External ear canal exostectomy: influence of surgeon’s experience on 3-years recurrence and occurrence of complications

Background External ear canal exostoses are usually bilateral and broad-based, secondary to external ear canal chronic cold exposure, especially water. Objectives The objectives were to analyze the influence of the surgeon’s experience on the 3-year recurrence and on the complication. We also studied the influence of prolonged exposure to cold water on the incidence of recurrence. Material and Methods This monocentric retrospective study included 98 ears operated for canalplasty between 2009 and 2016 by nine different operators including one senior, a junior, and seven beginner surgeons. Senior, Junior, and Beginner groups were compared. Results 3-year recurrence rate was higher in the Beginner and Junior groups than in the Senior group (69% and 38% vs 18%, P = .001). Although there was a difference between the Beginner (69%) and Junior (38%) groups, it was not significant ( P = .407). Among the recurrences, 48% had continued exposure to cold water while only 7% of the ears without recidivism were still exposed ( P < .001, OR = 1.25 [4.4; 36.1]). The complication rates were similar between groups, concerning pain (8% vs 30% vs 12%), per procedure perforation (17% vs 10% vs 16%), scarring disorders (25% vs 20% vs 13%), and osteitis (8% vs 0% vs 1%). Hearing was unaffected. Conclusions This is the first study evaluating the risk of recurrence of external ear canal exostoses after canalplasty based on the surgeon’s experience. This risk of recurrence seems to decrease with the surgeon’s experience. There was no difference in complication rates.

Multicentre clinical trial to evaluate microbial spectrum in acute diffuse otitis externa in the residents of Ukraine

Introduction: Acute diffuse otitis externa is a spread skin inflammation of the external ear canal of the bacterial origin. It is reported at an incidence of up to 10% among healthy population of all age groups. Treatment is known to be based on the empirical approach for prescribing topical antibacterials. Therefore studying the bacterial spectrum of otitis externa causative agents is of great value in terms of relevant antimicrobial therapy. Aim: The objective of the study was to evaluate microbial spectrum in diffuse otitis externa in patients – residents of Ukraine. Materials and methods: Four hundred and ninety-three out-patients diagnosed with acute diffuse otitis externa were enrolled. Microbial composition of the external ear canal microflora was tested and aetiologically relevant titres of colony-forming units (CFU) were determined. Criteria for evaluation: titres of 104 to 106 CFU and >106 CFU were considered aetiologically relevant. titres of <104 CFU were considered aetiologically nonrelevant. Results and discussion: In the majority of cases of acute diffuse otitis externa, infection with Staphylococcus aureus in aetiologically relevant titres is reported in 53.2% and Pseudomonas aeruginosa in 23.6%. Cases of multimicrobial infection predominantly involving Gram-negative flora were also reported in 27.9%; each of them results in no more than 2 to 3% of otitis externa. Titres of Candida spp. (3.2%) and Staphylococcus epidermidis (2.6%) were measured as aetiologically non-relevant. Conclusion: common microbial pathogens in acute diffuse otitis externa in patients of the Ukrainian population are Staphylococcus aureus and Pseudomonas aeruginosa. Multimicrobial associations predominantly involving Gram-negative flora, which do not exceed 2 to 3% of cases. Fungal infections are a rare cause of otitis externa.

Otitis externa: the role of the veterinary nurse

Otitis externa is a common problem in primary care veterinary practice. While the diagnosis and treatment of disease is the responsibility of the attending veterinary surgeon, the veterinary nurse, as an integral part of the veterinary surgeon-led team, plays an important role in the investigation and management of disease. Veterinary nurses are more than capable of assessing the external ear canal both macroscopically and cytologically to help the veterinary surgeon to make a diagnosis. Client facing nurse communications can help with the administration of therapy, provide owner support during treatment to increase compliance and help with follow-up assessments.

Prevalence and in vitro antifungal susceptibility of commensal yeasts in the external ear canal of cats

Background Lifestyle factors such as hair length, the frequency of ear cleaning and bathing, age, cat rearing, and sex may contribute to opportunistic yeast infections in the external ear canal of cats. This study aimed to determine the prevalence of commensal yeast organisms in cats’ external ear canals, evaluate their predisposing lifestyle factors, and test the susceptibility of Malassezia pachydermatis to antifungal agents. Results A total of 53 cats (33 male and 20 female) seronegative for feline leukemia virus and feline immunodeficiency virus were enrolled in this study. Their mean age (± standard deviation) was 6.04 (± 3.49) years. Fungal cultures and polymerase chain reaction tests were performed to identify the yeast species derived from the external ear canal. The association between lifestyle factors and the presence of M. pachydermatis was evaluated using Fisher’s exact test. The susceptibility of M. pachydermatis to antifungal agents was also analyzed. M. pachydermatis was the most frequently recovered yeast species, with a prevalence of 50.94 % (95 % confidence interval [CI]: 36.84–64.94 %). There was an association between hair length and a positive culture for M. pachydermatis (p = 0.0001). The odds of a negative culture for M. pachydermatis among short-haired cats was 11.67 (95 % CI, 3.22–42.24) times higher than that among long-haired cats (p = 0.0002). There was also an association between the frequency of ear cleaning and the presence of M. pachydermatis (p = 0.007). The odds of a negative culture for M. pachydermatis in cats that were receiving ear cleaning at intervals of ≤ 2 weeks was 5.78 (95 % CI, 1.67–19.94) times greater than that of cats receiving ear cleaning at intervals greater than 2 weeks or never (p = 0.0055). Ranges of minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations for itraconazole, ketoconazole, miconazole, and terbinafine against M. pachydermatis were ≤ 0.063–4 and ≤ 0.063–≥32, ≤ 0.063–8 and 0.125–≥32, ≤ 0.063–≥32 and 0.5–≥32, and ≤ 0.016–1 and 0.125–8 µg/ml, respectively. Conclusions M. pachydermatis was the most commonly identified yeast organism in the external ear canal of healthy cats. Hair length and the frequency of ear cleaning played a role in the colonization of M. pachydermatis. The M. pachydermatis isolates had various MIC levels for common fungicides.

Clinical health markers in dogs fed raw meat based or commercial extruded kibble diets

The interest and demand for healthy and less processed foods for people has been mirrored in the pet industry, with an explosion of alternative diets available. Several non-traditional feeding methodologies including raw meat based diets (RMBD) are believed by many dog owners to be superior to traditional extruded commercial dog foods. Despite the strong opinions, limited data are available comparing objective health measures among healthy dogs fed using different methods of diet preparation. Therefore, we compared health markers in client owned dogs fed a RMBD to markers in dogs fed a high quality, extruded kibble. We hypothesized that healthy adult dogs fed RMBD would show differences in biochemical and hematological parameters and improved clinical health scores (e.g.,dental, external ear canal and integument scores) compared to dogs fed a kibble diet. A cross-sectional observational study was performed comparing hematology, serum biochemistry, urinalysis management history and clinical health scores in healthy client-owned dogs reported as fed RMBD (n=28) or kibble (n=27) for &gt; 1 year. Dental, external ear canal and integument health scores were assigned by a single veterinary evaluator blinded to feed group, using a scale where 0 was normal and 3 was most severely affected. Spearman correlation coefficient (rs) was calculated to assess the strength and direction of the relationship of biochemical outcomes with age and BCS, while analysis of variance was used to determine if biochemical analytes differed by breed or gender. Biochemical data were analyzed using multiple linear regression models, adjusting for the covariates gender, breed, age and BCS. A composite clinical health score, CCS= 9- (dental score + otitis score + integument score), was compared between feeding groups using Mann Whitney test. Serum alkaline phosphatase activity (P&lt;0.001) and globulin concentration (P&lt;0.001) was lower, while lymphocyte count (P&lt;0.05) was higher in dogs fed RMBD. No differences were found in urinalysis between diet groups. Dogs fed RMBD showed a slight improvement in CCS compared to kibble fed dogs (CCS: P=0.03). Owner management significantly differed with greater likelihood of management interventions including dietary supplements and sporting activities in the RMBD group. Further work is needed to specifically determine the impact of diet processing and nutrient content on canine health.

Preoperative and Intraoperative Culture Results of Patients with Chronic Otitis Media; Is Culture Swab Reliable?

Objective: The aim of this study was to analyze the culture antibiogram results of samples obtained directly from the middle ear and/or mastoid cells in the operating room, and from the external auditory canal in the outpatient. Methods: This study was conducted between 2016-2018 in Microbiology and Otorhinolaryngology Department. Swab cultures were obtained through the external ear canal preoperatively in outpatients. Middle ear swabs and mastoid granulation tissue were collected intraoperatively, respectively. Demographic datas, bacterial identifications and antibiotic susceptibilities were compared in both groups. Results: Two hundred thirty eight patients with chronic otitis media were enrolled in the study. Out of the 238 cases, 86 patients had negative culture results. P. aeruginosa (n=44), Coagulase Negative Staphylococcus (n=33), S. aureus (n=27), Proteus mirabilis (n=16) and E. coli (n=10) were the most common grown bacteria in both groups. Most common identified groups were Gram-positive bacteria (n=92), non-fermenter Gram-negative bacteria (n=55) and Enterobactericeae (n=42). Gram-positive cocci were higher in outpatient group, whereas Enterobactericeae were higher in intraoperative group (p<0.05). Antibiotic susceptibilities of P. aeruginosa and S. aureus were found to be lower especially in the preoperative group (p <0.05). Conclusion: P. aeruginosa was the most common bacteria in both preoperative and intraoperative cultures and high ciprofloxacin resistance of the isolates were remarkable. Although contamination is an issue in samples collected from the external ear canal of outpatients using cotton swabs, similar microorganisms grew in outpatient and intraoperative cultures