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Treating twenty-five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase®): a case series Utilising Flixonase® in treatment of chronic otitis externaKey points:Chronic cases of otitis externa, resistant to conventional treatments are notoriously difficult to treat, with resolution in these cases challenging.Guidelines suggest the use of corticosteroid in chronic otitis externa, however, there is no specific advice on which corticosteroid to utilise.Our case-series demonstrates the potential benefit of fluticasone propionate in patients who have previously failed a multitude of conventional management options.Despite the limitations of our study, our experience highlights a gap in the literature and suggest fluticasone propionate as an exciting and potentially important tool in the arsenal of the otolaryngologist.

Summary Chronic otitis is one of the most common reasons why dogs are presented to veterinary facilities in Lebanon. The chronicity of this disease is due to the failure to diagnose correctly the primary cause and the incapacity to treat it effectively. The objective of this study is to show the importance of the video otoscopy in the diagnosis and treatment of recurrent otitis externa and/or otitis media. A total of twenty cases (twelve dogs) with chronic otitis externa and/or media were used for this study. Video otoscopy was performed in all 20 cases where it was used for diagnosis in 13/20 cases and treatment in 17/20. Thirteen (65%) of the cases showed a change in the diagnosis after undergoing video otoscopy. Seventeen (85%) of the cases showed an improvement after using the video otoscopy for ear flushing and lavage, in conjunction with home therapy, for treatment purposes. Improvements were judged subjectively seven, fourteen, and twenty-one days after the otoscopic lavage took place. Three (15%) of the cases underwent a surgery due to the presence of polyps that were not removable with the video otoscope.

The purpose of this retrospective study was to compare outcome measures in dogs treated by a primary care veterinarian (pcDVM) before referral and after seeking collaboration with a board-certified veterinary dermatologist (BCVD) for cases of severe recurrent chronic otitis externa. Medical records of 65 client-owned dogs were retrospectively reviewed, and data were obtained regarding treatment history, referral timeframe, recurrence rate, clinical signs, and resolution of signs. The median number of otitis recurrences while under the care of the pcDVM was 4 (range 1–40) versus collaborative BCVD care of 2 (P < .01). There was a longer median time to otitis recurrence with collaborative care (171 days) compared with dogs managed by the pcDVM before referral (21 days; P > .01). Proliferative changes in the ear canals improved in 41/45 (91%) of cases under BCVD care compared with 6/45 (13%) under care by the pcDVM (P < .01). Dogs with chronic otitis had better long-term outcomes when collaboration with a BCVD was pursued within 6 mo of treatment. Referral or consultation with a BCVD should be considered for cases of chronic canine otitis that are persistent or quickly recurrent (20–30 days) over a 6 mo period.

Treating twenty-five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase®): a case series Utilising Flixonase® in treatment of chronic otitis externaKey points:Chronic cases of otitis externa, resistant to conventional treatments are notoriously difficult to treat, with resolution in these cases challenging.Guidelines suggest the use of corticosteroid in chronic otitis externa, however, there is no specific advice on which corticosteroid to utilise.Our case-series demonstrates the potential benefit of fluticasone propionate in patients who have previously failed a multitude of conventional management options.Despite the limitations of our study, our experience highlights a gap in the literature and suggest fluticasone propionate as an exciting and potentially important tool in the arsenal of the otolaryngologist.

Objective To determine azithromycin concentration in severely inflamed canine external ear canals. Material and methods Five dogs of various breeds and ages with severe and chronic otitis externa underwent ear canal reconstruction surgery. A single oral dose of azithromycin at 10 mg/kg was administered 12 to 24 hours prior to surgery. Tissue samples were collected from the excised external ear canals and azithromycin concentration was determined using a liquid chromatography-tandem mass spectrometry method. Results Azithromycin concentrations ranging from 11.4 to 107.0 μg/g (mean 59.2 ± 44.6 μg/g, median 50.9 μg/g) were detected in the chronically infected external ear canal tissue 12 to 24 hours after administration. Clinical significance Little information exists on antibiotic concentrations in pathological tissues of dogs. Macrolides are known to concentrate in skin tissue. In light of the present results, investigation of clinical efficacy of azithromycin in chronic canine otitis externa is warranted.

Implantable auditory devices (IADs) are a viable hearing restoration option for patients with hearing loss. Conditions such as chronic otitis externa, congenital aural atresia, and chronic otitis media can be treated with a variety of implants. Progressive disease are also amenable to restoration with IADs, providing stabilized hearing. When considering the best rehabilitative options, the patient's preference, ease of surgery, ease of device use, quality of life, and the traditional alternatives (such as ossiculoplasty, hearing aids, and cochlear implants) need to be considered. Patients with conductive, mixed, and sensorineural losses, mild to severe in nature, can be candidates for IADs.

The aim of this evaluation study was to assess the possible role of a specific nutraceutical diet in relieving main clinical symptoms of chronic bilateral otitis externa (occlusion of ear canal, erythema, discharge quantity, and odor) in 30 adult dogs. Thirty dogs of different breeds (mean age ± SEM; 6.03 ± 0.15 years and mean weight ± SEM; 32.01 ± 1.17 Kg; 53.3 % males, 46.6 % females) with evident chronic clinical otitis symptoms were equally divided and randomly assigned to receive either the nutraceutical diet (ND group) or a standard diet (SD group) over a period of 90 days. In all cases a topical pharmacological treatment was given. The nutraceutical diet, also endowed with anti-inflammatory and antioxidant activities, significantly decreased the mean score intensity of all symptoms after 90 days of intervention (P

Background: Certain climatic conditions tend to favor the development of some ear infections and inflammations especially of the external ear. Otitis externa connotes the inflammation of the external ear and tends to occur commonly. This study is aimed at determining the frequency of occurrence, the type of otitis externa and management of patients seen in an ear nose and throat clinic in Port Harcourt.Methods: A retrospective review of all patients diagnosed with otitis externa within the period of January 2017 to December 2019. The diagnosis was mainly clinical. The clinic registers and patient’s case files were the source of data. Data sought included demographics, clinical features, forms and management of otitis externa. Patients with incomplete data were excluded. Data extracted were then analyzed using IBM statistical package for social sciences (SPSS) 25 version. Results were presented in scientific tables and figures.Results: There were a total number of 1296 of patients with otitis externa. Prevalence of otitis externa in the study was 28.77%. There were 54.2% females and 45.8% males with a ratio of 1.4:1. The age group 21-30 years was the age group most affected; n= 404 (31.2%). Chronic otitis externa was the commonest form seen; 74.8%. Unilateral affectation was commoner, seen in n=1073 (82.8%). Debris in the ear was found to be the commonest clinical feature followed by otalgia; 31.1% and 29.6% respectively. The treatment was mainly medical; comprising systemic and topical broad spectrum antibiotics, topical antifungal and steroidal drops, and aural toileting with wick dressing and analgesics. There were no major complications noted.Conclusions: Otitis externa is common in the ORL clinic and the diagnosis is often based on history and physical examination. The chronic form is the commonest type encountered and treatment is mainly empirical.

Chronic otitis externa due to Mycobacterium tuberculosis complex is extremely rare and very few cases have been presented in the medical literature. We report here the case of an immunocompetent 68-year-old male with chronic auricular drainage, otalgia, hearing loss, external ear canal and tympanic membrane thickening for 3 years who was ultimately diagnosed with tuberculous chronic otitis externa on biopsy of external auditory canal granulation tissue using molecular diagnostic techniques. Later, sputum cultures were positive for Mycobacterium tuberculosis complex indicating disseminated tuberculosis. However, two plausible explanations could be pulmonary TB that disseminated to the ear canal with evidence of middle and outer otitis, or upper airway/nasopharyngeal involvement with direct extension into the middle and outer ear canals. Although extremely rare, extrapulmonary laryngeal head and neck tuberculosis should be considered in immunocompetent patients who present with chronic otitis without prior known exposure to tuberculosis when they fail standard therapy and in whom no other microbiologic cause can be identified.

Summary Introduction: The implantable prosthesis of osseous conduction (BAHA) is deemed to be an excellent option in the auditory rehabilitation of patients with conductive and mixed hearing loss, unilaterally or bilaterally, and unilateral sensorineural hearing loss. It has been a good advantage over the conservative bone conduction apparatus and those of individual sound-amplifier apparatus (ISAA), when their usage becomes unfeasible because of chronic otitis externa, which has a hard clinic control. Objective: To introduce the first BAHA case performed in Brazil, as duly authorized by ANVISA (National Agency for Sanitary Surveillance), to rehabilitate the mixed hearing loss with occurrences of chronic otitis externa. Method: 50-year-old female patient with right-ear moderate and left-ear severe hearing loss, bilateral tinnitus derived from otosclerosis, was submitted to 04 surgeries of stapedotomy and unable to use ISAA as a result of otorrhea and bilateral otalgia. The medical and audiological evaluation indicated the benefit of using BAHA. Having surgery been performed and BAHA implemented, the patient showed a significant improvement in audiometric thresholds, speech perception and distinction, as well as she declared to be extremely satisfied with the esthetic factor. Final commentaries: BAHA surgical process is safe, simple and swift, thus providing excellent audiological results and a higher degree of satisfaction to patients.

Objective To analyze the ototoxicity of Burow solution as an otologic preparation. Background Burow solution has been used for years in the treatment of acute or chronic otitis externa and chronic suppurative otitis media. This acidic solution has antibacterial and antiedematous properties. Ototoxic effect of Burow solution has not been known, so the current study was designed to observe the ototoxic effect of Burow solution experimentally. Materials and methods Experiments were performed in 32 young, male albino guinea pigs (weight, 450-550 g). Twenty animals in the experimental group were divided into 2 groups of 10 animals each. The first group received 13% Burow solution (13% aluminum subacetate), and the second received 4% Burow solution (4% aluminum subacetate). Twelve animals in the control group were divided into 2 groups of 6 animals each. The first group received gentamicin (40 mg/mL; ototoxic control), and the second received saline solution (negative control). Under general anesthesia, pretreatment auditory brainstem responses (ABRs) from the right ear were obtained from the animals in all groups. The right tympanic membranes were widely perforated, and a small piece of Gelfoam was applied to the middle ear. Ear solutions at concentrations of 0.1 mL were applied through transcanal approach to the middle ear twice a day in 10 days. Under general anesthesia, the Gelfoam was removed from the right middle ear, and posttreatment ABRs were obtained 14 days later after the initial time in all groups. Results Baseline ABR results were normal in right ears of all animals tested. Animals undergoing placement of Gelfoam with either 13% Burow solution, 4% Burow solution, or saline in the middle ear showed no changes in ABR threshold. The gentamicin group showed significant change in the ABR threshold. Conclusion Burow solution was considered to be an effective and safe otologic preparation.

We evaluated the effectiveness of Burow's solution prepared by the rapid preparation method for the treatment of intractable chronic suppurative disease of the external ear canal and middle ear.We examined 34 ears of 29 patients ranging from 1 to 84 years of age. There were 19 males and 10 females with disease persisting for a range of 1 month-50 years. The disease and number of ears were as follows; chronic granulated myringitis (8 ears), chronic otorrhea caused by ventilation tubes (6 ears), chronic otitis media with perforation (6 ears), chronic otitis externa (5 ears), postoperative mastoid cavity problems (5 ears) and fungal otitis exrerna (4 ears).Burow's solution prepared by the rapid preparation method was dripped into the ear canal for about 15 minutes or small cotton balls soaked with the solution were applied directly to the lesion.Overall, 19 (61%) of 31 ears were cured, 7 (23%) were improved. The newly developed Burow's solution showed almost the same effectiveness in the treatment of the chronic granulated myringitis and chronic otitis externa (67-100%), but was not effective for the treatment of chronic otitis media with perforation (33%).

Introduction: Wearing hearing aid earmoulds has been implicated as a predisposing factor in the development of chronic otitis externa. Audiologists come into contact with a large number of hearing aid earmoulds and these could potentially harbour pathogenic micro-organisms, with the risk of subsequent cross infection. Cleaning with dilute alcohol is widely used in an attempt to break the chain of infection.Objective: To determine the presence and nature of microbial flora on hearing aid earmoulds and the efficacy of cleaning methods used to prevent cross infection.Setting: Secondary health care within the audiology department of Addenbrooke's Hospital, Cambridge, UK.Design: A prospective, observational study.Methods: Hearing aid earmoulds were swabbed before and after cleaning. Samples were cultured to determine qualitatively and quantitatively the microbiological flora present before and after cleaning.Results: Twenty out of 21 (95 per cent) earmoulds had microbes present and, of these, 19/20 (95 per cent) had a polymicrobial profile. Coagulase negative staphylococci and diphtheroids were the most frequent microbial isolates, but pathogenic bacteria and fungi were also demonstrated on earmoulds both before and after cleaning.Conclusions: The polymicrobial flora, including recognized pathogens, that colonizes earmoulds may lead to chronic otitis externa. Cleaning with 70 per cent alcohol solution was ineffective, in particular for pathogenic fungi on earmoulds.

We describe the identification and characterization of a novel nontuberculous mycobacterium (NTM), isolated from an ear swab of an adult male patient with chronic otitis externa. Genetically, the bacterium is most closely related toMycobacterium cosmeticum; however, growth and biochemical features indicate that it is distinctly different. Here, we highlight for the first time an unusual NTM that is a probable cause of ear infection.

The Vibrant Soundbridge is the world's most often implanted active middle ear implant or hearing aid. During the last few years, the device indications have expanded from sensorineural hearing loss to conductive and mixed hearing loss. Titanium couplers have led to improved contact of the floating mass transducer with the middle ear structures. The resulting hearing gain is satisfying for most patients, but so far, there is no clear audiologic advantage over conventional hearing aids. Currently, the indications are mainly related to intolerance of conventional hearing aids (eg, chronic otitis externa), severe mixed hearing loss with a destructed middle ear and certain medical diagnosis (eg, congenital atresia).

BACKGROUND In literature and based on clinical observations, the shape of the osseous external auditory canal (OEAC) has often been suggested to be an etiologic factor in chronic otitis externa (COE). However, to date, no evidence has been presented to confirm this correlation. The aim of this study was to see whether evidence of such a correlation exists, and if so, what shape of the OEAC is related to COE. METHODS Using CT scans of 2 groups of patients (with and without COE), a novel and easy to use method was introduced to measure 2 dimensions of the OEAC: the pretympanic recess (the depth (DPTR) and anterior curvature (ACPTR)). In addition, a descriptive classification of the entire OAEC was introduced. RESULTS The proposed method was demonstrated to be useful as excellent interobserver agreements were found (r = 0.89). No significant differences in the descriptive classifications of the OEAC were observed between COE and the non-COE patients. The DPTR was significantly deeper in COE patients. For the ACPTR, no significant differences were observed. CONCLUSION Based on a new method of determining the DPTR, we demonstrate that the DPTR is significantly deeper in COE patients and that the shape of the OEAC is thus of importance in the pathogenesis of COE.

Acute and chronic otitis externa and otitis media are common disorders in dogs and cats. In combination with other diagnostic and therapeutic procedures, the video-otoscope is a useful and effective tool in the management of clinical cases. The enhanced illumination and magnification provide the practitioner with more detailed information for diagnosis and prognosis, and the configuration of the working channel facilitates sampling, improves efficacy of cleaning procedures, and decreases risks of iatrogenic injury to structures of the middle and inner ear. Photographic documentation of clinical cases enhances the medical record, communication with colleagues, and client education. Although video-otoscopy facilitates diagnosis and therapy, it does not replace other important diagnostic tests such as evaluation for atopy, adverse food reactions, and immune-compromising disease. Failure to identify the underlying primary cause usually results in treatment failure regardless of the technology employed.

OTITIS externa is a common disease in dogs, and Proteus and Pseudomonas species are frequently cultured from chronic cases ([Welch Fossum 2002][1], [Krahwinkel 2003][2]). Otitis media in dogs is usually preceded by a bacterial infection of the external ear canal. The signs of otitis media, such as a

The traditional meatoplasty operations performed for chronic otitis externa, which has entered the ‘fibrotic’ phase, are often unsatisfactory because the results in terms of canal patency, hearing gain and patient satisfaction are variable. Although the use of laser in chronic ear surgery is well recognized, it has not been previously reported as a meatoplasty technique. Ten KTP laser meatoplasty operations were performed on eight patients with chronic otitis externa. This pilot study shows the technique to be effective, fast and with a high patient satisfaction rate in the short-term (mean follow-up period 9.3 months). The average increase in hearing thresholds was 24 dB HL. Significant patient benefit was obtained in at least six out of eight patients using the Belfast rule of thumb. The technique has many advantages over the traditional meatoplasty operations but the long-term results require evaluation.

Hearing function was measured in normal dogs and in dogs with otitis using brainstem auditory evoked response testing. Data were obtained from 86 normal ears and from 105 ears with otitis, categorised into four degrees of severity. The data were analysed to illustrate the differences between the hearing function in the normal and abnormal ears and to estimate the degree of impairment associated with differing degrees of pathology. While severe hearing loss seemed to be present in the dogs with more severe otitis, only two individuals were identified as being totally deaf in the affected ears and no dogs were identified in which the cleaning and examination processes had caused damage to hearing function. Cleaning the ear canal produced measurable improvements in hearing in several dogs, indicating the profound effect of physical obstruction of the external ear canal by debris. It is concluded that most dogs with chronic otitis externa are not totally deaf and that the hearing impairment that does occur has the characteristics of conductive hearing loss.

THIS, the third in a series of articles on otitis externa in the dog and cat, briefly reviews the pathological changes which occur in chronic otitis to explain the rationale for surgery, and then goes on to discuss a variety of surgical approaches which aid the management of the condition. The previous articles covered the primary causes and investigation of otitis externa (January 1996, pp 9-16) and medical treatment (February 1996, pp 66-71).

We describe an endaural technique for soft tissue and bony meatoplasty and canalplasty in the surgical management of chronic otitis externa unresponsive to medical treatment and out-patient microsuction. Following analysis of the surgical outcome via a retrospective review of patient records, we would recommend this surgical treatment in this patient group.

PLEASE NOTE A NEW 4TH EDITION HAS BEEN PUBLISHED AND IS AVAILABLE IN THE LIBRARY AND IN PRINTOtitis is a frequent clinical presentation in practice. It should be considered a consequence of an underlying disease, thus the investigation and management of ear disease forms part of veterinary dermatology. Otitis is defined as any inflammation of the ear canal, whatever the cause or clinical presentation. Based on the history and the clinical signs, it is possible to differentiate between the various subtypes of otitis. This is useful because the clinical approach and therapy will vary depending on the type of otitis present. This chapter discusses Definitions; Pathogenesis of otitis; Acute otitis externa; Chronic otitis externa; Suppurative otitis externa; Feline otitis externa; and Ear canal surgery.

Chronic otitis externa (COE) remains a frustrating problem for both patient and physician. The end stage of disease, medial fibrosing otitis externa, is very challenging to repair. New and old therapies and promising approaches to the treatment of this often recalcitrant problem are presented in this review.Tacrolimus, a nonsteroidal immunosuppressant, and fluocinolone acetonide oil 0.01%, a medium-high potency steroid preparation, may offer additional therapeutic options in the struggle against this inflammatory ear canal/skin condition of often unknown cause. Relative potencies of many steroid preparations will be presented along with several treatment strategies for controlling COE. Underlying autoimmune problems such as Sjögren's disease, sarcoidosis, and amyloidosis must be searched and, if present, addressed and treated for resolution of symptoms. Cutting edge therapies, including use of bacteriophages and inflammatory proteases, will also be reviewed.No single therapy will be successful for every patient with COE. The search for an underlying cause, the removal of all possible irritants to the ear canal skin (e.g. Q-tips, water), debridement, and both topical and occasionally, systemic therapy will control (not cure …) the disease process in the vast majority of patients.

The effect of pain or discomfort induced by intractable pruritus on an animal’s quality of life has not traditionally been addressed at length in veterinary dermatology texts, yet chronic skin disease undoubtedly has a significant impact on the health and well being of both the pet and the family. This chapter explains Skin innervation and the perception of pain and pruritus; Pruritus in dogs; and Pruritus in cats. Case examples: Chronic otitis externa in a dog; Non-seasonal pruritus in a dog.

During a survey of the occurrence of Malassezia species in the external ear canals of dogs with chronic otitis externa, lipid-dependent Malassezia species were isolated in three dogs. These species were identified as Malassezia furfur and M. obtusa but showed atypical assimilation patterns. To our knowledge, this is the first report of the isolation of lipid-dependent species of the genus Malassezia in association with canine otitis.

Objectives: We investigated 1) the correlation between the degree of acute otitis externa (AOE) and a change of pH and 2) the recovery of pH after acidification compared to an antibiotic otic solution in AOE. A change of pH in the external auditory canal (EAC) is very important for the pathogenesis of otitis externa. Therefore, not only an antibiotic otic solution, but also acidification, is known to be a good treatment for AOE. However, pH has only been investigated in chronic otitis externa, and not in AOE. Methods: This was a prospective randomized control study. Forty adult patients (56 ears) with AOE and 40 normal control subjects (80 ears) participated in this study. The severity of disease was graded as mild, moderate, or severe. The pH of each EAC was then measured. The patients were randomly assigned into 2 groups: One for vinegar irrigation and the other for topical antibiotics. The pH of the diseased ears was measured at 1 and 2 weeks after the treatment. Results: The mean (±SD) pH for the normal control subjects was 5.4 ± 0.48, and the EAC lost its acidity proportionately to the degree of disease (p < 0.05). For both the vinegar irrigation and topical antibiotic groups, the acidity was restored dramatically (p < 0.05) at 1 and 2 weeks for the moderate and severe grades of otitis, but not for the mild grade. There was no difference in recovery between the 2 groups. Conclusions: The EAC lost its acidity proportionately to the degree of disease in AOE. Vinegar irrigation and topical antibiotics were equally effective for restoration of pH.

Besalti O., Y.S. Sirin, Z. Pekcan: The Effect of Chronic Otitis Externa-Media on Brainstem Auditory Evoked Potentials in Dogs. Acta Vet. Brno 2008, 77: 615-624. The objective of the study was to present normative Brainstem Auditory Evoked Potentials (BAEP) data elicited by both air-conducted clicks (30-100 dBHL) and bone-conducted clicks (100-130 dBHL) for healthy dogs, and dogs with chronic otitis externa-media (COEM). The data were analyzed to acquire reference values in 55 normal dogs and to estimate the degree of hearing impairment associated with the disease. Fifty-four dogs with COEM were divided into two degrees of severity. The first one included dogs with severe (n = 16), and the second with moderate COEM (n = 38). The recognisability wave V was found higher than the others at every stimulation level. Wave VII was not seen by the bone-conducted click at all stimulation levels, and also in cases with severe COEM by the air-conducted click. Recognisability of wave V was seen more than 50% at 60 dBHL in severe COEM. This ratio was seen at 30 dBHL in moderate COEM. In healthy dogs, the latencies of waves (I-VII) were compared between the left and the right side, and there were no significant differences between each side except for a shorter latency of wave VI. In conclusion, COEM caused increasing latency rather than total deafness, and BAEP can be suggested as an ancillary diagnostic tool in ear disorders.

Ventral bulla osteotomy was combined with total ear canal ablation for the treatment of chronic otitis externa and otitis media in 13 dogs (14 ears) that had been refractory to medical and surgical treatments. Resolution of disease occurred in 11 dogs (12 ears). One dog with unilateral disease underwent a second operation before achieving a good result. One dog was euthanatized for persistent unilateral disease after three surgical procedures. The recurrence of disease in these two dogs (15%) was associated with remnants of ear canal integument within the osseous horizontal canal or tympanic bulla. Facial paralysis occurred in four dogs (31%) and there were no complications in eight dogs (62%). This technique shows no advantage over lateral bulla osteotomy combined with total ear canal ablation for the treatment of chronic otitis externa and otitis media.

A long-standing diffuse chronic otitis externa can lead to itching. Resultant scratching may then lead to irreversible skin changes with canal stenosis by scar tissue. The poor ventilation and increased humidity gives rise to bacterial and fungal growths leading to breakdown of the skin defences and worsening itching. This vicious itching–scratch cycle or downward spiral often fails to respond to medical treatment. For these cases a simple conchal flap meatoplasty may improve ventilation of the external auditory canal and may lead to a self cleaning ear. We reviewed 84 patients who had undergone conchal flap meatoplasty in Calderdale and Huddersfield NHS Trust Hospitals from April 1993 to June 2002. A long-term follow up of conchal flap meatoplasty in chronic otitis externa showed no records of complications or further otitis in 93.2 per cent of cases. Thus surgical intervention plays an important role in the treatment of otitis externa not responding to treatment.

Although uncommon, acquired external auditory canal stenosis is an entity that is encountered by many otolaryngologists. This paper reviews the causes, pathogenesis, assessment, and management options for external auditory canal stenosis.Initially, acquired external auditory canal stenosis was described as resulting from a number of different causes. Since then, histology and imaging studies of this disease have shown that a common cascade of inflammatory changes resulting from these different causes is the primary pathogenesis leading to medial canal fibrosis. Once there is complete obstruction of the external auditory canal, surgery is the primary treatment. Understanding the strong role of inflammation in the pathogenesis of external auditory canal stenosis may lead to new preventative medical therapies.Although acquired external auditory canal was described several years ago, its underlying pathophysiology is now better understood. From this knowledge, improved medical as well as surgical approaches can be developed.

Problem: The aim of this study was to evaluate the problems encountered in the development of a Bone Anchored Hearing Aid (BAHA) program in a district general hospital, over a period of 11 years. Patient satisfaction was also assessed. Methods: Patient records and a patients’ database were evaluated retrospectively. Demographics, pre- and postoperative audiogram, surgical technique, and surgical and skin complications were recorded and analyzed. Patient satisfaction was assessed prospectively using a visual analog questionnaire. Results: BAHAs have been fitted to wide age group of patients (ranging from 7 to 80 years). Indications for surgery are congenital abnormalities in children and following mastoid surgery/CSOM (74%) in adults. The remainder is due to chronic otitis externa or otosclerosis. Half of these patients were tertiary referrals. Intially surgery was carried out in 2 stages (43%), Now all are performed in 1 stage with a local skin flap. Complications requiring further surgery (18%) have been due to trauma, primary failure to integrate, or as a result of late infections. Forty-one percent of patients have had no complications, including skin reactions. Review of patient questionnaires showed that 91% express their complete satisfaction with their device. Over 88% use their BAHA every day and for more than 8 hours. Ninety-five percent felt that one-on-one conversation was better with a BAHA. Most were pleased with the cosmetics of the abutment, ease of use of aid, with only 15% expressing difficulty cleaning the abutment. We had no nonusers in the study. Conclusion: Surgical complications were higher than other published data in the early stages of program development. Patient satisfaction was generally high, but improved significantly with the introduction of a multidisciplinary team approach. Significance: The BAHA service has developed steadily over the years. Surgical techniques have improved. Complications, especially skin problems have been reduced by the development of a specialized team approach involving the surgeon, nurse, audiologist, and patient. Support: None reported.

This article describes a surgical technique for the treatment of chronic stenosing otitis externa. A retrospective survey of the post-operative course in eight patients (10 ears) showed this to be a satisfactory treatment with no recurrence of symptoms.