Pattern of Otitis Externa in ENT Outpatient Department of BSMMU, Dhaka, Bangladesh
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Keywords

Otitis
Externa
Fungal infection
Acute infection

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Halder H, Al Robbani A, Sattar MA, Mamun AD. Pattern of Otitis Externa in ENT Outpatient Department of BSMMU, Dhaka, Bangladesh. Integr J Med Sci [Internet]. 2022 Mar. 15 [cited 2022 Nov. 30];9. Available from: https://mbmj.org/index.php/ijms/article/view/652

Abstract

Introduction: Otitis externa is an acute or chronic reaction of the whole or a part of the skin of the external ear arising from local or general causes or a combination of both. It is a widespread medical problem affecting 5%–20% of patients who visit otolaryngologists in the tropical and subtropical regions. Objective: This study assesses the pattern of otitis externa in the ENT Outpatient Department. Methods: A prospective study was carried out in the Outpatient Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) among 200 patients (220 affected ears) with the aural symptoms suggestive of otitis externa and 110 healthy controls (220 ears) from July 2002 to December 2003 to find out the pattern of the disease among patients suffering from otitis externa in Bangladesh. Results: The maximum number (35%) of patients were within the 21–30 age group. Most patients were male (56%), with a male-female ratio of 1.3:1. The higher numbers of patients fall within the lower- and middle-income family groups (up to 2,500 and 3,501–4,000 taka per month, respectively). Most patients (30%) were laborers, and most patients were literate. The majority lived in a paka (44%) or semi-paka (38%) house and used tap water for bathing (53.5%). Most patients used cotton buds (49%) for cleaning of ears. Otitis externa was primarily found in the summer and rainy season (69%), with maximum occurrence during June (18.2%) and July (16.4%). In most patients, symptoms persisted for less than two months (76.3%), of which itching, pain in the ear, and a sense of blocking are the commonest triad of symptoms. Itching is the predominant symptom (98.2%) in fungal otitis externa, and pain is the dominant symptom (92.8%) in the bacterial type. Acute infection is commonly painful, whereas chronic disease is mostly itchy. The right ear was more involved (60%) than the left one, and the ear canal was more commonly diffusely involved (84.5%). Among the predisposing factors for the causation of otitis externa, ear cleaning by self or others ranked in the top 42 causes, 7% of the list. It was mainly associated with acute cases. The fungus was isolated from the affected ear in most instances (49.1%), followed by bacteria (31.8%). Moreover, bacteria were often associated with acute cases, and fungus was found more in chronic cases. Aspergillus was found in 89.7% of the fungal species, and Candida was found in 7.5% of cases. Pseudomonas was the predominant organism (40%), and Staphylococcus was the second most common (37.1%) among the bacterial species isolated. The microbiological finding among the healthy controls showed that the external ear canal is less commonly harboring pathogenic organisms. Bacteria were isolated from 18.2% of cases, and fungus was isolated from only 6.3%. Conclusion: From this study, it is also evident that although bacteria could be detected from control cases, fungus isolation was negligible. Most of the bacteria were normal commensals. On the other hand, in the diseased ear, the presence of fungus in the ear canal was highly significant (p < 0.001), which signifies the prerequisite of an altered aural flora and fauna for the development of fungal infection.

https://doi.org/10.15342/ijms.2022.652
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References

Gray RF, Hawthorne M. In: Synopsis of Otolaryngology, 5th edn. London; Butterworth-Heinemann. 1992: 83-96.

Senturia BH, Marcus MD, Lucente FE. Disease of the external ear. New York; Grune and Stratton 1980: 6-62: 1-23.

Cambon AC, Khalyfa A, Cooper NG, Thompson CM. Analysis of probe level patterns in Affymetrix microarray data. BMC Bioinformatics. 2007 May 4; 8:146. https://doi.org/10.1186/1471-2105-8-146

Raza SA, Denholm SW, Wong JC. An audit of the management of acute otitis externa in an ENT casualty clinic. J Laryngol Otol. 1995 Feb; 109(2):130-3. https://doi.org/10.1017/s0022215100129469

Ruddy J, Bickerton RC. Optimum management of the discharging ear. Drugs. 1992 Feb; 43(2):219-35. https://doi.org/10.2165/00003495-199243020-00008

Sander D, Grafman J, Zalla T. The human amygdala: an evolved system for relevance detection. Rev Neurosci. 2003;14(4):303-16.https://doi.org/10.1515/revneuro.2003.14.4.303

Jones EH. External otitis, Diagnosis and treatment. Thomas C (Publisher), Springfield, Illinois, U.S.A. 1965: 50-51.

Cassisi N, Cohn A, Davidson T, Witten BR. Diffuse external otitis: clinical and microbiologic findings in the course of a multicenter study on a new solution. Ann Otol Rhinol Laryngol Suppl. 1977 May-Jun; 86(3 Pt 3 Suppl 39):1-16. https://doi.org/10.1177/00034894770863s201

Walsh DM, Klyubin I, Fadeeva JV, Cullen WK, Anwyl R, Wolfe MS, et al. Naturally secreted oligomers of amyloid β protein potently inhibit hippocampal long-term potentiation in vivo. Nature. 2002 Apr 4; 416(6880):535-9. https://doi.org/10.1038/416535a

Bhalla SS. Imagine there's no country: Poverty, inequality, and growth in the era of globalization. Peterson Institute. 2002. [Accessed 2022 Mar 14]. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.457.3832&rep=rep1&type=pdf

Sander CS, Chang H, Salzmann S, Müller CS, Ekanayake-Mudiyanselage S, Elsner P, et al. Photoaging is associated with protein oxidation in human skin in vivo. J Invest Dermatol. 2002 Apr;118(4):618-25. https://doi.org/10.1046/j.1523-1747.2002.01708.x

Bojrab DI, Bruderly T, Abdulrazzak Y. Otitis externa. Otolaryngol Clin North Am. 1996 Oct; 29(5):761-82.

Beg MH, Bhukhari AT. Otomycosis in Karachi. Practitioner. 1983 Nov;227(1385):1767-70.

Yassin A, Mostafa MA, Moawad MK. Fungus infection of the ear. J Laryngol Otol. 1964 Jun; 78:591-602. https://doi.org/10.1017/s0022215100062472

Khan AFM. A comparative bacteriological and mycological study on otitis externa. IPGM&R, Dhaka. July, 1997 [Thesis).

Chessbrough M. Medical laboratory manual for Tropical countries. 15 edition. vol.11. Cambridgeshire, England; Tropical health Technology. 1984:372-382.

Khan AA, Rahman KM. Fungus infection of the ear. Bangladesh Med Res Counc Bull. 1977 Jun;3(1):28-31.

Anwarullah M, Jayakar PA. A microbiological study of otomycosis in Visakhapatnam. J Indian Med Assoc. 1987 Aug; 85(8):229-32.

Than MK, Naing KS, Min M. Otomycosis in Burma and its treatment. Am J Trop Med Hyg. 1980 Jul;29(4):620-3. https://doi.org/10.4269/ajtmh.1980.29.620

Hawke M, Wong J, Krajden S. Clinical and microbiological features of otitis externa. J Otolaryngol. 1984 Oct; 13(5):289-95.

Mugliston T, O'Donoghue G. Otomycosis, A continuing problem. J Laryngol Otol. 1985 Apr; 99(4):327-33. https://doi.org/10.1017/s002221510009678x

Rowland S, Donkin P, Smith E, Wraige E. Aromatic hydrocarbon “humps” in the marine environment: unrecognized toxins? Environ Sci Technol. 2001 Jul 1; 35(13):2640-4. https://doi.org/10.1021/es0018264

Waitzman NJ, Smith KR. Phantom of the area: poverty-area residence and mortality in the United States. Am J Public health. 1998 Jun;88(6):973-6. https://doi.org/10.2105/ajph.88.6.973

Timón ML, Ventanas J, Carrapiso AI, Jurado A, García C. Subcutaneous and intermuscular fat characterisation of dry-cured Iberian hams. Meat Sci. 2001 May; 58(1):85-91. https://doi.org/10.1016/s0309-1740(00)00136-4

Nazma K. Prevalence of chronic supporative otitis media among children of two selected slum dwellers in Dhaka city, NIPSOM. Dhaka; 2001 (Dissertation).

Pahwa Vk, Chamyal PC, Suri PN. Mycological study in otomycosis. Indian J Med Res. 1983 Mar;77:334-8.

Marcy SM. Infections of the external ear. Pediatr Infect Dis. Mar-Apr 1985;4(2):192-201.

Roland PS, Stroman DW. Microbiology of Acute Otitis Externa. The Laryngoscopo. 2002 Jul;112(7 Pt 1):1166-77. https://doi.org/10.1097/00005537-200207000-00005

Lucente EF. Fungal infection of the external ear. Otolaryngol Clin North Am. 1993 Dec;26(6):995-1006.

Hirsch BE. Infections of the external ear. Am J Otolaryngol. 1992 May-Jun;13(3):145-55. https://doi.org/10.1016/0196-0709(92)90115-a

Glasgold AL, Boyd JE. Otitis externa - control of bacterial and mycological infections - A preliminary report. Eye Ear Nose Throat Mon. 1973 Mar; 52(3):94-6.

William PL, Warwich R, Dayson M, Bannister LH. Development of special sense organs: the ears. In: Gray's anatomy, 37'h edn. Churchill Livingstone, 1987: 204-6.

Conley JC. Evaluation of fungus disease of the external auditory canal. Arch Otolaryngol. 1948; 47(6): 721-745. https://doi.org/10.1001/archotol.1948.00690030748002

Singer De, Freeman E, Hoffert Wr, Keys Rj, Mitchell Rb, Hardy Av. Otitis externa. Bacteriological and mycological studies. Ann Otol Rhinol Laryngol. 1952 Jun;61(2):317-30. https://doi.org/10.1177/000348945206100201

Alhozaimy AM, Soroushian P, Mirza F. Mechanical properties of polypropylene fiber reinforced concrete and the effects of pozzolanic materials. Cement Concrete Composites. 1996; 18(2): 85-92. https://doi.org/10.1016/0958-9465(95)00003-8

Sipila P, Jokiph AM, Jokiph L, Karma P. Bacteria in the middle ear and ear canal of patients with secretory otitis media and non-inflamed ears. Acta Otolaryngilogicia. 1981; 92(1-2): 123-130. https://doi.org/10.3109/00016488109133246

Browning GG, Picozz GL, Sweeney G, Calder IT. Role of anaerobes in chronic otitis media. Clin Otolaryngol Allied Sci. 1983 Feb; 8(1):47-51. https://doi.org/10.1111/j.1365-2273.1983.tb01671.x

Akobjanoff L, Carruthers C, Senturia BH. The chemistry of cerumen: a preliminary report. J Invest Dermatol. 1954 Jul; 23(1):43-50. https://doi.org/10.1038/jid.1954.81

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Copyright (c) 2021 Kishore Kumar Halder, AM Al Robbani, Md. Abdus Sattar, AHM Delwar Mamun

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