complication of CSOM in the two eras ( P = 0.18), there was a notable shift toward predominant extracranial pattern of complication in the recent group ( P = 0.04). The prevalence of CSOM has shown a significant reduction after two decades and it appears that there has been a shift in the epidemiology of CSOM towards a predominantly adult population in the recent years. Despite an overall reduction in the incidence of intracranial complications of CSOM in our series, its complication rates have not changed remarkably after 20 years. [ABSTRACT FROM AUTHOR]

Background: Multidrug resistance is a global health issue. Hence integration of traditional medicine like honey and modern medicine could be a best option in the treatment of patients infected with drug resistant bacteria. Despite the multi floral and huge honey production in the region, there are no studies that evaluate the antibacterial activity of honey against multidrug resistant bacteria. Objective: To evaluate the antibacterial activity of honey against multidrug resistant human pathogenic bacterial isolates of wound and ear infections. Methods: Red and white honeys were obtained from three districts Eastern Zone of Tigray namely Temben, Atsbi and Samre. The antibacterial potential of these honeys was determined against multidrug resistant isolates of clinical isolates of bacterial species of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Coagulase negative Staphylococcus, Streptococcus pyogenes and Klebsiella pneumonia, and five controls bacterial using tube dilutions methods. Undiluted and twofold serial dilutions of honeys were tested to determine minimum inhibitory concentration (MIC) using broth tube dilution methods through visual inspection and minimum bactericidal concentration (MBC) was determined by sub-culturing tubes showing no visible sign of growth/turbidity in MIC. Results: The mean MIC of red honeys for control and test bacteria was 7.7-8.9 and 12.6-17.9 % (v/v) respectively. Whilst the MIC of white honey was 12.2-12.5 % (v/v) for control and 16.1-27.7 % (v/v) for test bacteria. Mean MBC of red honeys for control and test isolates was from 25-40 to 30.4-62.5 % (v/v) respectively, and 40-55 and 60.7-75 % (v/v) for white honeys. Honey collected from Samre area has shown better antibacterial activity than other sites. Similarly red honeys from all areas were found to have better antibacterial activity against the multidrug bacteria than the white honey. Over all the MIC and MBC of all isolates was between 6.25-50 and 12.5-100 % (v/v) respectively. Conclusion: Red honey from all sites showed better antibacterial activity than the white honey. Likewise, honey from Samre area showed better antibacterial activity than Temben and Atsbi districts. All collected honeys showed varied bacteriostatic and bactericidal activities, and none of the isolates was resistant to tested honeys. [ABSTRACT FROM AUTHOR]

Background: 'Darwin's tubercle' is a term used to describe an atavistic swelling of the posterior helix that is present in some individuals. Little is known about its prevalence, characteristics, and function. With growing interest in the individuality of external ear patterns and its possible applications to personal identification, more knowledge about this tubercle is warranted. Purpose: We review the history, clinical presentation, and modern-day influences of Darwin's tubercle. Method: A comprehensive review of the literature was performed. Pubmed was searched with the key words: auricle, congenital, Darwin, ear, evolution, helix, pinna, tubercle, Woolnerian. Result: Darwin's tubercle has been documented to be present in about 10.5% of the Spanish adult population, 40% of Indian adults, and 58% of Swedish school children. It has a variety of clinical presentations, which may be classified by its degree of protuberance. The influence of genetics on the expression of Darwin's tubercle is unclear, and there are conflicting observations about its correlations with age and gender. Although usually present bilaterally in individuals who do possess this trait, a portion of this population does display asymmetric expression. Conclusion: Darwin's tubercle is a benign and unique helical feature. It contributes to the individuality of human ears and may have applications toward personal identification in the future. [ABSTRACT FROM AUTHOR]

Ear infection linked with frequent antibiotic prescription, hearing impairment, severe disability and death is a public health threat in developing countries. However, there is scarcity of documented data in the study area. Therefore, this study aimed at determining bacterial etiologic agents and their antimicrobial susceptibility patterns among patients of all age groups referred to Bahir Dar Regional Health Research Laboratory Center. Retrospective data recorded on culture and antimicrobial susceptibility profile were retrieved for analysis. Pus swabs from discharging ears collected and processed for aerobic bacteria culture and susceptibility testing. Of the total 368 pus swab samples processed, 296 (80.4 %) were culture positive. Of which, 289 (97.6 %) were bacteria and 7 (2.4 %) were yeast cells. The proportion of ear infection was higher in males (92.7 %) than females (65 %) (P = 0.014). The frequency of ear infection below 21 years of age was 65.2 %. The predominant isolate was Pseudomonas aeruginosa (29.7 %) followed by Staphylococcus aureus (26.3 %) and Proteus spp. (21.9 %). High level of antimicrobial resistance rates were observed for amoxicillin/clavulanic acid, ampicillin and penicillin whereas ciprofloxacin, ceftriaxone, chloramphenicol, cotrimoxazole, gentamicin and amikacin were found effective against the isolated bacteria. Aerobic bacterial otitis media linked with high levels of resistance against amoxicillin/clavulanic acid and ampicillin is major health problem in the study area. Moreover, considerable level of oxacillin resistant S. aureus suggests the diffusion of methicillin resistant S. aureus in the community. Therefore, treatment of otitis media in the study area needs to be guided by antibiotic susceptibility testing of isolates. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of clotrimazole, miconazole and fluconazole in empirical treatment of otomycosis in our tertiary care hospital and to appraise possible better outcome in otomycosis. Two hundred and ninety five patients who presented with clinical otomycosis at our Melmaruvathur Adiparasakthi Institute of medical sciences were incorporated in this study. Two hundred and fourteen patients who satisfied our criteria were recognized and they were randomly alienated into three groups A, B, C. Group A patients were advised to instill clotrimazole ear drops by themselves. Miconazole cream instillation were done by our trained personal in group B patients. Group C patients were advised to use fluconazole ear drops. Patients were educated to keep ear dry and instructed to come for evaluation in first and second week after initial visit. A randomized double blinded prospective study. In the first week, clotrimazole had a good response than miconazole and fluconazole in our patients and in the second week, our patients showed a drastic response in patients instilling flucanozole ear drops compared to those using micanozole and clotrimazole. This better outcome doesn't show statistical significance since p value is 0.882. Clotrimazole drops, miconazole cream and Fluconazole drops showed almost same therapeutic efficacy in Otomycosis [ABSTRACT FROM AUTHOR]

Ototoxicity is a common side effect of cisplatin chemotherapy. The aim of this study was to investigate the potential protective effect of chrysin against cisplatin-induced ototoxicity. Thirty-four adult female Wistar albino rats were separated into four groups: a cisplatin group (Group A), with cisplatin administered to ten rats once daily for three consecutive days at doses of 8 mg/kg body weight intraperitoneally (i.p.); a cisplatin plus chrysin group (Group B), with 8 mg/kg of cisplatin administered i.p. daily to ten rats for three consecutive days and 25 mg/kg of chrysin administered via oral gavage in a corn oil for 5 days: a chrysin group (Group C), with 25 mg/kg of chrysin administered via oral gavage in corn oil for 5 days to seven rats; and a control group (Group D), with 5 ml/kg of corn oil administered to seven rats via oral gavage for 5 days. Distortion product otoacoustic emission measurements were performed in the same ear of the rats under general anesthesia at baseline and on the first and fifth days after drug administration. No significant differences were noted between the measurements either in the chrysin group or in the control group. In the cisplatin group, there was a significant worsening of hearing compared to baseline and the measurements on the fifth day at all frequencies. In the statistical analysis, a statistically significant difference was observed at 5039, 6351, 8003, and 10078 Hz frequencies between the measurements on the first and fifth days. In the cisplatin plus chrysin group, there were statistically significant differences at frequencies of 2,003 and 5,039 Hz between the measurements at baseline and on the fifth day, at 3,175 and 5,039 Hz between the measurements on the first and fifth days, and at 8,003 and 100,078 Hz between the measurements at baseline and on the first day. According to these results, this study demonstrates that cisplatin-related ototoxicity can be prevented in rats by the administration of chrysin. [ABSTRACT FROM AUTHOR]

Biofilms are organized bacterial communities that may be homogeneous or heterogeneous. They play a significant role in the pathogenesis of chronic nasal sinusitis, chronic tonsillitis, cholesteatomas, and device-related infections. Despite this, few studies have been done that examine the presence of bacterial biofilms in tissues from patients with different types of COM or middle ear cholesteatomas. In the current study, we examined the presence of biofilms in surgical tissue specimens from humans with chronic ear infections using scanning electron microscopy (SEM). We hypothesize that bacterial biofilms present differently in patients with different types of chronic otitis media. Our results provide new insights regarding treatment of chronic otitis media. A prospective study was conducted in which middle ear tissues were obtained from 38 patients who underwent tympanoplasty and/or tympanomastoid surgery due to chronic ear infections. A total of 50 middle and mastoid tissue samples were processed for SEM analysis. In addition, 38 middle ear secretion specimens were obtained for routine bacterial culture analysis. Bacterial biofilms were present in 85 % (11 of 13) of patients with middle ear cholesteatoma, 92 % (12/13) of patients with chronic otitis suppurative media (CSOM), and 16 % of patients (2/12) with tympanic membrane perforation (TMP). Fungal biofilms were found in two cases of cholesteatoma. The positive coincidence rate between bacterial biofilms visualized by SEM and bacteria detected by culture was 82 %. Our findings suggest that bacterial biofilms are very common in CSOM and middle ear cholesteatomas. Positive bacterial cultures imply the presence of biofilm formation in CSOM and cholesteatomas. As such, our results provide new insights regarding treatment of chronic otitis media. [ABSTRACT FROM AUTHOR]

The objective of our study was to review retrospectively the clinical, radiological and therapeutic findings in 62 adults with acute mastoiditis treated at the ENT Department of Ferrara from 1992 to 2010. 62 adult cases fulfilled the following inclusion criteria: otoscopical evidence of co-existent or recent otitis media; postauricular swelling, erythema or tenderness; protrusion of the auricle; fever and/or significant radiological findings of mastoiditis. Conservative treatment comprehended antibiotic ± ventilation tube. Surgical procedures comprehended mastoidectomy or mastoido-tympanoplasty. The incidence of adult's mastoiditis in our district (0.99 cases/year/100.000 inhabitants) has maintained quite stable during the considered 19-year period. The typical clinical presentation was observed in 48 % of cases. Complications were meningitis (15 cases), meningo-encephalitis (1), meningitis associated with lateral sinus thrombosis (1), facial nerve paralysis (11), and labyrinthitis (8). In all cases except one, the facial palsy recovered completely and no mortality was observed due to these complications. Complete cure was obtained with conservative treatment in 69 % of uncomplicated cases and in 24 % of patients with intracranial complications. Mastoiditis in adults may present as the acute classical form, as well as latent forms which often have prolonged and insidious development followed by a rapid clinical deterioration. Clinical features are frequently atypical, while incidence of meningitis and other complications is still high particularly in the most elderly. Thus, great care is required from clinicians to make an early diagnosis in order to promote adequate treatment. [ABSTRACT FROM AUTHOR]

Thrombosis of the lateral sinus can be classified into nonseptic lateral sinus thrombosis and septic lateral sinus thrombosis. Nonseptic lateral sinus thrombosis differs from septic lateral sinus thrombosis in that it is not associated with ear or sinus infection. Etiologies of these conditions are different and hence the management of these conditions is different. Nonseptic lateral sinus thrombosis requires medical line of management and anticoagulant therapy, where as septic lateral sinus thrombosis needs surgical treatment along with antibiotics therapy. An otologist should be familiar with the septic lateral sinus thrombosis existence and nonseptic variant lateral sinus thrombosis for early recognition and initiation of appropriate treatment. [ABSTRACT FROM AUTHOR]

Otitis media (OM) is one of the most frequent diseases in young children, causing to visit a physician, and also the most common indication for antibiotic prescription. The peak incidence and prevalence of OM is 6 to 18 months of age. In children, second-hand smoke (SHS) exposure is associated with upper and lower respiratory tract infections, such as acute otitis media (AOM), pneumonia, and bronchitis. Despite the overwhelming evidence of the role of SHS exposure on infant health, a very high proportion of children still continue to be exposed. This important relationship between all kinds of smoking and poor health may not be appreciated universally. With this article, we aim to review tobacco smoke exposure and OM connection. How this exposure may cause OM especially in young children? What can be done to prevent and to reduce the harmfull effects of tobacco smoking? [ABSTRACT FROM AUTHOR]

Otolaryngology, although considered a surgical specialty, also covers many diseases that are not cured by surgery. These are treated medically and thus the otolaryngologist should have a good knowledge of drug treatments. It also entails ability to recognize, when an ENT symptom may be caused by one of the patient's medications, particularly as this is easily remedied by changing the drug. Although most of us know the common drugs that can cause otological side effects, there are many others that we may not be aware of. Here we have tried to consolidate a list of some commonly used drugs having otological side effects. [ABSTRACT FROM AUTHOR]

In this study ototoxic effect of ionizing radiation was studied in 70 ears with minimum follow up of 6 months post radiotherapy. Patients of nasopharyngeal carcinoma and with conductive deafness pre radiotherapy were excluded from the study to eliminate mechanical obstruction that may play role in Eustachian tube dysfunction. We found that Eustachian tube dysfunction and conductive deafness were reversible where as Sensorineural hearing loss was an irreversible effect of radiotherapy. Dose of radiation was directly proportional to ototoxicity, minimum 60 Gys of total radiation dose was required to produce significant ototoxicity. [ABSTRACT FROM AUTHOR]

Cisplatin is a widely used and effective chemotherapeutic agent, although its use is restricted by the high incidence of irreversible ototoxicity associated with it. In children, cisplatin ototoxicity is a serious and pervasive problem, affecting more than 60% of those receiving cisplatin and compromising language and cognitive development. Candidate gene studies have previously reported associations of cisplatin ototoxicity with genetic variants in the genes encoding glutathione S-transferases and megalin. We report association analyses for 220 drug-metabolism genes in genetic susceptibility to cisplatin-induced hearing loss in children. We genotyped 1,949 SNPs in these candidate genes in an initial cohort of 54 children treated in pediatric oncology units, with replication in a second cohort of 112 children recruited through a national surveillance network for adverse drug reactions in Canada. We identified genetic variants in TPMT (rs12201199, P value = 0.00022, OR = 17.0, 95% CI 2.3–125.9) and COMT (rs9332377, P value = 0.00018, OR = 5.5, 95% CI 1.9–15.9) associated with cisplatin-induced hearing loss in children. [ABSTRACT FROM AUTHOR]

The purpose of the study was to evaluate the effectiveness of caspofungin and voriconazole in the treatment of experimental Aspergillus otits media in an experimental rabbit model. A total of 30 New Zealand white rabbits were divided into four treatment groups and one control group. The rabbits were immunosuppressed by cyclophosphamide and triamcinolone acetonide. The right ear of each rabbit was infected by an injection of the inoculum of 0.1 ml (8.6 × 103 CFU/0.1 ml) of Aspergillus fumigatus into the middle ear cavity. At 72 h after the inoculation, amphotericin B 1 mg/kg per day ( n = 6), itraconazole 10 mg/kg per day ( n = 6), voriconazole 10 mg/kg per day ( n = 6) and caspofungin 5 mg/kg per day ( n = 6) were injected to each treatment group. No antifungal drug was administered to the control group ( n = 6). Clinical and histopathological examination scores and microbiological analysis of middle ear mucosa were compared.There was statistically significant difference in the clinical scores, histopathological scores, and mean CFU/g between the treatment and control groups ( P < 0.05). There was no statistically significant difference among the treatment groups in the clinical and histopathological scores, whereas there was statistically significant difference in the mean CFU/g ( P < 0.05). The mean CFU/g of amphotericin B and caspofungin groups were similar and both were lower than the itraconazole and voriconazole groups. Also, the mean CFU/g of voriconazole group was lower than the itraconazole group ( P < 0.05). Caspofungin and voriconazole were demonstrated at least as effective as amphotericin B and itraconazole. We suggest that caspofungin and voriconazole may be considered for the treatment of fungal infection of the ear. [ABSTRACT FROM AUTHOR]

Primary tuberculous otitis media of which infection focus cannot be found elsewhere in the body is a rare disease. Route of the infection has been hypothesized as Eustachian tube or external auditory canal with tympanic membrane perforation but it is hard to ascertain in the patient. We present a case of an 8-year-old child who suffered chronic otorrhea after tympanostomy tube insertion. The radiological and histopathological findings revealed tuberculous otitis media, which occurred as a complication of tympanostomy tube insertion. [ABSTRACT FROM AUTHOR]

Ears infected with ear rot were collected from five provinces in Ecuador. Of the 44 samples analysed 26 carried Fusarium verticillioides, 11 F. subglutinans, two F. graminearum and five carried fungi different from Fusarium. The pathogenicity of ten isolates, seven of F. verticillioides and three of F. subglutinans, were tested. Per isolate 30 ears of the susceptible cultivar Mishca were inoculated by pricking a steel pin, dipped into a spore suspension, through the husks in the central part of the ear 14 days after mid-silk. Ears inoculated with sterile water and ears without any treatment, natural infection, served as controls. The disease severity (DS) of the ears ranged from 14 to 58% ear rot, the range being similar for both species. The DS of the water control, 19%, was much higher than that of the natural control of 2%. Five strains gave a DS of over 40%, significantly higher than the water control. The DS of the others were similar to the water control. In a series of experiments the effect of various methods of applying Fusarium spores through the husks into young ears were compared. All tested methods resulted in DSs significantly higher than those of the two controls. Inoculation with tooth picks and steel pins dipped in a spore suspension gave similar ear rot percentages. Inoculations at 7 to 14 days after mid-silk produced the highest DS’s. There was no significant effect of spore concentration on the DS. Cultivars differed considerably, the range being from around 20% to over 50%. Surprisingly, only wounding the husks, the sterile water control, resulted in a fairly high DS, much higher than that of the natural control. As the ranking order of the cultivars after wounding only and after inoculation did not seem to be different from the ranking order of the natural control it is suggested to use in areas with high inoculum pressures like the Andes only wounding by means of a steel pin for screening for resistance to maize ear rot. [ABSTRACT FROM AUTHOR]

The article studies in vitro acaricidal performance of monoterpenes and usage of solvents against Otodectes cynotis (O. cynotis). O. cynotis which is popularly known as ear mite causes ear infections in animals. It is known that frequent use of acaricides could build resistance in the mites. The study tries to examine a solvent which could dilute monoterpenes and test the affect of acaricidal activity in vitro of four monoterpenes against O. cynotis. To solubilize the monoterpenes three solvents were tried namely acetone, paraffin oil and 20 percent glycerol dissolved in water. Life cycle and resistivity of mites were observed in three solvents. The Mean Survival Time was calculated for the mites in different solvents. From the three solvents paraffin oil was chosen to dissolve the monoterpenes. The study demonstrates that monoterpenes could be used as acaricides without any harmful environmental impact.

Pneumocephalus is commonly associated with head and facial trauma, ear infection or surgical interventions. We describe the rare case of a spontaneous pneumocephalus arising from lateral mastoid air cells. A 48-year-old man presented with a 10-day history of sudden, repetitive, ‘hammering-like’ acoustic sensations in his left ear that were followed by word-finding difficulties and loss of vision in the right visual field. Imaging revealed a large, left temporal pneumatocele associated with a small acute intracerebral hemorrhage. Left temporal and subtemporal craniotomy and decompression were performed. Further exploration confirmed a dural and osseous defect in the anterolateral surface of the mastoid that was consecutively closed watertight. Although extremely rare, a spontaneous pneumocephalus with mastoidal origin should be considered as a possible diagnosis in patients with suggestive acoustic phenomena and other non-specific neurological symptoms. [ABSTRACT FROM AUTHOR]

Atherosclerosis and tympanosclerosis are disorders that affect different organs in the body. When tissue samples taken from atherosclerotic and tympanosclerotic lesions are compared under light and electron microscopes, common pathological characteristics become apparent in both tissues. These similarities indicate that genetic predisposition to atherosclerosis is also seen in the middle ear. For the purpose of evaluating this genetic predisposition, the incidence of tympanosclerosis in atherosclerotic patients was examined and compared with the normal population. Otoscopic examination of 1,024 atherosclerotic patients was performed, and myringosclerosis was revealed in 66.6%. Myringosclerosis was found in 36 out of 300 non-atherosclerotic patients (12%). In the group of atherosclerotic patients, 174 individuals had past histories of previous ear infections. Myringosclerosis was detected in 147 of these patients (84.5%) during ear examinations. In 637 non-atherosclerotic patients with histories of ear infections, this figure was 114 (17.7%). The high rate of tympanosclerosis observed in atherosclerotic patients in comparison to the normal population was found to be statistically significant. These findings indicate that there must be a genetic predisposition for sclerotic degeneration in some individuals. [ABSTRACT FROM AUTHOR]

Ofloxacin is a synthetic fluoroquinolone antibacterial agent that inhibits the supercoiling activity of bacterial DNA gyrase, halting DNA replication. Ofloxacin has been formulated as a 0.3% otic solution for the treatment of ear infections. Topical administration of ofloxacin otic solution 0.3% produces very high concentrations of drug in the ear, thus broadening the spectrum of activity of ofloxacin greatly, to cover most common ear pathogens. Results of clinical trials indicate that ofloxacin otic solution 0.3% is as effective as topical neomycin/polymixin B/hydrocortisone preparations in the treatment of otitis externa (clinical cure rate >80% in adults and >95% in children for both treatments) and oral amoxicillin/clavulanic acid in the treatment of otitis media in the presence of tympanostomy tubes in children (clinical cure rates 76 and 69% for ofloxacin and amoxicillin/clavulanic acid, respectively). It is also effective in the treatment of chronic suppurative otitis media in adolescents and adults with perforated tympanic membranes (75 to 91% clinical cure rate). Because of the limited systemic absorption after topical administration, ofloxacin otic solution 0.3% is well tolerated. Adverse events were usually classed as mild to moderate, with ≤2% considered severe. The most frequent adverse events were bitter taste (5%), primarily in patients with non-intact tympanic membranes, and pruritis (2%). The incidence of adverse events with ofloxacin otic solution 0.3% was similar to that with other ototopical preparations and significantly less than that with oral amoxicillin/clavulanic acid. Unlike comparative ototopical antibacterials, ofloxacin was not ototoxic or chondrotoxic in animal studies. In addition, no ototoxicity was detected in clinical studies in humans. Conclusions: Ofloxacin otic solution 0.3% is clinically effective in the treatment of otitis externa and otitis media in patients with tympanic membrane perforations or tympanostomy tubes. The high concentrations achieved with this ototopical solution render it active against a broad spectrum of organisms. It is well tolerated, avoiding many systemic adverse events, and is not associated with ototoxicity. As the first ototopical agent approved for use in patients with non-intact tympanic membranes, ofloxacin otic solution 0.3% provides a valuable advantage over current treatment alternatives. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae (pneumococcus) is a principal cause of bacterial middle ear infections, pneumonia, and meningitis. Capsule-targeted pneumococcal vaccines have likely contributed to increased carriage of nonencapsulated S. pneumoniae (NESp). Some NESp lineages are associated with highly efficient DNA uptake and transformation frequencies. However, NESp strains lack capsule that may increase disease severity. We tested the hypothesis that NESp could acquire capsule during systemic infection and transform into more virulent pneumococci. We reveal that NESp strains MNZ67 and MNZ41 are highly transformable and resistant to multiple antibiotics. Natural transformation of NESp when co-administered with heat-killed encapsulated strain WU2 in a murine model of systemic infection resulted in encapsulation of NESp and increased virulence during bacteremia. Functional capsule production increased the pathogenic potential of MNZ67 by significantly decreasing complement deposition on the bacterial surface. However, capsule acquisition did not further decrease complement deposition on the relatively highly pathogenic strain MNZ41. Whole genome sequencing of select transformants demonstrated that recombination of up to 56.7 kbp length occurred at the capsule locus, along with additional recombination occurring at distal sites harboring virulence-associated genes. These findings indicate NESp can compensate for lack of capsule production and rapidly evolve into more virulent strains. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include the high risk of ear infections in children, the safety guidelines for buying toys for the children and the health benefits of outdoor activities to prevent myopia in children.

The article reports on the results of a study which show the effective parasite killing of the collective production of nitric oxide (NO). The findings that inducible NO synthase (iNOS) was expressed by mononuclear phagocytes during Leishmania major infection using a mouse ear infection model are discussed. Also explained is the conclusion of the study citing that cooperative mechanism allows the host to contain intracellular pathogens at the tissue level.

An unusual case of a patient presenting with myringitis bullosa haemorrhagica (MBH), who subsequently developed acute otitis media and meningo-encephalitis, is described. The aetiology of MBH is discussed, and recommendations for the management of patients with acute otitis are made. [ABSTRACT FROM AUTHOR]