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Objective: This review sought to answer the following research question: What are the characteristics of pediatric necrotizing otitis externa (NOE)? Moreover, we wanted to highlight the clinical importance of the current limitations in the literature., Methods: A scoping review was performed to determine what is known about NOE in the pediatric population. Four databases (COCHRANE Library, CINAHL, PubMed, and Scopus) were queried for articles published in English between 1976 to 2022. Variables extracted included comorbidities, demographics, outcomes, and treatment., Results: A total of 20 studies (N = 439) reported sufficient measures to be included in the review. Patients with NOE had a mean age of 10.0 years (range 2 months to 14 years) with a male-to-female gender ratio of 1.1:1. Mean length of hospital stay was 2.9 days (95%CI: 2.7-3.0). Demographics included 45.4% Caucasian, 6.0% African American, and 2.7% Asian/Pacific Islander. Less than 5% of patients had diabetes, while other reported comorbidities included neutropenia (n = 6), anemia (n = 5), dehydration/malnutrition (n = 4), Stevens Johnson Syndrome (n = 2), some form of immunosuppression/organ transplantation (n = 2), thrombocytopenia (n = 2), and leukopenia (n = 2). There have been no reported deaths from NOE in children., Conclusions: In the adult population NOE most commonly affects patients with diabetes, but our review reveals that diabetes does not appear to play as big a role in children. The disease seems to commonly affect patients with immunosuppression or severe health conditions. Complications such as cranial nerve palsies appear to be more common in the pediatric population. Specifically, the role of biopsy and culture in the treatment of pediatric NOE is stressed as they are important in treatment decisions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Although rare, Malignant otitis externa is responsible for a high morbidity and could sometimes be fatal. The management of this condition is still challenging., Aim: To analyse the clinical, microbiological and radiological profile of malignant otitis externa, and the management of this condition., Methods: A descriptive, cross-sectional study was conducted at ENT Department of Kairouan's hospital including 38 patients hospitalised and treated for malignant otitis externa from January 2013 to August 2021., Results: The mean age of patients was 67.7 ± 12.9 years (35-98). All patients presented with continuous otalgia that resists to usual analgesics. Otorrhea was noticed in 76.3% of cases, facial palsy in 2 cases (5.3%) and dysphonia in one case (2.6%). Pseudomonas Aeruginosa was the main responsible pathogen (42%). Concomitant bacterial and fungal infection was noticed in 6.4% of the cases. First-line intravenous antibiotherapy used was mainly based on an association of Cephalosporins and Fluoroquinolones. Complete remission was noticed in 30 patients (79%). However, 8 cases of recurrences (21%) and 2 cases of deaths (5.2%) were noticed in our series. The mean follow-up was 4.6±6.3 (1-26 months)., Conclusions: Pseudomonas Aeruginosa remains the main responsible pathogen for malignant otitis externa. Nevertheless, fungal infections are rising because of the overuse of antibiotics. Antibiotherapy should be adapted to culture results and resistance profile of pathogens in hospital. Practionners should be aware of the possibility of concomitant fungal infection, especially in the case of unfavorable evolution.

This study was conducted to evaluate the prevalence of otitis externa (OE) in cats using cytology, direct otoscopic examination, and parasitological examination through swabs and curettage, and to compare the accuracy between collection methods for parasitological examination. Direct otoscopic evaluation of the external auditory canal (right and left), swabs for cytological examination of the external auditory canal, and collection of cerumen for parasitological examination through swabs and curettage of 137 cats from a veterinary hospital care were conducted between March 2021 and March 2022. The influences of age, sex, habitat, street access, and the presence of fleas on OE were evaluated. Cytological evidence of OE was observed in 25.5 % of cats and was statistically associated with flea and mite parasitism. Otodectes cynotis was found in 13.9 % of the cats. Cocci and Bacilli were the secondary factors in 34.3 % and 22.9 % of cats with OE, respectively. The Malassezia genus was a secundary factor in 57.1 % of the cats with OE. The frequency of OE was high in cats receiving hospital care. O. cynotis was a frequent primary cause of OE in cats. The curette sampling method is a great option for diagnosing O. cynotis infestation due to its ease of use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Necrotizing otitis externa (OEN) is an aggressive and morbid infection of the external acoustic meatus. What are the risk factors for OEN extension?, Methods: French monocentric retrospective study (2004-2021), including patients with OEN defined by the association of an inflamed EAM, a positive nuclear imaging, the presence of a bacteriological sample and the failure of a well-followed local and/or general antibiotic treatment. OEN was extensive if it was associated with vascular or neurological deficits, if nuclear imaging fixation and/or bone lysis extended beyond the tympanic bone., Results: Our population (n = 39) was male (74%), type 2 diabetic (72%), aged 75.2 years and pseudomonas aeruginosa was found in 88% of cases. Complications for 43% of patients were extensive fixation on nuclear imaging, for 21% of them the presence of extensive bone lysis, for 13% the appearance of facial palsy, for 5.3% the presence hypoglossal nerve palsy and for 2.5% the presence of thrombophlebitis or other nerves palsies. 59% of our population had extensive OEN. The diagnosis of the extensive OEN was made 22 days later (p = 0.04). The clinical presentation was falsely reassuring due to easier identification of the tympanic membrane (70% vs 46%, p = 0.17) but associated with periauricular oedema (42% vs 0%), bone exposure (16% vs 0%) and a temporomandibular joint pain (41% vs 12%)., Conclusion: Delayed treatment of OEN, identification of clinical bone lysis, especially when the tympanic membrane is easily visualized, and the presence of unbalanced diabetes are potential risk factors for extension of OEN., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: A recent increase in the occurrence of canine skin and soft tissue infections, including otitis externa and pyoderma, caused by antimicrobial-resistant Staphylococcus pseudintermedius and S. schleiferi has become a significant public and veterinary health issues., Objective: We investigated the virulence potentials associated with the occurrence of canine otitis externa in S. pseudintermedius and S. schleiferi., Methods: In this study, the prevalence of genes encoding leukocidins, exfoliative toxins, and staphylococcal enterotoxins (SEs) was investigated using previously characterized S. pseudintermedius (n = 26) and S. schleiferi (n = 19) isolates derived from canine otitis externa. Susceptibility to cathelicidins (K9CATH and PMAP-36) and hydrogen peroxide (H 2 O 2 ) was also examined in both staphylococcal species., Results: A high prevalence of genes encoding leukocidins ( lukS/F-I , lukS1/F1-S , and lukS2/F2-S ), exfoliative toxins ( siet , expB , and sset ), and SEs was identified in both S. pseudintermedius and S. schleiferi isolates. Notably, S. pseudintermedius isolates possessed higher number of SE genes, especially newer SE genes, than S. schleiferi isolates harboring egc clusters. Although no significant differences in susceptibility to K9CATH and H 2 O 2 were observed between the two isolate groups, S. pseudintermedius isolates exhibited enhanced resistance to PMAP-36 compared to S. schleiferi isolates., Conclusions: These findings suggest that high a prevalence of various toxin genes together with enhanced resistance to cathelicidins may contribute to the pathogenicity of S. pseudintermedius and S. schleiferi in canine cutaneous infections., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Korean Society of Veterinary Science.)

Otitis externa is a canine disease of multifactorial etiology in which bacteria plays a significant role. Due to the predominant bacterial etiology otitis is usually treated with antibiotics. However, non-prudent use of antibiotics promotes the emergence of antibiotic-resistant bacteria thus compromising the therapy effectiveness. Currently, the increase of antimicrobial resistance (AMR) is one of the biggest threats to global health. For this reason, the aim of the study was to investigate prevalence of the microbiological causes of canine otitis externa and the antibiotic susceptibility of the isolated bacterial strains. The research and sampling were conducted at Veterinary Clinics for small pets in Serbia. Samples were sent to laboratory for bacteriological and mycological testing. Additionally, the sensitivity of the isolated bacteria to antibiotics was evaluated using disc diffusion method. Sixty dogs with otitis externa clinical symptoms were included in the study. Out of a total of 53 positive samples for pathogen presence, bacteria were present in 40. The most prevalent bacteria was Staphylococcus pseudintermedius, followed by Pseudomonas aeruginosa and Proteus spp., while Malassezia pachydermatis was the only isolated yeast pathogen occurring in 36 samples. Generally, the lowest resistance against all bacteria showed enrofloxacin. On the contrary, high resistance to penicillin and amoxicillin was a common finding for G+ and G- bacteria. These results indicate the need for laboratory testing in terms of isolation, identification and antibiotic susceptibility testing, not only in the case of otitis externa in dogs, but in all diseases when it is possible, in order to enhance antimicrobial stewardship and consequently to contribute AMR reduction., (Copyright© by the Polish Academy of Sciences.)

Purpose: We aimed to present the management of the patients with necrotizing otitis externa (NOE) and its comorbidities in early and long-term follow-up., Methods: Between 2011 and 2022, 30 patients with the diagnose of NEO, who had cortical bone erosion or trabecular demineralization in temporal bone computed tomography and administered at least 6-week antimicrobial therapy were included in the study. Clinical, laboratory and imaging findings of patients, and comorbidities during follow-up were analysed. NOE extending further from the petro-occipital fissure on magnetic resonance imaging was accepted as medial skull base (MSB) involvement., Results: 30 patients, (8 women, 22 men, mean age 66.2 ± 1.7), with NOE were followed 36.4 ± 29.6 months. The mortality rate was 23.33% and the mean survival time was 12.37 ± 11.35 months. Repeated cultures reveal a new or second pathogen in 5 patients (20%). Severe and profound sensorineural hearing loss (SNHL) were observed in 4 and 12 patients, respectively. Labyrinthitis ossificans emerged in 3 of 6 surviving patients with profound SNHL during follow-up. Chronic disease anemia (CDA) (66.66%), cerebrovascular disease (CVD) (43.33%), chronic renal failure (CRF) (30%), and retinopathy (26.66%) were the most frequent comorbidities in patients with NOE. Cranial nerve paralysis (CNP) (P < 0.001), SNHL (P < 0.04), CDA (P < 0.005), and mortality (P < 0.022) were significantly associated with the presence of MSB involvement., Conclusions: NOE is a disease that requires long-term follow-up, causes severe morbidity, and has a high mortality rate. MSB involvement is associated with CNP, SNHL and labyrinthitis ossificans. Moreover, CDA, CVD, CRF and retinopathy are the most common comorbitidies needed to be managed., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Otomycosis is considered a recurring fungal ear infection. The external auditory canal provides an appropriate and optimal situation for fungal growth., Objectives: The study aimed to identify the causative agents of otomycosis and determine corresponding antifungal drug susceptibility patterns in north-western Iran., Methods: From October 2020 until November 2021, 200 patients attended an otolaryngology referral centre with otitis externa, and their ear discharge and debris were examined and cultured. The identification of the fungal agents was implemented by polymerase chain reaction-restriction fragment length polymorphism and sequencing. In vitro antifungal susceptibility testing of the isolates was conducted in accordance with the CLSI broth microdilution protocols., Results: The prevalence of otomycosis was measured 50.5% (n = 101/200). The majority of patients were in their forties (n = 35, 34.6%) and female (n = 57, 56.4%), and the most prevalent symptom was otalgia (56.4%). The most underlying factor was remarked manipulation employing a cotton swab (65.3%). Regarding fungus, Aspergillus section Nigri (58.57%) was the foremost isolate, followed by Aspergillus section Flavi (19.23%) and Candida parapsilosis (14.96%). The predominance of Aspergillus isolates had minimal in vitro sensitivity to tioconazole and nystatin. Candida species represented higher geometric mean minimum inhibitory concentrations (MIC) against nystatin. The MIC of three Aspergillus species isolates shown above the epidemiologic cut-off values (ECV) against itraconazole., Conclusions: Otomycosis incidence surpassed in comparison with the previous study as the most common cause of otitis externa. The MIC distribution of Aspergillus species isolates against triazole antifungals is close to the defined ECVs and likely outrun it over time., (© 2022 Wiley-VCH GmbH.)

Abstract: Staphylococcus pseudintermedius ( SP ) is an important opportunistic pathogen, frequently associated with pyoderma and otitis in dogs. The emergence and rapid expansion of methicillin-resistant Staphylococcus pseudintermedius (MR SP ) is problematic due to multidrug resistance and reduced treatment options. The aim of this study was to determine i) the prevalence of MR SP in dogs with pyoderma or otitis externa, ii) the antimicrobial resistance patterns of MR SP from South African isolates, and iii) the risk factors for MR SP -associated pyoderma or otitis externa in dogs in South Africa (RSA). Sixty-eight presumptive clinical SP isolates (collected from 65 dogs) from five geographically dispersed laboratories in RSA were collected over 2 years. Possible MR SP isolates were flagged when resistance to oxacillin was observed. Thereafter, all isolates were confirmed as SP by polymerase chain reaction (PCR) and further genotyped for the mec A gene. Fifty-seven of 68 isolates were confirmed to be SP (83.8%), while 49/57 (85.9%) carried mec A. Our findings showed that preliminary phenotypic methods supplemented by genotypic methods increased the accuracy of correctly identifying SP . All isolates were resistant to at least one antimicrobial drug. There was a high incidence of amoxicillin (70.1%) and enrofloxacin (65%) resistance. Important risk factors for mec A positive carriage were previous hospital admission, pruritus, and previous antibacterial failure. This study demonstrates a high prevalence of mec A positive carriage (85.9% of samples) in MR SP pyoderma and otitis in dogs in RSA. There is an urgent need for better laboratory diagnosis of MR SP and surveillance of dogs presenting with pyoderma and otitis in South Africa., (Copyright© Authors.)

Otitis externa (OE) is a condition that involves inflammation of the external ear canal. OE is a commonly reported condition in humans and some veterinary species (for example, dogs, cats), but has not been reported in the literature in macaques. Here, we present a case series of acute and chronic OE likely precipitated by abrasion of the ear canal with a tympanic membrane electrode in 7 adult male rhesus macaques ( Macaca mulatta ). All animals displayed purulent, mucinous discharge from 1 or both ears with 3 macaques also displaying signs of an upper respiratory tract (URT) infection during the same period. A variety of diagnostic and treatment options were pursued including consultation with an otolaryngologist necessitated by the differences in response to treatment in macaques as compared with other common veterinary species. Due to the nature of the studies in which these macaques were enrolled, standard audiological testing was performed before and after OE, including tympanometry, auditory brainstem responses (ABRs), and distortion product otoacoustic emissions (DPOAEs). After completion of study procedures, relevant tissues were collected for necropsy and histopathology. Impaired hearing was found in all macaques even after apparent resolution of OE signs. Necropsy findings included abnormalities in the tympanic membrane, ossicular chain, and middle ear cavity, suggesting that the hearing impairment was at least partly conductive in nature. We concluded that OE likely resulted from mechanical disruption of the epithelial lining of the ear canal by the ABR electrode, thereby allowing the development of opportunistic infections. OE, while uncommon in macaques, can affect them and should be included as a differential diagnosis of any macaque presenting with otic discharge and/or auricular discomfort.

Background: External otitis is common in dogs, and one of the main agents involved is Malassezia pachydermatis , a yeast belonging to the otic microbiota. Empirical treatment can fail; therefore, it is essential to know the antifungal susceptibility profile to prescribe appropriate treatment, a fact scarcely reported in Chile., Aim: This study aimed to determine the antifungal sensitivity of M. pachydermatis isolated from the external auditory canal of dogs in central Chile., Methods: Ear swabs from 30 dogs (15 healthy and 15 with external otitis) were used. Samples were subjected to cytology and fungal culture. The antifungal susceptibility was determined according to clinical and laboratory standards institute (CLSI) document M44A-2 using the disk diffusion test from amphotericin B, Caspofungin, fluconazole, nystatin, clotrimazole, and voriconazole were used., Results: The prevalence of M. pachydermatis was 66.7% from 8 healthy dogs and 12 with otitis. While fungal culture was not associated with the patient's clinical condition ( p = 0.24), the yeast count by cytology was significantly higher in dogs with otitis ( p = 0.003). The strains were sensitive to all antifungals except for Caspofungin, where 55% of the strains were resistant., Conclusion: Malassezia pachydermatis is isolated more frequently in dogs with otitis, and the ear cytological examination is useful to differentiate colonized dogs versus dogs with otitis. In addition, most antifungals in vitro are active against this yeast, except Caspofungin, an antifungal used in human medicine. This situation should be further monitored in epidemiological programs to evaluate the possible impact on Chilean public health., Competing Interests: The authors declare that they have no conflicts of interest.

Objective: This study investigated how the coronavirus disease 2019 pandemic has impacted on presentations to ENT first-on-call services., Methods: All appointments to a rapid access triage clinic from 1 June to 31 August in 2019 and 2020 were reviewed retrospectively and their reasons for consultation classified. A binomial proportion test was used to determine whether the proportions of consultations per presentation differed significantly between years. This analysis was repeated with the number of unique patients per presenting complaint., Results: The proportions of nine reasons for consultation differed significantly between 2019 and 2020, including an increase in otitis media and nasal trauma presentations, and a decrease in otitis externa and tonsillitis presentations. Reattendances caused some variation in the frequency of certain diagnoses., Conclusion: Our data suggest a shift in the presentations to first-on-call services, which may be a result of changes in patient behaviour and access to healthcare services.

Objective: The current study showed the relation between otitis externa and COVID-19 infection and compared otitis externa with other symptoms of COVID-19 as anosmia., Methods: 257 cases who were confirmed positive for COVID-19, were examined otoscopic and endoscopic for otitis externa, onset of starting symptoms of otitis externa and its relation to days of infection with COVID-19 were documented and the prevalence of otitis externa with anosmia in the study group were estimated., Results: Increased incidence of otitis externa in COVID-19 patients (18% of study group) and symptoms starting mainly between the 5th to 8th day of COVID-19 infection. Combined otitis externa and anosmia occurred in 13% of study group., Conclusions: Otitis externa has a relation to COVID-19 infection. Further research needed to study its pathogenesis and mechanisms., (Copyright © 2020. Published by Elsevier Inc.)

Malignant otitis externa is a progressive infection of the external auditory canal and skull base. Pseudomonas aeruginosa is the most isolated microorganism and it affects mostly to diabetic, elderly, and immunocompromised individuals. Non-resolving otalgia and chronic otorrhea are the clinical manifestations presented. Facial nerve palsy is a common and well recognized complication. (Computed tomography) CT scan is useful for initial assessment, Technetium-99m is highly sensitive and is part of the protocol for diagnosis. Treatment should be individualized, with multidisciplinary cooperation among specialties. Management involves systemic antipseudomonal antibiotics and monitoring with radiologic techniques, it also involves the strict control of diabetes. It is essential to follow up the patients for at least a year post-treatment. In refractory malignant otitis externa and affection of facial nerve, surgical management is recommended. We reviewed the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment to provide an update on Malignant Otitis Externa that can offer an overview for clinical practice and future research., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Feline otitis externa is a dermatological disorder with a multifactorial complex etiology., Aim: This study aimed to investigate the prevalence of different etiological agents, particularly the parasitic and bacterial, responsible for the cases of feline otitis externa in Tripoli, Libya, and to assess the antimicrobial susceptibility of the bacterial isolates from those cases., Methods: Cerumen and otic discharges of the suspected cats were collected for parasite detection and bacterial culture. Kirby-Bauer's disk diffusion method was used for antimicrobial susceptibility testing., Results: The results showed that otodectic mites and bacterial causes were equally the most prevalent in those cases, with a prevalence of 47.1% each. Otodectes cynotis infestation was more frequently bilateral and severe. Staphylococcus spp. were the most prevalent among bacterial causes (75%), followed by Proteus spp. (16.6%) and Pseudomonas spp. (8.4%). Norfloxacin and gentamicin were the most effective antimicrobials against bacterial isolates, as they were effective against 83.3% and 70.8% of isolates, respectively., Conclusion: Otodectes cynotis infestation and staphylococcal infections constituted the most common etiology of feline otitis externa in Tripoli, Libya, and norfloxacin represented a cogent antibacterial for the treatment of otitis externa., Competing Interests: The authors declare that there is no conflict of interest.

Background: Acute otitis externa (AOE), is a common infectious disease affecting children and adults. Its peak prevalence is around the summer months, it involves the external auditory canal and in most cases is due to bacterial agents., Methods: This is a retrospective observational analytical case-based study involving all consecutive patients under the age of 18 years old presenting with AOE to a pediatric emergency department., Results: We collected data from 337 patients under 18 years of age with 344 visits to the Emergency Department, between the years 2011-2018. Nearly half of the visits presented during the summer months. Children were divided into two subgroups: hospitalized and non-hospitalized. Median hospitalization time was 3 days. The hospitalized sub-group had higher rates of failed treatment, as well as higher rates of external ear canal edema, systemic fever, canal discharge and auricular edema. On multivariable analysis the following variables had the strongest correlation for hospital admission: auricular edema (OR 27.98), otorrhea (OR 1.82), narrowing of the ear canal by more than 50% (OR 1.91), fever (OR 2.92), and previous systemic treatment (OR 2.53). Pseudomonas aeruginosa (PA) was isolated in 78% of cultures in the hospitalized sub-group. All PA strains were sensitive to ciprofloxacin., Conclusions: This study highlights the main clinical variables which may predict hospitalization among children with AOE as well as the dominant role of sensitive strains of PA in the pathogenesis of this condition in children., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To summarize modern data about the epidemiology, etiology, clinical course and diagnosis of otitis externa., Material and Methods: Materials of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed were used as a data source. The choice of material was carried out according to the keywords: otitis externa, etiology, diagnosis, treatment, local treatment., Results: The role of combined drugs in the main etiopathogenetic mechanisms of the external ear inflammatory process is shown., Conclusion: Analysis of published data from clinical trials indicates the importance of a fixed antibacterial agents and anesthetic combination in increasing the effectiveness of topical therapy for otitis externa.

Staphylococcus pseudintermedius (SP) and methicillin-resistant SP (MRSP) is one of the most important veterinary pathogens in the dog. Herein, from a total of 126 S. pseudintermediusstrains, 23 MRSP (18%) were identified. Multi-Locus Sequence Typing (MLST) revealed that most of MRSP strains belonged to ST71 (26%), which have been already reported in Italy and other countries. Interestingly, nine new sequence types (39%), from 1053 up to 1061, were described for the first time. Moreover, the isolated MRSP strains showed relevant antibiotic resistance profiles. This report highlights the circulation of new sequence types of MRSP in Italy and underlines the need of a global epidemiological surveillance to limit the increasing spread of multidrug-resistant MRSPstrains worldwide, since they may represent a considerable concern for dog's health., (Copyright© by the Polish Academy of Sciences.)

Objective: To assess for changes in trends of the disease process, management, and outcomes of necrotizing otitis externa (NOE) over the last decade., Data Sources: Articles in English, published between January 2011 and June 2019, were searched in PubMed, Scopus, Web of Science, ScienceDirect, and the Cochrane Database., Study Selection: Inclusion criteria: 1) reported evidence of NOE, 2) details on patient demographic and underlying medical disorder, 3) details on treatments, 4) documented outcomes, and 5) greater than 10 cases., Data Extraction: Study demographics, underlying conditions, infectious etiology, treatments, signs and symptoms, and outcomes., Data Synthesis: Ten studies, totalling 284 patients with a mean age of 67.8 years, were included. The time period of collected patient data ranged from 2000 to 2018. Temporal subgroup analysis was conducted before and after 2009. Cure rate was lower in the post-2009 group (76.0 versus 94.1%, p < 0.01) while disease-specific mortality remained stable. Increases in proportions of diabetes and culture negative results (p < 0.01) were also observed in this latter group. Rate of extensive surgery and the use of ciprofloxacin decreased (p < 0.01), while the use of ceftazidime increased in the post-2009 group (p < 0.01)., Conclusion: A decrease in cure rate of NOE patients was observed in the setting of an increase in prevalence of diabetes. Various antipseudomonal agents are being used and an increase in culture negative results is seen.

Background: Fungal infection of animals or humans are common all over the world. Some of microorganisms like fungi, exist on the skin and can be transmitted onto other individuals, other animal species or even humans and cause skin infections. Moreover, they can be the causative agents of severe generalized infections especially in immunocompromised individuals. The study aimed to evaluate the most frequent etiological agents of skin diseases and to compare the prevalence of animal fungal infections in Poland, and to discuss the possibility of transmission to humans in Poland., Results: The obtained results are culture based. The fungi most frequently isolated from group of animals with skin lesions were Malassezia pachydermatis (29.14%), and Candida yeasts (27.07%), and dermatophytes (23.5%), including Microsporum canis as majority of them (59.25%), and Trichophyton genus (40.7%), most of them T. mentagrophytes, while Malassezia pachydermatis represented (80%) of isolates in animals with otitis externa. In over 19% of positive fungal cultures obtained from external ear canals Candida yeasts, mainly C. albicans, were identified., Conclusions: Dermatomycoses in companion animals are caused by both, mycelial fungi and yeasts. Most frequently isolated were Malassezia pachydermatis and Candida spp. Dermatophytes (Trichophyton, Microsporum), were also cultured, but the total number of these isolates seems to decrease. We have not found Cryptococcus neoformans in tested clinical samples.

Objective: Despite studies reporting a possible association between malignant otitis externa (MOE) and diabetes, there are no large-scale population-based empirical studies. This nationwide, population-based case-control study explored the association of MOE occurrence with previously diagnosed diabetes., Methods: Data were retrieved from Taiwan's National Health Insurance Research Database, 753 patients with MOE (cases) and 2 259 propensity score-matched patients without MOE (controls). Multiple logistic regressions were conducted to examine the association of MOE with previously diagnosed diabetes., Results: In total, 728 (24.2%) out of 3 012 sample patients had diabetes prior to the index date. Chi-square test revealed a significant difference in diabetes prevalence among cases and controls (54.8% vs 13.9%, p  < 0.001). Simple logistic regression showed the odds ratio for prior diabetes among cases versus controls was 7.50 (95% CI, 6.22~9.03). The adjusted odds ratio of prior diabetes for cases versus controls was 10.07 (95% CI, 8.15~12.44) after adjusting for patient demographics and medical co-morbidities., Conclusions: This study found an association between MOE and diabetes. One clinical practice implication of our study is that when a patient with diabetes complains of otalgia or otorrhea, and physical examination shows swelling of the ear canal or granulation growth, physicians should consider the possibility of MOE.

Background: Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline., Objective: This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management., Methods: A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review., Results: Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately., Conclusion: This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.

Background: Canine otitis externa (OE) is a common inflammatory disease that is frequently complicated by secondary bacterial and/or yeast infections. The otic microbial population is more complex than appreciated by cytological methods and aerobic culture alone., Hypothesis/objectives: Differences in bacterial and fungal populations of the external ear canal will correlate with specific cytological and culture-based definitions of bacterial and Malassezia otitis., Animals: Forty client-owned dogs; 30 with OE and 10 with healthy ears., Methods and Materials: Prospective study comparing cytological samples, aerobic bacterial cultures and culture-independent sequencing-based analyses of the external ear canal. Subjects with OE included 10 dogs with only cocci [≥25/high power field (HPF)] on cytological evaluation and culture of Staphylococcus spp.; 10 dogs with rods (≥25/HPF) and exclusive culture of Pseudomonas aeruginosa; 10 dogs with only yeast on cytological results morphologically compatible with Malassezia spp. (≥5/HPF)., Results: Staphylococcus was the most abundant taxa across all groups. Ears cytologically positive for cocci had decreased diversity, and all types of OE were associated with decreased fungal diversity compared to controls., Conclusions and Clinical Importance: Cytological and culture-based assessment of the ear canal is not predictive of the diverse microbiota of the ear canal in cases of Pseudomonas or Malassezia otitis. Less abundant bacterial taxa in cases of staphylococcal OE are worth scrutiny for future biological therapy., (© 2020 ESVD and ACVD.)

Objective: To determine association of gender, causative organisms, control of diabetes, facial paralysis, infectious agent, and hearing loss with disease outcome, in terms of six-month improvement of symptoms, static condition or expiry of patients presenting with necroinflammatory otitis externa (NOE)., Study Design: Descriptive study., Place and Duration of Study: ENT Department in collaboration with Pathology Department, KEMU/Mayo Hospital, Lahore from 2016 to 2019.  Methodology: Patients with NOE were inducted. Studied variables included age at presentation, gender, diabetes, glycated hemoglobin (HbA1c) levels, comorbid conditions, facial nerve involvement, hearing loss, CT and biopsy findings, and causative organisms; and their association with outcome was observed with significance at p<0.05., Results: Out of 28 patients, there were 17 males (60.7%) and 11 females (39.3%). Association between gender and survival showed that 41.2% (7) males and 27.3% (3) females survived; and 23.5% (4) males and 1 (9.1%) female expired within six months of diagnosis. Thinning of temporal bone (2/5=40%) was common among the expired patients. Twenty percent (1/5) patients diagnosed with squamous cell carcinoma and 80% (4/5)with granulation tissue (GT) expired (p=0.543) All ten patients (100%) that improved had mild to moderate hearing loss (p <0.001). Among expired group, 80% (4/5) had HBA1c of more than 7 and 20% (1/5) had good control of diabetes. Aspergillus (2/5=40%) and Pseudomonas (1/5=20%) were the commonest among expired patients; Staphylococcus (6/10=60%) and Pseudomonas (3/10=30%) infections were more frequent among the survived (p=0.005)., Conclusion: Previously pseudomonal infection was described as the only causative agent of NOE. This study showed a rising community-acquired disease with Staphylococcus aureus 6/10 (60%) and Pseudomonas 3/10 (30%) infection. Fungal infection is associated with poor survival and death, thus requiring aggressive management. Thinning of temporal bone on CT, uncontrolled diabetes, sever hearing loss and facial paralysis score V/VI were associated with poor outcome of disease. Key Words: Necroinflammatory otitis externa, Pseudomonas aeruginosa. Diabetes, Hearing loss, Facial paralysis, Temporal bone thinning, CT scan.

Background: Otitis Externa is a common inflammatory condition of external ear. It is more common in patients having predisposing conditions like trauma, swimming, patients using hearing aids, certain skin pathologies and immunocompromised patients. Increased humidity in rainy season increases the predisposition to otitis externa., Methods: This descriptive study was carried over the duration of one year in ENT department of Ayub Teaching Hospital, Abbottabad. Patients of all ages and both genders suffering from acute otitis externa were included in the study after taking informed consent. All the information's were recorded in predesigned proforma and then finally evaluated by using SPSS program., Results: The mean age of the patients presenting to us was 39.84±14.48 years (Range 1-78 Years) more commonly in male patients (54.14%). The disease was most commonly seen in rainy season, presenting unilaterally and affecting young adults of age ranging from 31-40 years., Conclusions: Prevalence of otitis externa is more common in humid climate. Precautionary measures should be taken in rainy and humid condition such as avoidance of self cleaning the ear.

Purpose: Pseudomonas aeruginosa is commonly found in suppurative perichondritis, but the significant pathogens in non-abscess perichondritis are unclarified. We aimed to explore the bacterial findings and evaluate the effectiveness of different antibiotic regimes in the treatment of patients with perichondritis., Methods: All patients treated for perichondritis at the two Ear-Nose-Throat Departments in Central Denmark Region (covering 20% of the Danish population) from January 1990 to October 2018 were included., Results: In total, 112 patients with (n = 12) or without (n = 100) abscess were included in the study. Potential pathogens were found in 40 of 55 cultures. P. aeruginosa was recovered in 58% of abscess cases, while Staphylococcus aureus was predominant in non-abscess infections (49%). Eighty-two percent of S. aureus recovered were isolated as heavy or moderate growth. In non-abscess cases, no significant differences in clinical progress (p = 0.65), alteration in antibiotic therapy (p = 0.31), duration of hospitalization (p = 0.65), or frequency of relapse of infection (p = 1.00) or sequelae (p = 0.38) were found between patients treated with antibiotics covering S. aureus vs. P. aeruginosa., Conclusions: Our findings suggest that intravenous antibiotic therapy covering S. aureus is sufficient and appropriate empirical treatment in the majority of patients with non-abscess perichondritis. Antibiotic coverage should be expanded to include P. aeruginosa if the clinical response is disappointing or cultures grow P. aeruginosa. The risks and downsides to this approach seems limited as only a minority of patients suffered (minor) cosmetic sequelae and relapse of infection in our cohort of non-abscess perichondritis patients initially treated with antibiotics not covering P. aeruginosa.

Introduction: Malignant otitis externa (MOE) is a potentially life-threatening infection of the soft tissues of the external ear, quickly spreading to involve the periosteum and bone of the skull base. Treatment includes antibiotics and eventually surgery. Hyperbaric oxygen treatment (HBOT) has been proposed as an adjunctive therapy. However, in the tenth consensus conference, this disease was considered as a non-indication for HBOT. The aim of this study was to evaluate the effectiveness of HBOT in MOE treatment., Methods: Retrospective and observational study was conducted of patients with MOE treated in our centre. Staging of the disease was made according to the clinicopathological classification system., Results: From March 1998 to November 2016, 16 patients were referred. 6% patients were on stage 1 of the disease at the time they were referred, 20% in stage 2, 7% in stage 3a, 13% in stage 3b and 53% in stage 4. Seven (43.75%) patients had VII nerve palsy and three (18.75%) patients had multiple nerve palsy. Average length of symptoms of disease was 5 months (maximum 11 months). Average number of sessions was 33 and the length of hospitalization prior to HBOT (median 90 days) was significantly longer than the time between beginning HBOT and cure (p = 0.028, Wilcoxon signed rank test). There were no fatalities due to MOE and all patients were considered free of disease after HBOT., Conclusion: HBOT was well tolerated and revealed to be a helpful adjuvant treatment in MOE. According to our data, HBOT should be considered for patients who failed conventional treatments and in severe cases.

The Bulldog is a popular companion breed in the UK despite widely reported disease predispositions. This study aimed to characterise the demography, mortality and common disorders of Bulldogs under veterinary care in the UK during 2013. VetCompass collates anonymised clinical data from UK primary-care veterinary practices for epidemiological research. The clinical records of all Bulldogs available in the VetCompass study dataset were reviewed manually in detail to extract the most definitive diagnoses recorded for all disorders that existed during 2013 and for all deaths. Bulldogs comprised 1621 (0.36%) of 445,557 study dogs. Bulldogs increased from 0.35% of the 2009 birth cohort to 0.60% in 2013. Median longevity was 7.2 years, which was lower in males (6.7 years) than females (7.9 years) (P = 0.021). The most prevalent fine-level precision disorders recorded were otitis externa (n = 206, prevalence 12.7%, 95% CI: 11.1-14.4), pyoderma (142, 8.8%, 95% CI: 7.4-10.2) and overweight/obesity (141, 8.7%, 95% CI: 7.4-10.2). The most prevalent disorder groups were cutaneous (n = 463, prevalence: 28.6%, 95% CI: 26.4-30.8), ophthalmological (292, 18.0%, 95% CI: 16.2-20.0), aural (211, 13.0%, 95% CI: 11.4-14.8), enteropathy (188, 11.6%, 95% CI: 10.1-13.3) and upper respiratory tract (171, 10.5%, 95% CI: 9.1-12.1). Provision of an evidence base on the most common disorders and causes of mortality within breeds can support owners, breeders and the veterinary profession to improve health and welfare within these breed., Competing Interests: The authors have declared that no competing interests exist.

Objective: In the Australian Aboriginal population, type 2 diabetes occurs at a much higher prevalence, with a much younger age of onset of the disease and its complications. Despite the clear association with malignant otitis externa, no previous studies have examined malignant otitis externa in this population. This study explores the pattern of malignant otitis externa amongst Australian Aboriginal patients in the Northern Territory., Design: Retrospective case series., Setting: Otolaryngology unit in a tertiary referral hospital in Northern Territory, Australia., Participants: Patients admitted with malignant otitis externa between January 2007 and October 2016 were identified by reviewing case notes. Patients diagnosed with malignant otitis externa based on results from clinical, microbiological and radiological criteria were included., Main Outcome Measures: Complications rates, duration of hospital stay and parenteral antibiotics, age of onset and causative organisms., Results: Nine patients were included. Six were Australian Aboriginal - all from regional centres. The most common causative organism was Pseudomonas aeruginosa. There was a higher-than-expected occurrence of fungal malignant otitis externa (33% of Australian Aboriginal patients), who tended to be younger at diagnosis, had longer hospital stays and had a higher disease-specific mortality. Over half of the patients did not receive follow-up gallium bone scans to monitor disease resolution, reflecting the limitations of rural health care., Conclusion: Malignant otitis externa in the Australian Aboriginal population is a challenging disease with high complication and mortality rates. Their rural and remote distribution is a significant barrier to specialist investigation and care. Providing effective care for this disease requires improved access to high-quality primary health care and tertiary specialist services., (© 2019 National Rural Health Alliance Ltd.)

Otitis externa is the inflammation of the external auditory canal. The disease is common and shows a seasonal variation with a greater incidence in warmer months. Pseudomonas aeruginosa is a common pathogen in otitis externa and in this retrospective study, we show a corresponding seasonal variation in the proportional incidence of P. aeruginosa isolates from otitis externa in South East England. In total 7770 patients were diagnosed with otitis externa over a period of 9 years from January 2008 to December 2016. P. aeruginosa was isolated from 2802 patients (proportional incidence of 36%). Incidence was higher in the months of August, September and October and in patients between 5 and 15 years of age. We postulate a combination of increased contact with water during warm weather in the holiday season and increased rainfall in the preceding season as a putative mechanism for the seasonal trends.

Objective: To characterize factors that affect outcomes for patients with malignant otitis externa (MOE)., Methods: Retrospective review of inpatients with MOE was performed. Patient demographics, comorbid conditions, complications, procedures, and mortalities were analyzed., Results: A total of 786 patients with MOE were identified. The mean hospitalization length of stay (LOS) was 18.6 days (SD = 19.7). The overall mortality rate was 2.5% (n = 20), and complication rate was 4.3% (n = 34). Increasing age significantly and positively correlated with the incidence of MOE (r = 0.979, P < .0001). Factors that were associated with an increased rate of mortality were sepsis (odds ratio [OR] = 18.5; ES = 0.94; 95% CI, 0.47-1.42), congestive heart failure (OR = 3.1; ES = 0.42; 95% CI, 0.02-0.82), weight loss (OR = 10.2; ES = 1.23; 95% CI, 0.61-1.85), and coagulopathy (OR = 8.8; ES = 1.84; 95% CI, 0.91-2.77). Surgical intervention was performed in 19.2% (n = 151) of patients. Facial nerve involvement was present in 15.5% (n = 122) of patients and was associated with a significantly longer LOS of 12.9 days (SD = 19.6; ES = 0.21; 95% CI, 0.03-0.41)., Conclusions: This large multi-institutional database study of MOE demonstrates that several patient factors impact the LOS and mortality. Patients at risk for unfavorable outcomes include the elderly, male gender, comorbidities, or cranial nerve involvement.

Malassezia pachydermatis causes infections of the skin and mucous membranes, especially in animals. It is commonly accepted that symptom manifestation depends on the physiological status of the host (different metabolic, hormonal, and immunological disorders). However, it should be considered whether distinct strains of M. pachydermatis could have different pathogenic potential and maintain opposite relations with the host, such as commensalism or parasitism. The scope of this study was to explore the population structure, genetic diversity, and phylogenetic relationships of M. pachydermatis strains isolated from dogs with clinical symptoms of otitis externa and from healthy dogs in order to investigate their relationships and evolutionary history. For all tests, a group of 30 strains derived from dogs with otitis externa and 34 strains from healthy dogs were used. The level of genetic diversity was initially assessed by polymerase chain reaction (PCR)-based random amplification of polymorphic DNA (RAPD-PCR), whereas evolutionary history was assessed by comparison of the nucleotide sequences of the internal transcribed spacer ITS1 region of nuclear rDNA. RAPD-PCR fingerprinting revealed a high level of genetic polymorphism in both tested groups (85% of unique profiles), but clinical isolates usually grouped together with other strains from otitis externa cases. Sequencing analysis identified 17 distinct genotypes with 59 polymorphic sites within both populations; however, putatively virulent strains were more closely related, indicating a probable correlation between the genotype and the virulence potential. Therefore, the hypothesis that M. pachydermatis virulence depends solely on the host's properties should be reconsidered including evolutionary and epidemiological data.

Objective: To identify epidemiological and pathophysiological factors, and treatment strategies, in external auditory canal cholesteatoma and benign necrotising otitis externa., Methods: A retrospective case study was conducted of patients suffering from external auditory canal cholesteatoma and benign necrotising otitis externa admitted to tertiary hospitals, in the Capital Region of Denmark, over a five-year period., Results: Eighty-three patients (95 ears) with external auditory canal cholesteatoma or benign necrotising otitis externa were identified. A minimum incidence rate of 0.97 per 100 000 inhabitants per year was demonstrated. Sixty-eight per cent of cases had a history of smoking. Most lesions (74 per cent) were localised in the floor of the ear canal. Treatment time was 3.2 months for patients who had surgery and 6.0 months for those who received conservative treatment., Conclusion: It is suggested that external auditory canal cholesteatoma and benign necrotising otitis externa are in fact the same disease, and therefore the diagnosis of external auditory canal cholesteatoma should be changed to benign necrotising otitis externa. Microangiopathy has a leading role in the aetiology. Surgery should be conducted in most cases.

Objectives Feline otitis externa is a multifactorial dermatological disorder about which very little is known. The objective of this study was to map the prevalence of external ear canal disorders and the pathogens causing otitis externa in stray cats roaming around the region of Ghent, Belgium. Methods One hundred and thirty stray cats were randomly selected during a local trap-neuter-return programme. All cats were European Shorthairs. This study included clinical, otoscopic and cytological evaluation of both external ears of each cat. Prospective data used as parameters in this study included the sex, age and body condition score of each cat, as well as the presence of nasal and/or ocular discharge, and the results of feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) Snap tests. Results Remarkably, very few (sub)clinical problems of the external ear canal were found in the stray cat population. Malassezia species was by far the most common organism found in the external ear canals of the 130 stray cats. A total of 96/130 (74%) cats were found to have Malassezia species organisms present in one or both ears based on the cytological examination. No correlation was found between the parameters of sex, age, body condition score, the presence of nasal and/or ocular discharge and FIV and FeLV status, and the presence of parasites, bacteria or yeasts. Conclusions and relevance This study provides more information about the normal state of the external ear canal of stray cats. The ears of most stray cats are relatively healthy. The presence of Malassezia species organisms in the external ear canal is not rare among stray cats.

Objectives/hypothesis: Malignant otitis externa (MOE) is a rare disorder that is not well studied in the inpatient setting. The Nationwide Inpatient Sample (NIS) database was utilized to analyze characteristics and predischarge outcomes of hospitalized MOE patients., Methods: MOE hospitalizations were identified in the 2002 to 2013 NIS. Patient demographics, length of hospital stay, hospital charges, concomitant diagnoses, treatment-related procedures, complications, and in-hospital mortality rates were examined, with comparisons made among age cohorts and between diabetes mellitus (DM) and non-DM groups., Results: A total of 8,300 cases of inpatient MOE were identified, with elderly DM patients compromising 22.7% of cases. Compared to adults, elderly patients had more inpatient procedures, longer hospitalizations (6.0 vs. 4.3 days), higher hospital charges ($26,712 vs. $19,047) (all P < 0.001), greater odds of in-hospital complications, and in-hospital mortality (odds ratio 14.435, 95% confidence interval 5.313-39.220). Adult/elderly patients with DM had more comorbidities, longer hospital stays (5.5 vs. 4.0 days), and higher hospital charges ($25,118 vs. $17,039) (all P < 0.001) than non-DM patients. However, DM was not associated with greater in-hospital mortality rates (0.6% vs. 0.5%; P = 0.640). Compared to the adult/elderly cohort, pediatric patients had higher rates of nonelective admissions (19.8% vs. 14.5%), shorter hospital stays (2.9 vs. 4.9 days), and lower hospital charges ($8,876 vs. $21,672) (all P < 0.05)., Conclusion: Elderly diabetic patients made up a smaller fraction of hospitalized MOE cases than anticipated. Elderly patients had greater in-hospital complications and mortality. Diabetes mellitus in adult/elderly patients was not associated with increased mortality. Pediatric patients fared well with low complications rates and no instances of in-hospital mortality., Level of Evidence: 2C. Laryngoscope, 127:2328-2336, 2017., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To determine the prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa., Design: Cross-sectional retrospective review of otoscopy results obtained during a school health screening campaign conducted between March and June 2015. Descriptive statistics through percentages and frequency tables were used to analyse the data. Logistic regression was used to determine associations between age, gender and pathologies observed., Study Sample: Medical folders of 1089 pupils., Results: Forty-nine percent had normal otoscopy results. A significant 36% (n = 392) had impacted cerumen. Furthermore, 45% of those with impacted cerumen were bilaterally impacted. Additionally, 4% presented with foreign bodies and a further 8% had otitis externa and otitis media. The remaining 3% had tympanic membrane perforations. The odds of developing outer and middle ear pathologies were higher in pupils below 6 years of age (p = 0.046)., Conclusion: This study highlights a high prevalence of outer and middle ear pathologies in paediatrics in Limpopo and therefore recommends comprehensive baseline and periodic screenings; to identify children with outer and middle ear pathologies and need further management, and consequently prevent the complications of these pathologies. Additionally, this report highlights a rising need for large-scale research to provide comprehensive analysis of these pathologies.

Introduction: Although otitis externa (OE) is a common disease, data related to (military) divers are limited. This study aimed to determine the incidence of OE in military divers during their initial training. We also wished to consider seasonal influences on incidence and whether early detection increases completion of the diving course., Methods: From January 2011 to October 2016 the Royal Netherlands Navy Diving School trained 189 divers. Up to December 2015 we used the training records for the analyses. From January 2016 onward all divers were prospectively screened. Pearson's chi-squared 2 and Fisher's exact tests were used to analyse the data., Results: In the 162 included divers, 30 cases of OE were identified. The incidence in 2016 was significantly higher than in 2011-2015 (17/35 (49%) versus 13/127 (10%), P < 0.001). Almost all cases developed after three weeks of diving. No influence of season was found (P = 0.354). Early diagnosis and treatment of OE does not seem to affect completion of diving courses (P = 0.28). Only in three cases did a diver have to discontinue the course due to OE., Discussion: This study suggests that OE is more frequent among military divers than earlier reported, most likely caused by prolonged water exposure. Diving activities can often be continued with standard topical treatment.

Background: American Cocker Spaniels are overrepresented among breeds that require surgery as a treatment of end-stage otitis externa. However, the prevalence of otitis externa (OE) in this breed remains unknown. We reviewed the year 2010 medical records of 55 private veterinary clinics in Finland to determine the prevalence of OE in American Cocker Spaniels compared with English Cocker and English and Welsh Springer Spaniels. An American Cocker Spaniel owner questionnaire was designed to identify potential risk factors for end-stage OE., Results: From the medical records of 98,736 dogs, the prevalence of OE was highest in Welsh Springer Spaniels (149 out of 468, 31.8%, [95% confidence interval 27.6-36.0]), followed by American Cocker (89/329, 27.0%, [22.2-31.7]), English Springer (96/491, 19.6%, [16.1-23.1]) and English Cocker Spaniels (231/1467, 15.7%, [13.8-17.6]). The mean number of OE episodes in ear-diseased dogs and the number of ear surgeries were highest in American Cocker Spaniels. Owner questionnaires were received for 151 American Cocker Spaniels, 85 (56%) of which had suffered from OE. In 47% (40/85) of these dogs, OE occurred without concurrent skin lesions, 46% (33/72) displayed the first signs of OE before 1 year of age. In 24% (20/85) of the dogs, the signs of OE recurred within 1 month or continued despite treatment, 16% (14/85) required surgery (n = 11) or were euthanized (n = 5; 2 of the operated dogs and 3 others) due to severe OE. The onset of OE before the age of 1 year significantly increased the risk (OR 3.8, 95% CI 1.1-13.6) of end-stage OE., Conclusions: The prevalence of OE in American Cocker Spaniels in Finland was higher than previously reported in Cocker Spaniels, but the highest prevalence of OE was found in Welsh Springer Spaniels. Compared to the other Spaniels, OE was more often recurrent and more frequently surgically managed in American Cocker Spaniels. Based on the questionnaire, early onset (<1 year) of OE increased the risk of end-stage OE. In American Cocker Spaniels, OE requires an intensive approach from the first treatment, and prevention of recurrence should be emphasised. The causes and treatment of OE in this breed warrant further study.

From May 2008 to December 2013, 320 cases of otitis externa were diagnosed among 2012 dogs undergoing routine physical examinations at Celtic Creatures Veterinary Clinic, Sydney River, Nova Scotia for a diagnosis frequency of 15.9% [95% confidence interval (CI): 14.3% to 17.6%]. Twenty-four percent of these dogs exhibited 1 or multiple recurrences despite initial treatment with topical antimicrobial/anti-inflammatory solutions. The frequency of diagnosis was significantly higher in breeds with pendulous ears, but was not affected by ear hairiness. There were no seasonal patterns in the frequency of diagnosis. In clinical examination of 60 dogs with otitis externa, bacteria were evident in 47% of infections. Of 10 genera cultured, Staphylococcus spp. and diptheroids were most common. In this study, analysis of clinical records provided insights into the local prevalence of otitis externa and the efficacy of treatment in routine clinical situations.

Introduction: Malignant external otitis is a necrotizing infection, which extends from the squamous epithelium of the ear canal to the adjacent tissue. The objective of the study was to investigate its incidence and other epidemiological data in Spain, reporting the largest case series to date., Methods: A descriptive, retrospective study of the Spanish population was carried out using the minimum basic data set (MBDS) based on data of patients admitted to hospitals in the 2008-2013 period. Patients whose diagnosis (principal or secondary) at discharge was encoded as 380.14 (malignant external otitis), according to ICD-9-CM, were included as cases. The Spanish incidence rate was calculated for all its communities and provinces, as well as by season and mortality., Results: A total of 355 patients (302 as principal diagnosis and 53 as secondary) were diagnosed. The incidence rate was 1.30 (95% CI, 1.17 to 1.44) per 106 inhabitants and year, although there were variations among geographical areas. The median age of cases with main diagnosis was 74 years (range 10-95 years). The predominant age group was in patients over 84 years old (19.3 cases per 10 6 inhabitants and year). The incidence was higher in men and the male-female relative risk was 2.4. Diabetes was present in 74.6% of patients. The diagnosis was predominant in the last quarter of the year. The gross in-hospital mortality rate was 3.7%., Conclusions: Malignant external otitis is seen mostly among male elderly and diabetic patients. The incidence and mortality rate are low in Spain., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

We reviewed 25 cases of patients diagnosed with necrotizing otitis externa in our tertiary university-affiliated medical center between 2009 and 2015. Mean overall hospitalization duration was 14.52days, 95% of the patients showed specific seasonal incidence. Mean duration of symptoms prior to hospitalization was 6weeks and the duration correlated with outcome. Only 8% of the patients presented with cranial neuropathies; however, this presentation correlated with adverse outcome. Pseudomonas aeruginosa was the main causative organism (50%), with a 30% multidrug-resistance rate. A high rate (35%) of fungal pathogens was noted. Seventeen patients (68%) were eventually operated; however, only 5 patients needed extensive surgery under general anesthesia. Computed tomography (CT) evidence of adjacent structures' involvement correlated with adverse outcome. Eighty percent of our patients improved clinically. The overall death rate was 12% and the disease-related mortality rate was 8%. Our findings state the importance of limited surgical intervention and microbiologic cultures in disease treatment. This is particularly important in patients with cranial neuropathies and CT finding of adjacent structural involvement that correlate with adverse prognosis. A rising pseudomonal antibiotic resistance and fungal infections may challenge antibiotic treatment in the future., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Malignant external otitis (MEO) is an aggressive infection, primarily affecting elderly diabetic patients. It begins in the external ear canal and spreads to adjacent structures. This study investigated the clinical characteristics of patients diagnosed and treated for MEO and analyzed factors affecting patient outcomes., Study Design: Historical cohort., Setting: Tertiary medical center., Methods: Medical records of all patients diagnosed and treated for MEO from 1990 to 2013, were retrospectively reviewed. Clinical features, laboratory, imaging and outcomes were analyzed., Results: 88 patients were included, mean age was 73±11.5years, 61 (69%) were male. Of these, 75% had diabetes. Mean follow-up was 60months. The most common presenting symptoms were otalgia (89%), external ear canal edema (86%) and otorrhea (84%). Pseudomonas aeruginosa was isolated in 61% of ear cultures. All patients were treated with antibiotics, 22% had surgery and 8% hyperbaric oxygen. Overall survival rate was 38% in 5years, with disease specific mortality 14%. DM, facial nerve palsy, positive CT scan and age above 70 were found to correlate and predict disease-specific mortality., Conclusions: MEO carries a grave prognosis. The presence of two or more of the following features, DM, facial nerve palsy, positive CT scan and age above 70, predicts poor outcome, and highlights the need for prolonged, vigorous treatment., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Malassezia (M.) pachydermatis is the lipophilic yeast, which is normally present on the skin and in the ear canal of dogs but under certain conditions it may cause dermatitis and otitis. There is less known about the occurrence of lipid-dependent Malassezia species in dogs. The aim of this study was to detect whether lipid-dependent yeasts are part of the normal microflora in dogs. Two groups of animals were selected for comparison. The group of healthy dogs contained samples of 118 individuals and the group of dogs with cutaneous lesions or otitis externa comprised 328 dogs. The isolates of Malassezia were identified by using genotypic methods that allow the precise identification. M. pachydermatis was the most frequently isolated species in this study (121 isolates). Only four isolates were identified as M. furfur and one isolate was identified as M. nana.

Background: Pseudomonas aeruginosa is associated with otitis and pyoderma in dogs and is frequently resistant to several antimicrobial drugs. Resistance genes can be carried by integrons with quinolone resistance mainly due to mutations in DNA topoisomerases II and IV., Objective: To evaluate the antimicrobial susceptibility, integron carriage, and gyrA and gyrB mutations in P. aeruginosa isolates from canine otitis and pyoderma., Animals: One hundred and four P. aeruginosa strains isolated from dogs with otitis externa (n = 93) and pyoderma (n = 11)., Methods: Antimicrobial susceptibility against 16 antibacterial agents was evaluated through agar diffusion tests. Integron carriage, class and gyrA and gyrB mutations were analysed by PCR, restriction fragment length polymorphism (RFLP)-PCR and genetic sequencing assays., Results: Isolates were mostly resistant to enrofloxacin (72.2%) and ticarcillin (59.7%). Lower resistance to ciprofloxacin (7.7%), tobramycin (3.8%) and polymixin B (0.0%) was detected. Ten (9.6%) multidrug-resistant (MDR) strains were detected. Eight (7.7%) strains carried class 1 integrons and this was associated with MDR (three isolates, P ≤ 0.05). Five of the integron-carrying strains exhibited aminoglycoside resistance genes. Mutations of gyrA and gyrB were observed in 10 isolates, seven of them resistant to all fluoroquinolones tested., Conclusions and Clinical Importance: Enrofloxacin and ticarcilin resistance was widespread in P. aeruginosa isolated from dogs in Brazil. Pseudomonas aeruginosa carrying integrons may present a significant challenge for treatment., (© 2016 ESVD and ACVD.)

Objective: To determine if providers prescribe more affordable topical antibacterial therapy for patients who are economically disadvantaged or come from economically disadvantaged communities., Study Design: Prescription drug database review., Setting: Large academic hospital network., Subjects and Methods: Ototopical prescription records of 2416 adults and children presenting with acute and chronic otologic infections from 2009 to 2013 were reviewed. Prescription, patient, provider, and institution variables including diagnosis, prescription type, demographics, health insurance status, healthcare provider type and setting were analyzed., Results: Otitis externa and acute otitis media were the most common diagnoses. Non-OHNS (Otolaryngology-Head and Neck Surgery) providers served 82% of all patients. OHNS providers prescribed proportionally less fluoroquinolone, and more brand-name antibiotics compared to non-OHNS providers. Adults were more likely to receive a non-fluoroquinolone antibiotic and a generic prescription versus pediatric patients. Patients who self-identified as 'white' ethnicity received proportionally more fluoroquinolone prescriptions than patients who identified as 'non-white,' but there was no difference in provider type. The proportion of fluoroquinolone prescriptions was significantly higher in patients from low-poverty counties, however poverty level was not associated with patients seeing a particular provider type. The majority of our patients had commercial insurance, followed by Medicaid. Medicare patients had the lowest proportion of fluoroquinolone antibiotic prescriptions, and were less likely to receive fluoroquinolone prescriptions versus commercial insurance. Non-insured patients received proportionally more generic versus brand prescriptions than insured patients., Conclusion: Our results indicate potential provider, patient demographic, and financial factors producing considerable variability in the prescribing patterns for topical antibiotics for common otologic infections., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both this condition has been reported to be found in all age groups. The aims and objectives were, study/determine the prevalence of Otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna, study the pattern of presentation among patients with otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna, and evaluate the choice of drug treatment for otitis externa in the specialist otolaryngology clinic in National Ear Care Center Kaduna., Methods: Data of patients diagnosed with otitis externa between January 2009 and March 2013 were extracted from the recorded cases of ear disease seen within the same period. The ages, sex/ gender, complains(symptoms), duration of symptoms, clinical examination findings, diagnosis, mode of drug treatment, number of visits and complication records were extracted from the case notes of the patients and analyzed descriptively using SPSS (Statistical package for Social Sciences) version., Results: Out of 13,328 cases of ear diseases seen within the period under review, 133 cases were diagnosed with otitis externa across all age groups. Hospital prevalence stands at 1.0%. There were 81(60.9%) males and 52(39.1%) females in ratio 1.5:1. Children age 0-15 constitute 55(41.3%) while young adults and adults were 78(58.6%). The minimum age at presentation was one year, while maximum age was 64 years. Mean age was 24 years with a standard deviation of ± 1.12 Years. Ear pain as only presenting symptom was the major complain found in this study accounting for 68(51.1%). Acute diffuse otitis externa was the commonest diagnosis accounting for 101(75.9%) and associated clinical findings ranging from tragal tenderness, hyperaemia and oedema of ear canal in 57 (54.9%). Ear swab was not routinely done and only 6(15.8%) of the discharging ears had microscopy done and the organisms were Pseudomonas spp and klebsiella. Empirical treatment was the commonest treatment modality and about 91% of the patients had complete symptom resolution by second visit. Complication was observed in only one case of necrotizing otitis externa who was retro-viral positive., Conclusion: Otitis externa accounted for small fraction of cases seen in our clinic (1%). Acute diffuse otitis externa is the commonest diagnosis made with symptoms ranging from ear pain, ear discharge, hearing loss and itchiness. Most patients were treated empirically with significant success within first two visits. No major complication was recorded within the period under study.

Background: Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed., Methods: A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated., Results: There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421)., Conclusion: Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

Previous reports describing the prevalence of ear diseases in dogs have primarily been based on dogs presenting with clinical signs of disease. The prevalence of subclinical ear disease remains unknown. The purpose of this cross-sectional retrospective study was to describe the prevalence of lesions consistent with middle and external ear disease in dogs presented for multidetector computed tomography (CT) of the head and/or cranial cervical spine at our hospital during the period of July 2011 and August 2013. For each included dog, data recorded were signalment, CT findings, diagnosis, and treatment. A total of 199 dogs met inclusion criteria. Nineteen dogs (9.5%) were referred for evaluation of suspected ear disease and 27 dogs (13.5%) had histories or physical examination findings consistent with otitis externa. A total of 163 dogs (81.9%) had CT lesions consistent with external ear disease (i.e. ear canal mineralization, external canal thickening, and/or narrowing of the external canal). Thirty-nine dogs (19.5%) had CT lesions consistent with middle ear disease (i.e. soft tissue attenuating/fluid material in the tympanic bullae, bulla wall thickening or lysis, and/or periosteal proliferation of the temporal bone). Findings from this study indicated that the prevalence of external and middle ear disease in dogs could be higher than that previously reported., (© 2014 American College of Veterinary Radiology.)