Ear microbiota and middle ear disease: a longitudinal pilot study of Aboriginal children in a remote south Australian setting

Background Otitis media (OM) is a major disease burden in Australian Aboriginal children, contributing to serious long-term health outcomes. We report a pilot analysis of OM in children attending an outreach ear and hearing clinic in a remote south Australian community over a two-year period. Our study focuses on longitudinal relationships between ear canal microbiota characteristics with nasopharyngeal microbiota, and clinical and treatment variables. Results Middle ear health status were assessed in 19 children (aged 3 months to 8 years) presenting in remote western South Australia and medical interventions were recorded. Over the two-year study period, chronic suppurative OM was diagnosed at least once in 7 children (37%), acute OM with perforation in 4 children (21%), OM with effusion in 11 children (58%), while only 1 child had no ear disease. Microbiota analysis of 19 children (51 sets of left and right ear canal swabs and nasopharyngeal swabs) revealed a core group of bacterial taxa that included Corynebacterium, Alloiococcus, Staphylococcus, Haemophilus, Turicella, Streptococcus, and Pseudomonas. Within-subject microbiota similarity (between ears) was significantly greater than inter-subject similarity, regardless of differences in ear disease (p = 0.0006). Longitudinal analysis revealed changes in diagnosis to be associated with more pronounced changes in microbiota characteristics, irrespective of time interval. Ear microbiota characteristics differed significantly according to diagnosis (P (perm) = 0.0001). Diagnoses featuring inflammation with tympanic membrane perforation clustering separately to those in which the tympanic membrane was intact, and characterised by increased Proteobacteria, particularly Haemophilus influenzae, Moraxella catarrhalis, and Oligella. While nasopharyngeal microbiota differed significantly in composition to ear microbiota (P (perm) = 0.0001), inter-site similarity was significantly greater in subjects with perforated tympanic membranes, a relationship that was associated with the relative abundance of H. influenzae in ear samples (rs = − 0.71, p = 0.0003). Longitudinal changes in ear microbiology reflected changes in clinical signs and treatment. Conclusions Children attending the ear and hearing clinic in a remote Aboriginal community present with a broad spectrum of OM conditions and severities, consistent with other remote Aboriginal communities. Ear microbiota characteristics align with OM diagnosis and change with disease course. Nasopharyngeal microbiota characteristics are consistent with the contribution of acute upper respiratory infection to OM aetiology.

ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018 Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia. Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

EFFICACY OF PERMEATAL ENDOSCOPIC MYRINGOPLASTY IN INACTIVE (MUCOSAL) CHRONIC OTITIS MEDIA

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020. Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17. Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% & in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was........

Two New Species of Pristimantis (Anura: Strabomantidae) from Amazonas Department in Northeastern Peru

We describe two new species of terrestrial-breeding frogs in the genus Pristimantis from the Andes of northeastern Peru, Amazonas Department. Both species share several characters with other congeners from northern Peru, such as the presence of prominent conical tubercles on their eyelids and heel, prominent conical tubercles along the outer edge of the tarsus, and discs on fingers and toes widely expanded. However, both species can be diagnosed from morphologically similar Pristimantis in the region. Pristimantis kiruhampatu has axillae, groins, and hidden surfaces of hindlimbs that are cherry with white minute flecks, tympanic membrane and tympanic annulus evident, conical tubercles along the edge of snout and outer edge of tibia, and \/ shaped folds in the scapular region. Pristimantis paulpittmani has yellow or dirty cream groins and hidden surfaces of hindlimbs, whitish cream irises with scattered dark brown reticulations, and a thin vertical dark brown streak at the middle of the eye, snout subacuminate with a conical tubercle at the tip, and lacks a tympanic annulus and membrane. Additionally, we provide a short description of the advertisement call of P. kiruhampatu.

Ear Wax and its Impaction: Clinical Findings and Management

Cerumen, sometimes known as "earwax," is a natural material that cleans, coats, and smooths the external auditory canal. It is the most common cause of ear canal obstruction. While cerumen blockage of the ear canal is usually painless, it can result in a variety of implications, for example, loss of hearing, tinnitus, overflowing, itching, otalgia, discharge, odour, and cough. Ear wax becomes a concern only when it causes hearing loss or other ear-related ailments. Cerumen build-up can arise for various causes, including an inability to self-clear, overproduction or underproduction of its essential components due to delayed skin movement, or mechanical difficulties such as usage of cotton buds or hearing aids. Wax can obstruct the understanding and view of the tympanic membrane and must be gone for investigative purposes or to take imprints before installing hearing support or creating earplugs. Cerumen impaction is usually innocuous; however, it might be associated with more significant symptoms. The removal of affected cerumen is typically regarded safe. However, as eardrum tear, canal laceration, and unsuccessful ear wax elimination. These dangers can be reduced by recognizing risky individuals and customising care measures to their specific needs. All common cerumen removal strategies are Cerumenolytics (ear wax emollient agents), irrigation, and manual elimination. It is also prudent not to interfere if asymptomatic individuals and tympanic membrane visualization are not required.

Surgical results and factors affecting outcome in patients with fat-graft myringoplasty

Objectives: We evaluated the closure rate after fat-graft myringoplasty (FGM) of perforations differing in size and location. We explored whether patient’s factors and the FGM surgical technique influenced surgical outcomes. Methods: We retrospectively studied patients with tympanic membrane perforations who underwent FGM from March 2015 to March 2019. All procedures were performed by a single senior surgeon at our tertiary hospital. The patients who followed-up for at least 6 months after surgery were enrolled. We recorded hypertension and diabetes status, age, any prior ear surgery, any calcific plaques adjacent to the perforation, and perforation size and location. Results: A total of 150 patients were enrolled. Our success rate of FGM was 90%. Hypertension, diabetes, prior ear surgery history, and eardrum calcific plaques did not affect the surgical outcomes. There was no statistical difference in the surgical success rate according to the size (< 50%) or location of perforation. The closure rate was 97.2% in patients aged 1660 and 87.5% in patients aged > 60, respectively. However, FGM was successful in only two of six children (33.3%) aged ≤ 15 years, thus significantly less than in the other groups. Conclusion: FGM is a fast, safe, and efficient method for repairing tympanic membrane perforation. The surgical outcome is not significantly affected by underlying disease, perforation size or location, or by the condition of the tympanic membrane or older age. However, it may be poor in children with dysfunctional Eustachian tube.

Prevalence of Tympanic Membrane Perforations Among Adolescents, Adults, and Older Adults in the United States

Tympanic membrane (TM) perforations can occur at any age, but limited population-level data are available. Using data from the National Health and Nutrition Examination Survey, we performed a cross-sectional analysis of the prevalence and population estimates for TM perforations among individuals ≥12 years old in the United States. Overall, TM perforations have a prevalence of 2.1% (95% CI, 1.7%-2.6%), corresponding to 5.8 million Americans. Across the life course, older adults have the highest prevalence of TM perforations at 6.1% (95% CI, 4.7%-7.6%), corresponding to nearly 3 million Americans, as opposed to a prevalence of 0.6% (95% CI, 0.3%-0.9%) in adolescents, which equates to 0.2 million Americans. Males and females have a similar prevalence at 2.3% (95% CI, 1.6%-3.0%) among males and 2.0% (95% CI, 1.4%-2.6%) among females. These prevalence and population estimates provide the first US-based population estimates of the burden of TM perforations over the life course.