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Otitis media (OM) is one of the most common ear diseases affecting humans. Children are at greater risk and suffer most frequently from OM, which can cause serious deterioration in the quality of life. OM is generally classified into two main types: acute and chronic OM (AOM and COM). AOM is characterized by tympanic membrane swelling or otorrhea and is accompanied by signs or symptoms of ear infection. In COM, there is a tympanic membrane perforation and purulent discharge. The most common pathogens that cause AOM are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis whereas Pseudomonas aeruginosa and Staphylococcus aureus are commonly associated with COM. Innate and adaptive immune responses provide protection against OM. However, pathogens employ a wide arsenal of weapons to evade potent immune responses and these mechanisms likely contribute to AOM and COM. Immunologic evasion is multifactorial, and involves damage to host mucociliary tract, genetic polymorphisms within otopathogens, the number and variety of different otopathogens in the nasopharynx as well as the interaction between the host's innate and adaptive immune responses. Otopathogens utilize host mucin production, phase variation, biofilm production, glycans, as well as neutrophil and eosinophilic extracellular traps to induce OM. The objective of this review article is to discuss our current understanding about the mechanisms through which otopathogens escape host immunity to induce OM. A better knowledge about the molecular mechanisms leading to subversion of host immune responses will provide novel clues to develop effective treatment modalities for OM., Review on how otopathogens employ wide arsenal of weapons to evade potent host immune responses and induce otitis media.

The aim of the study was to investigate prospective, longitudinal associations between maternal prenatal cortisol response to an interpersonal stressor and child health for the subsequent 3 years.One hundred twenty-three women expecting their first child provided salivary cortisol samples between 12 and 32 weeks of gestation (M (SD) = 22.4 (4.9) weeks) before and after a videotaped couple conflict discussion with their partner. Mothers reported on overall child health and several indicators of child illness (sick doctor visits, fevers, ear, and respiratory infections) when children were 6 months (n = 114), 1 (n = 116), and 3 (n = 105) years old. Associations between maternal prenatal cortisol reactivity and recovery and later child health at each of the three time points were analyzed using longitudinal regression models.Greater cortisol reactivity in response to the couple conflict discussion was associated with maternal self-report of better overall child health (p = .016, 95% CI = 0.06-1.30, Cohen's f = 0.045) across the study period. Greater cortisol reactivity was also associated with lower incidence rate ratios for maternal reports of sick doctor visits (incidence rate ratio 95% CI = 0.25-0.83, p = .006), fevers (95% CI = 0.25-0.73, p = .002), ear infections (95% CI = 0.25-0.58, p.001), and respiratory infections (95% CI = 0.08-1.11, p = .073). Cortisol recovery was unrelated to study outcomes (all p's0.05). Maternal prenatal depressive symptoms moderated the association between cortisol reactivity and overall child health (p = .034, 95% CI = 0.07-1.87 for interaction term) but no other health outcomes (p's0.05). Among women with lower depressive symptoms, cortisol reactivity was not associated with overall child health; among women with higher levels of depressive symptoms, greater cortisol reactivity was associated with better overall child health.This study provides longitudinal evidence that greater maternal cortisol reactivity to a salient interpersonal stressor during pregnancy is associated with fewer child health problems and better maternal report of overall child health during infancy and into early childhood.Clinicaltrials.gov ID NCT01901536.

Objective.To assess patient-reported burden of disease in pediatric patients with relapsing polychondritis (RP) and to compare those findings to adult patients.Methods.A survey based on known clinical symptoms of RP was developed and administered to patients with a pediatric diagnosis of RP. Adult patients completed a similar survey.Results.Twenty-one pediatric patients, or their parents, completed surveys. Median age at symptom onset was 6 years (interquartile range 1.8–12). Prior to diagnosis, most pediatric patients went to the emergency room (ER; 61.9%), saw > 3 physicians (57.1%), and took > 1 year to be diagnosed (61.9%). Pediatric patients were often diagnosed with asthma (42.9%), ear infections (42.9%), or sinusitis (33.3%) prior to diagnosis of RP. Symptoms prior to diagnosis included ear pain/redness (85.7%), joint pain/swelling (61.9%), and airway symptoms (38.1%). Four pediatric patients (19%) reported tracheomalacia requiring tracheostomy. Pediatric patients frequently missed school because of their disease (71.4%). Surveys from 290 adult patients were compared to pediatric patients. Pediatric patients were significantly more likely to undergo biopsy (42.9% vs 17.4%; p < 0.01) and be treated with biologics (42.9% vs 19%; p = 0.02). Adults were significantly more likely to be female (87.8% vs 28.6%; p < 0.01) and to report airway symptoms (77.9% vs 47.6%; p = 0.01). Prevalence of disease complications was not significantly different between adult and pediatric patients.Conclusions.The burden of disease in pediatric patients with RP includes missed school, diagnostic delay, ER visits, and multisystem disease, with resultant damage to cartilaginous structures. Differences in airway involvement and treatment approaches may exist between pediatric and adult patients.

Rising rates of antibiotic-resistant infections make reducing unnecessary antibiotic use for outpatient illness a key public health issue. This study examines the association between parent-provide...

Infections of the ear are a common presentation to an acute care environment. In this article, the authors aim to summarize the most common presentations, and diagnostic and treatment options for typical infections of the ear. This article is geared toward the emergency physician, urgent care provider, and primary care provider who will likely be the initial evaluating and treating provider to assist them in determining what treatment modalities can be managed in a clinic and what needs to be referred for admission or specialty consultation.

The research problem shows that the researcher’s job as a swimming teacher and supervised swimming academies during the summer, she noticed that many children are at risk of catching skin diseases and colds as result of unhygienic habits such as getting used to personal hygiene and un personal objects and special injures to eye and ear infections in swimming besides the injures that could result from not obeying a teacher’s instructions. The researcher attributes this to the child’s lack of healthy habits of swimming. In the light of the foregoing and the recommendations of previous studies it is essential to focus on health education for sports practitioners while learning. The aim of the search is to develop a health education guide for swimming school learners by getting to know: 1. Aims of the educational guide for swimming school learners. 2. Content of the health education guidebook for swimming school learners. 3. Implementation of health educational guidebook for swimming school learner? 4. Evaluation methods for the health educational guidebook for swimming school learners. Research sample was selected randomly, (60) of technical and swimming teachers from swimming schools in the clubs and special entities in Assuit governorate. Data collection tools: Questionnaire to target the content of healthy educational guidebook for swimming school learners. Questionnaire to determine the aims of healthy educational guidebook for swimming school learners. Questionnaire to determine the implementation methods of healthy educational guidebook for swimming school learners. Questionnaire to determine the evaluation methods of healthy educational guidebook for swimming school learners. The results showed the top three axis contents were: Following the public and personal hygiene of swimming learners Emergency, first aid and treatment for swimming learners, Teaching learners the healthy rules for swimming.

Ardita vata presenting with palsy of one side of the face is akin to Bell's palsy or acute idiopathic lower motor neuron facial palsy. This is characterized by sudden-onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. Bell's palsy is an idiopathic, presumed immune-mediated phenomenon, possibly with an infection as the inciting event. In contemporary science, administration of steroids is the treatment of choice for complete facial palsy. A 17-year-old boy diagnosed with Ardita vata due to chronic ear infection was treated with Karpasasthyadi taila Nasya and oral Ayurvedic medicines along with two sittings of the Panchakarma procedure. The total duration of the treatment was 4 months; however, significant results observed after 1 month of treatment shown almost complete recovery without any concurrent medications. The patient suffers from the same complaint 5 years ago in the right side of his face, and for that, he took 2 years of allopathic treatment and got complete relief. This case is evidence to demonstrate the effectiveness of Ayurveda treatment in case of Ardita vata (Bell's palsy) and as a proposition for further research on a greater number of patients.

Background: Pathology of the middle ear is the third most common reason of visiting a general practitioner or a family doctor. In children and teenagers, inflammatory conditions of the middle ear are the most frequent reasons to prescribe antibiotics and perform surgery.In the majority of these cases, proper diagnosis is made by clinical examination alone and patients will not benefit from additional diagnostic imaging studies. However, the prevalence of ear infections increased significantly and this may suggest that the current approach to preventing and treating middle ear inflammation is not adequate. Therefore, especially in complicated and recurrent conditions, imaging plays an important role; imaging findings may fundamentally influence the treatment. Also, in non-inflammatory conditions of external and middle ear Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) would provide a diagnosis and/or necessary information for surgery in a significant number of cases.Aim of Work: Evaluation the role of Multi-Detector Computed Tomography (MDCT) in diagnosis Chronic Sup-purative Otitis Media (CSOM) with or without cholesteatoma and staging of middle ear Cholesteatoma and assess its impact on the selection of the surgical procedure.Patients and Methods: A prospective study included 30 patients with mean age 30.4 years with CSOM with or without cholesteatoma. They were evaluated regarding to their clinical symptoms, temporal multidetector computed tomography findings, and postoperative results. MDCT staging classified cholesteatoma according to its site in the tympanic cavity (S); erosion of the ossicular chain (O); and associated complications (C).Results: MDCT imaging of these patients showed opaci-fication of middle ear cavity with integrity of the ossicular chain with 100% accuracy. Nondependent soft tissue masses in the middle ear, eroded scutum (n=20), eroded ossicles (n= 20), intact tegmen tympani (n=30), lateral mastoid fistula (n=2) and labyrinthine fistula (n=1) were observed in CSOM with cholesteatoma. All these patients underwent surgical intervention that confirmed the diagnosis of the presence of cholesteatoma in all these patients. But it also added the presence of lateral mastoid fistula and labyrinthine fistula in 1 other patient and discovered the presence of facial nerve injury in 1 patient.Conclusion: MDCT scanning has limitations, but it is a useful in diagnosis, staging and surgic

Background/purpose: Molar-Incisor-Hypomineralisation (MIH) is the term used to depict a condition in which one or more of the permanent molar teeth and usually no less than one incisor tooth is hypomineralised and the prevalence rates vary from 2.4 to 40.2%. The aim of this study was to assess the prevalence and the risk factors of MIH in children in Istanbul, Turkey. Materials and methods: A total of 1511 (760 M, 751 F), 8- to 11-year-old children were examined who had their first permanent molar and incisors evaluated using the EAPD criteria for MIH. Hypomineralized molars and incisors were recorded based on developmental defects of enamel index. The potential aetiological factors were retrieved through personal interview and etiological questions were asked to the parents. Statistical analysis was performed with a chi-Square test. Results: MIH was observed in 215 (14.2%; 102 male, 113 female) children. The sample (1511 children) comprised 71 (9.9%) 8 year-olds with MIH and 144 (18.2%) 11 year-olds with MIH. A significant difference was found between 8 (9.9%) and 11-year-old (18.2%) children with MIH (p ≤ 0.001). Complications during the mother's pregnancy, birth prematurity, average breast feeding period, diarrhea frequency, digestive system diseases, asthma, frequent high fever, ear infection, renal failure, rubeola, chickenpox and parotitis were found to be significantly associated with MIH (p

Background: Environmental tobacco smoke (ETS) exposure in infants and children causes more frequent and severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome. The aim of this study was to measure ETS exposure in children in Israel (ages 4–11 years) using urinary cotinine measurements, in order to compare exposure levels to other international populations, and to assess predictors of ETS exposure in children in Israel. Methods: A subset of children who participated in the National Health and Nutrition Survey (RAV- MABAT) in 2015–2016 were invited to participate in the Second Israel Biomonitoring Survey. We analyzed urinary cotinine and creatinine concentrations in 103 children. Parents of study participants were interviewed in person on children's exposure to ETS at home and in other environments and on sociodemographic variables. We calculated creatinine-adjusted and unadjusted urinary cotinine geometric means in children and analyzed associations in univariable and multivariable analyses, between sociodemographic variables and parental – reported exposure, and urinary cotinine concentrations. Results: Based on urinary creatinine measurement, over 60% of children are exposed to ETS (compared to

Exposure to secondhand smoke from burning tobacco products can cause sudden infant death syndrome, respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers (1). There is no risk-free level of secondhand smoke exposure (2). CDC analyzed questionnaire and laboratory data from the National Health and Nutrition Examination Survey (NHANES) to assess patterns of secondhand smoke exposure among U.S. nonsmokers. The prevalence of secondhand smoke exposure among U.S. nonsmokers declined substantially during 1988-2014, from 87.5% to 25.2%. However, no change in exposure occurred between 2011-2012 and 2013-2014, and an estimated one in four nonsmokers, or approximately 58 million persons, were still exposed to secondhand smoke during 2013-2014. Moreover, marked disparities persisted across population groups. Exposure prevalence was highest among nonsmokers aged 3-11 years (37.9%), non-Hispanic blacks (50.3%), and those who were living in poverty (47.9%), in rental housing (38.6%), or with someone who smoked inside the home (73.0%), or among persons who had less than a high school education (30.7%). Comprehensive smoke-free laws and policies for workplaces and public places and smoke-free rules for homes and vehicles can further reduce secondhand smoke exposure among all nonsmokers.

Introduction: Staphylococcus lugdunensis (SL), a tube coagulase negative Staphylococcus , is known to be pathogenic in adults, causing mainly skin infections. Gap Statement: Previous studies assessing SL's role in paediatric populations are sparse and are mainly limited to case reports. Aim: Present the clinical characteristics consistent with SL infections and its putative role as a pathogen in the paediatric population. Methodology: A retrospective multicentre study was conducted in four paediatric medical centres in Israel. Patients with isolates of SL presenting between 2009–2019 were included. Results: SL was isolated from 40 patients. Average (±SD) age at presentation was 5.9 (±6.2) years, with 22 (55 %) being female. Skin, soft tissue and musculoskeletal infections were the most common (n=20, 50%) followed by ear infections (n=13, 32.5%). Five cases of urine isolates and two isolates from blood culture samples were also reported. Skin abscess was the most common infection among skin and soft tissue isolates, reported in 17 children (85%) with SL being the only pathogen in 15 (75%). Otitis media was the most common ear infection accounting for 12 (92%) of all cases with SL as the only isolate reported in 6 (46%). Five cases of SL isolates from urine specimens were reported, all of which with poor growth of bacteria and normal urinalysis. Two cases of SL growth in blood culture were found in children presenting with signs and symptoms consistent with invasive blood stream infection. Conclusions: In the paediatric population, studied infections caused by SL are increasingly observed. The results of this study highlight its role as a pathogen in soft tissue infections and its putative role in otitis media and invasive blood stream infections. However, the role of SL as an uropathogen was not established.

Cold atmospheric plasma (CAP) is a new generation medical therapeutic option for bacterial infections. CAP causes physical cell wall rupture and DNA damage, therefore making it highly useful in the treatment of various conditions such as skin infections.The antimicrobial activity of cold atmospheric microwave plasma (CAMP) against major strains in canine skin infections was tested and the difference in antimicrobial activity between the antibiotic-resistant and antibiotic-susceptible strains of Staphylococcus pseudintermedius was evaluated.American Type Culture Collection (ATCC) strains (Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli) and clinical isolates identified as methicillin-resistant S. pseudintermedius (n = 27) and methicillin-susceptible S. pseudintermedius (n = 13) were exposed to CAMP for 10 s, 30 s and 60 s. Afterwards, the bacterial survival rate was confirmed.Gram-negative bacteria (P. aeruginosa and E. coli) were more susceptible than Gram-positive bacteria (S. aureus and S. pseudintermedius) for the same duration of CAMP exposure. Only the Gram-negative bacteria were completely killed after 60 s exposure. In S. pseudintermedius isolates, CAMP exposure had similar antibacterial effects regardless of antibiotic resistance.CAMP has sufficient antimicrobial activity against major bacterial strains that cause pyoderma and otitis externa in dogs, and may be an alternative therapeutic option for S. pseudintermedius skin infections, for which antibiotics often are ineffective because of antimicrobial resistance in clinical veterinary medicine.Le CAP (Cold atmospheric plasma) est une nouvelle génération de traitement pour les infections bactériennes. CAP cause une rupture physique de la paroi et endommage l’ADN, le rendant ainsi hautement utile pour le traitement d’atteintes variées telles que les infections bactériennes. HYPOTHÈSES/OBJECTIFS: L’activité antimicrobienne de CAMP (cold atmospheric microwave plasma) contre des souches majeures des infections cutanées canines a été testée et la différence d’activité antimicrobienne entre les souches résistances ou sensibles aux antibiotiques de Staphylococcus pseudintermedius a été évaluée. MATÉRIELS ET MÉTHODES: Les souches ATCC (American Type Culture Collection) (Staphylococcus aureus, Pseudomonas aeruginosa et Escherichia coli) et les souches cliniques isolées de S. pseudintermedius identifiées comme résistantes à la méticiline (n = 27) S. pseudintermedius sensibles à la méticiline (n = 13) ont été exposées à CAMP pendant 10 s, 30 s et 60 s. Ensuite, le taux de survie bactérien a été confirmé. RÉSULTATS: Les bactéries Gram-négatives (P. aeruginosa et E. coli) étaient plus sensibles que les bactéries Gram-positives (S. aureus et S. pseudintermedius) pour la même durée d’exposition au CAMP. Seules les bactéries Gram-négatives étaient complètement tuées après 60s d’exposition. Dans les souches de S. pseudintermedius, l’exposition à CAMP avait des effets antibactériens similaires au regard de la résistance antibiotique.Le CAMP a une activité antimicrobienne suffisante contre les souches bactériennes majeures causant pyodermite et otite externe chez le chien et peut être une option thérapeutique alternative pour les infections cutanées à S. pseudintermedius pour laquelle les antibiotiques sont souvent inefficaces en raison de résistances antimicrobiennes en médecine vétérinaire clinique.INTRODUCCIÓN: el plasma atmosférico frío (CAP) es una opción terapéutica médica de nueva generación para las infecciones bacterianas. El CAP provoca la ruptura física de la pared celular y el daño al DNA, por lo que es muy útil en el tratamiento de diversas afecciones, como las infecciones de la piel. HIPÓTESIS/OBJETIVOS: se probó la actividad antimicrobiana del plasma de microondas atmosférico frío (CAMP) contra las principales cepas en las infecciones cutáneas caninas y se evaluó la diferencia en la actividad antimicrobiana entre las cepas resistentes y sensibles a los antibióticos de Staphylococcus pseudintermedius. MÉTODOS Y MATERIALES: cepas de la American Type Culture Collection (ATCC) (Staphylococcus aureus, Pseudomonas aeruginosa y Escherichia coli) y aislados clínicos identificados como S. pseudintermedius resistente a meticilina (n = 27) y S. pseudintermedius sensible a meticilina (n = 13) fueron expuestos a CAMP durante 10 s, 30 s y 60 s. Posteriormente, se valoró la tasa de supervivencia bacteriana. RESULTADOS: las bacterias Gram negativas (P. aeruginosa y E. coli) fueron más susceptibles que las bacterias Gram positivas (S. aureus y S. pseudintermedius) durante la misma duración de exposición a CAMP. Solo las bacterias Gram negativas murieron por completo después de 60 s de exposición. En los aislados de S. pseudintermedius, la exposición a CAMP tuvo efectos antibacterianos similares independientemente de la resistencia a los antibióticos. CONCLUSIONES E IMPORTANCIA CLÍNICA: CAMP tiene suficiente actividad antimicrobiana contra las principales cepas bacterianas que causan pioderma y otitis externa en perros, y puede ser una opción terapéutica alternativa para las infecciones cutáneas por S. pseudintermedius, para las cuales los antibióticos a menudo son ineficaces debido a la resistencia a los antimicrobianos en medicina veterinaria.Kaltes atmosphärisches Plasma (CAP) zählt zu einer neuen Generation an medizinischen Behandlungsoptionen für bakterielle Infektionen. CAP verursacht eine physische Zellwandruptur und eine DNA Schädigung, was es in der Folge bei der Behandlung verschiedener Erkrankungen wie Hautinfektionen sehr wirkungsvoll macht.Die antimikrobielle Wirksamkeit von kaltem atmosphärischem Mikrowellenplasma (CAMP) wurde gegenüber wichtigen Stämmen bei Hautinfektionen des Hundes getestet und der Unterschied der antimikrobiellen Aktivität zwischen den Antibiotika-resistenten und den Antibiotika-empfindlichen Stämmen von Staphylococcus pseudintermedius evaluiert.Stämme (Staphylococcus aureus, Pseudomonas aeruginosa und Escherichia coli) aus der American Type Culture Collection (ATCC) und klinische Isolate, die als Methicillin-resistente S. pseudintermedius (n = 27) und Methicillin-empfindliche S. pseudintermedius (n = 13) isoliert worden waren, wurden CAMP für 10 s, 30 s und 60 s ausgesetzt. Danach wurde die bakterielle Überlebensrate bestätigt.Gram-negative Bakterien (P. aeruginosa und E. coli) waren empfindlicher als Gram-positive Bakterien (S. aureus und S. pseudintermedius) bei gleich langer Dauer der Exposition zu CAMP. Nur die Gram-negativen Bakterien waren nach einer 60 s dauernden Exponierung völlig abgetötet. In S. pseudintermedius Isolaten zeigte die Exponierung unabhängig von der antibiotischen Resistenz zu CAMP eine ähnliche antibakterielle Wirkung.CAMP zeigt eine ausreichende antimikrobielle Aktivität gegenüber bakteriellen Stämmen, die eine Pyodermie und eine Otitis externa bei Hunden verursachen und könnte eine alternative therapeutische Option für Hautinfektionen durch S. pseudintermedius darstellen, für die Antibiotika aufgrund der antimikrobiellen Resistenz in der klinischen Veterinärmedizin oft unwirksam sind.背景: 低温大気圧プラズマ (CAP) は、細菌感染症に対する新世代の治療法として注目されている。CAPは、物理的な細胞壁破壊とDNAの損傷を引き起こすため、皮膚感染症などの様々な症状の治療に非常に有用である。 仮説・目的: 本研究の目的は、犬の皮膚感染症における主要な菌株に対する低温マイクロ波プラズマ (CAMP) の抗菌活性を試験し、Staphylococcus pseudintermediusの抗生物質耐性菌株および抗生物質感受性菌株間の抗菌活性の違いを評価することであった。 材料・方法: American Type Culture Collection(ATCC) 株 (Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli)と、メチシリン耐性S. pseudintermedius(n = 27)およびメチシリン感受性S. pseudintermedius(n = 13)と同定された臨床分離株をCAMPに10秒、30秒、60秒曝露し、その後、細菌の生存率を確認した。 結果: グラム陰性菌 (P. aeruginosaおよびE. coli) は、同じCAMP曝露時間でもグラム陽性菌 (S. aureusおよびS. pseudintermedius) よりも感受性が高かった。60秒の曝露で完全に死滅したのはグラム陰性菌のみであった。S. pseudintermedius分離菌では、CAMP曝露は抗生物質耐性にかかわらず同様の抗菌効果を示した。 結論および臨床上の重要性: CAMPは犬膿皮症および外耳炎の原因となる主要な細菌株に対して十分な抗菌活性を有しており、臨床獣医学では抗菌剤耐性のために抗生物質が効かないことが多いS. pseudintermedius皮膚感染症の代替治療法となる可能性がある。.背景: 大气低温等离子体(CAP)是新一代细菌感染的药物治疗选择。CAP引起物理性细胞壁破裂和DNA损伤, 因此使其在皮肤感染等多种疾病的治疗中非常有用。 假设/目的: 检测了大气低温微波等离子体(CAMP)对犬皮肤感染中主要菌株的抗菌活性, 并评价了假中间型葡萄球菌的抗生素耐药性和抗生素敏感性菌株之间的抗菌活性差异。 方法和材料: 将美国典型培养物保藏中心(ATCC)菌株 (金黄色葡萄球菌、铜绿假单胞菌和大肠埃希菌) 和鉴定为耐甲氧西林假中间型链球菌(n = 27)和甲氧西林敏感假中间型链球菌(n = 13)的临床分离株暴露于CAMP 10s、30s和60s后, 证实了细菌存活率。 结果: 在相同的CAMP暴露时间内, 革兰氏阴性菌 (铜绿假单胞菌和大肠埃希菌) 比革兰氏阳性菌 (金黄色葡萄球菌和假中间型链球菌) 更敏感。暴露60s后仅完全杀灭革兰氏阴性菌。在假中间型链球菌分离株中, 无论抗生素耐药性如何, CAMP暴露均具有相似的抗菌作用。 结论和临床重要性: CAMP对引起犬脓皮病和外耳炎的主要细菌菌株具有足够的抗菌活性, 可能是假中间型葡萄球菌皮肤感染的替代治疗选择, 在临床兽药中, 由于抗菌药物耐药性, 抗生素通常无效。.O plasma atmosférico frio (PAF) é uma opção terapêutica de nova geração para infecções bacterianas. O PAF causa ruptura física da parede celular e danos ao DNA, sendo, portanto, altamente útil no tratamento de várias condições, como infecções de pele. HIPÓTESE/OBJETIVOS: A atividade antimicrobiana do plasma atmosférico frio de microondas (PAFM) contra as principais cepas em infecções cutâneas caninas foi testada e a diferença na atividade antimicrobiana entre as cepas de Staphylococcus pseudintermedius resistentes a antibióticos e suscetíveis a antibióticos foi avaliada. MÉTODOS E MATERIAIS: Cepas da American Type Culture Collection (ATCC) (Staphylococcus aureus, Pseudomonas aeruginosa e Escherichia coli) e isolados clínicos identificados como S. pseudintermedius resistente à meticilina (n = 27) e S. pseudintermedius sensível à meticilina (n = 13) foram expostos ao PAFM por 10 s, 30 s e 60 s. Posteriormente, a taxa de sobrevivência bacteriana foi confirmada.As bactérias Gram-negativas (P. aeruginosa e E. coli) foram mais suscetíveis do que as bactérias Gram-positivas (S. aureus e S. pseudintermedius) para a mesma duração da exposição PAFM. Apenas as bactérias Gram-negativas foram completamente mortas após 60 s de exposição. Nos isolados de S. pseudintermedius, a exposição ao PAFM teve efeitos antibacterianos semelhantes, independentemente da resistência aos antibióticos. CONCLUSÕES E IMPORTÂNCIA CLÍNICA: PAFM tem atividade antimicrobiana suficiente contra as principais cepas bacterianas que causam piodermite e otite externa em cães, e pode ser uma opção terapêutica alternativa para infecções cutâneas por S. pseudintermedius, para as quais os antibióticos muitas vezes são ineficazes devido à resistência antimicrobiana na medicina veterinária.

A middle ear infection is a prevalent inflammatory disease most common in the pediatric population, and its financial burden remains substantial. Current diagnostic methods are highly subjective, relying on visual cues gathered by an otoscope. To address this shortcoming, optical coherence tomography (OCT) has been integrated into a handheld imaging probe. This system can non-invasively and quantitatively assess middle ear effusions and identify the presence of bacterial biofilms in the middle ear cavity during ear infections. Furthermore, the complete OCT system is housed in a standard briefcase to maximize its portability as a diagnostic device. Nonetheless, interpreting OCT images of the middle ear more often requires expertise in OCT as well as middle ear infections, making it difficult for an untrained user to operate the system as an accurate stand-alone diagnostic tool in clinical settings. Here, we present a briefcase OCT system implemented with a real-time machine learning platform for middle ear infections. A random forest-based classifier can categorize images based on the presence of middle ear effusions and biofilms. This study demonstrates that our briefcase OCT system coupled with machine learning can provide user-invariant classification results of middle ear conditions, which may greatly improve the utility of this technology for the diagnosis and management of middle ear infections.

The prevalence of ear infections and hearing i mpairment among Greenlandic children is amajor public health problem, and studies investigating the association between hearing impairment and thriving among Greenlandic children are scarce. The aim of this study was to examine the association between hearing impairment and thriving in asample of school-children in Sisimiut, Greenland. This cross-sectional study included children from 5th to 10th grade from two schools in Sisimiut and two schools located in nearby settlements. Participants filled out aquestionnaire and underwent ear examination and audiometry. Binary logistic regression examined the associations of hearing impairment and thriving variables defined as self-rated health, headache and school satisfaction. 179 children participated from schools in Sisimiut, and 6 children were from schools in settlements. The prevalence of hearing impairment was 10% among school-children in Sisimiut. There was atendency among girls with hearing impairment to have higher odds ratios for low self-rated health, often headache and low school-satisfaction. This study indicates that girls with hearing impairment are more susceptible to low thriving compared to girls with normal hearing. Interventions targeting the thriving of hearing impairment among children in Greenland should take gender differences into account.

Otitis media (OM) represents a public health matter, being the main cause of preventable hearing loss in pediatric patients. Besides well-established risk factors for developing OM, such as craniofacial abnormalities, prematurity, low birth weight, or tobacco exposure, there is evidence that obesity could be associated with a high incidence of OM. Our aim is to perform a literature review on the state of current published research on the relationship between OM and obesity and to discuss the interconnectivity between these two entities. We conducted an electronic search in PubMed and EMBASE databases. Out of 176 references, 15 articles were included in our study. Our findings suggest that obesity and overweight might be risk factors for developing OM, and vice versa. The main mechanisms for developing OM in obese patients include alteration in cytokine profile, increased gastroesophageal reflux, and/or fat accumulation. Conversely, ear infections exposure might increase the risk of obesity, mostly by taste changes through middle ear cavity inflammation.

Candida auris is an emerging fungal pathogen of rising concern due to global spread, the ability to cause healthcare-associated outbreaks, and antifungal resistance. Genomic analyses revealed that early contemporaneously detected cases of C. auris were geographically stratified into four major clades. While Clades I, III, and IV are responsible for ongoing outbreaks of invasive and multidrug-resistant infections, Clade II, also termed the East Asian clade, consists primarily of cases of ear infection, is often susceptible to all antifungal drugs, and has not been associated with outbreaks. Here, we generate chromosome-level assemblies of twelve isolates representing the phylogenetic breadth of these four clades and the only isolate described to date from Clade V. This Clade V genome is highly syntenic with those of Clades I, III, and IV, although the sequence is highly divergent from the other clades. Clade II genomes appear highly rearranged, with translocations occurring near GC-poor regions, and large subtelomeric deletions in most chromosomes, resulting in a substantially different karyotype. Rearrangements and deletion lengths vary across Clade II isolates, including two from a single patient, supporting ongoing genome instability. Deleted subtelomeric regions are enriched in Hyr/Iff-like cell-surface proteins, novel candidate cell wall proteins, and an ALS-like adhesin. Cell wall proteins from these families and other drug-related genes show clade-specific signatures of selection in Clades I, III, and IV. Subtelomeric dynamics and the conservation of cell surface proteins in the clades responsible for global outbreaks causing invasive infections suggest an explanation for the different phenotypes observed between clades.

Otitis media (OM) is a group of inflammatory diseases of the middle ear and is the most frequent cause of physician visits and antibiotic prescriptions for children. Current diagnostic methods do not differentiate acute otitis media from otitis media with effusion, as both types of OM share many symptomatic features. A cohort of around 50 patients undergoing myringotomy were enrolled in this study, where Raman spectroscopy (RS) allowed non-invasive determination of OM subtype. Here we demonstrate the potential for RS to probe OM infection status in pediatric patients, to guide treatment protocol for ear infections and limit over-prescription of antibiotics.

Background According to the World Health Organization (WHO), hearing loss (HL) has a significant disease burden with a global prevalence as high a 5% with an expected exponential rise in the coming years. HL has medical, social, and psychological implications on one's health. A significant proportion of HL cases might be the result of preventable conditions, especially among the young. Aim To estimate the pattern of HL and its correlates among adolescent, adult, and elderly populations in the southern regions of Saudi Arabia. Methodology A retrospective observational study was carried out between May 2018 and April 2019 across four different ENT clinics located across Saudi Arabia. We included all patients who had a clinical diagnosis of conductive, sensorineural, or mixed HL with varying degrees of severity tested via Pure Tone Audiometer (PTA). Results We included 332 cases with HL, ages ranged from 14 to 62 years old with a mean age of 45.2 ±12.6 years. HL was bilateral in 72% of the cases and was associated with tinnitus in 43.1% of cases. Sensorineural HL was the predominant pattern of HL among the elderly and conductive pattern was more common among the young. Causes such as infections, congenital causes, and age-related damage were among the key causes of HL. Conclusion Our study showed that HL might be more prevalent among the Saudi population than previously reported. Sensorineural HL is most common among the elderly. However, conductive HL following ear infections is the main cause of HL among young. Therefore, there is a need for significant improvement in public health surrounding ear health to prevent reversible causes of HL, especially among the young.

BackgroundConsidering the importance of differential diagnosis of infectious otitis externa (OE), a stepwise PCR-based assay using universal and genus- or species-specific primers for the detection/identification of the most prevalent bacterial and fungal OE was developed and evaluated on the ear aspiration specimens of clinically suspected patients.Methods and MaterialsA total of 120 ear aspiration specimens with otomycosis suspicion were subjected to manual DNA extraction using phenol–chloroform extraction after tissue digestion with a lysis buffer. The multiplex PCR was initially performed using pan-fungal and bacterial homemade primers. Pseudomonas and Staphylococcus specific primers were simultaneously used in one reaction mixture to identify the bacterial genera. Furthermore, for the identification of fungal agents, Candida species-specific multiplex primers targeting the most clinically important Candida species causing OE (i.e., C. albicans, C. parapsilosis, and C. auris), as well as Aspergillus related multiplex PCR identifying the most prevalent Aspergillus species were used in two separate reaction mixtures. All the results of multiplex PCR were interpreted based on the amplicon size.ResultsThe overall multiplex PCR-based detection rate of bacterial (n = 88; 73.3%) and fungal (n = 97; 81%) OE was documented to be 100% along with and complete consistency with the results of direct examination and Giemsa staining. Double amplicon bands of bacterial and fungal pathogens were evidenced in 76 specimens (63.3%). Moreover, the positivity rate of pan-fungal PCR was higher than that of the culture result. Out of 88 pan-bacterial positive PCR specimens, 66 and 47 ones were positive for Staphylococcus and Pseudomonas, respectively. In addition, 30 samples exhibited mixed infection of both, and five specimens remained negative. Out of 97 pan-fungal positive PCR specimens, 67 and 51 ones contained Candida and Aspergillus species, respectively. It should be noted that dual amplicon bands of Candida and Aspergillus-related multiplex PCR were yielded in 30 specimens.ConclusionThe stepwise multiplex PCR assay proved to be more sensitive, more rapid, as well as less cumbersome in detection and identification of fungal and bacterial OE, compared to culture.

Chronic obstructive Eustachian tube dysfunction (ETD) is a common disorder of the middle ear. In recent years, two main diagnostic tools have become available: Eustachian tube score (ETS-7) and computed tomography (CT) combined with Valsalva maneuver. The aim of this study is to evaluate the outcomes of ETS-7 and CT in a group of patients affected by middle ear atelectasis with a strong suspicion of ETD. Three males and nine females, affected by middle ear atelectasis with retraction of the TM were enrolled. Each patient underwent to Eustachian tube dysfunction evaluation adopting the ETS-7 score and a temporal bone CT with Valsalva maneuver. The ears analyzed at steady state were divided into 2 groups: ETS

Introduction Primary lymphoma of the temporal bone is extremely rare, difficult to diagnose and to manage. It is essential that the clinician keeps in mind the possibility of this pathology as a differential diagnosis with the infections resistant to the usual treatment. Case report We report a rare case of a diffuse large B-cell lymphoma in a 70-year-old- woman, with history of diabetes. The pathological study was in favor of a Non-Hodgkin Lymphoma of the Temporal Bone. Discussion Lymphomas defined as malignant monoclonal proliferation of lymphoid cells, are not uncommon in the head and neck region. Literature presents with few cases. Conclusion The aim of this article is to report a rare case of a diffuse large B-cell lymphoma with primary mastoid and external auditory canal infiltration without systemic involvement initially presented as a benign ear infection., Highlights • Lymphomas defined as malignant monoclonal proliferation of lymphoid cells, are not uncommon in the head and neck region. • Primary lymphoma of the temporal bone is extremely rare. • Difficult to diagnose and to manage. • The diagnosis is confirmed after a biopsy with anatomopathological examination.

In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54, confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71, CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54, CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

Ear infections are exceedingly common, yet challenging to diagnose correctly. The diagnosis requires a clinician (such as a physician, nurse practitioner, or physician assistant) to use an otoscope and inspect the eardrum (i.e. tympanic membrane). Once visualized the clinician must rely on clinical judgment to determine the presence of changes typically associated with an ear infection such as eardrum color and/or position. Research has however consistently demonstrated systemic failure among clinicians to correctly diagnose and manage ear infections. With recent advancements of pattern recognition techniques, including deep learning, there has been increasing interest in the opportunity to automate the diagnosis of ear infections. While there are some previous studies that successfully apply machine learning to classify ear drum photos, these methods were developed and evaluated in non-real world settings and used single, crisp, still-shot photos of the eardrum that would be labor-intensive to acquire in uncooperative pediatric patients. Contrary to previous works, we present a deep anomaly detection based method that flags otoscopy video sequences as normal or abnormal, achieving a promising first step towards automated analysis of otoscopy video for in-clinic or at-home screening.

Temporal bone rhabdomyosarcoma is an aggressive entity that simulates chronic otitis ear infection. It is the most common soft tissue sarcoma amongst pediatric patients. Herein, we would like to report a case of temporal bone rhabdomyosarcoma involving a 2-year-old boy who presented with a one-month history of otorrhea with facial asymmetry. Early treatment led to remission of this severe neoplasm.

Otitis media (OM) or middle ear disease is a prevalent pediatric condition generally related to early growth of the cartilaginous Eustachian tube (CET). This study used a developmental series of dry crania to reconstruct CET and dilator tubae (DT, the muscle opening the CET) morphology. Timing and directionality of CET and upper respiratory tract (URT) growth were investigated. Traditional and 3D geometric morphometrics (GM) were used to assess bony landmarks on the crania. The series was divided using dental eruption into 7 growth stages ranging from before eruption of deciduous dentition (approximately the first 6 postnatal months) to eruption of the first permanent maxillary molar (after approximately 6 years). Bony endpoints of the CET and DT were used to calculate their morphology. GM analysis showed substantial shape differences between newborns, early infants and all later developmental stages. Univariate measures showed the largest growth change between birth and 6 months. Subsequently, CET morphology changed little in the latter half of year 1, instead maturing gradually until approximately 3 years whereas DT relative length and orientation finish growth by the end of year one. Incongruence in slower CET growth and faster DT growth could impact CET function between 6 and 12 months and be a contributing factor of OM. Tubal aeration may improve after this time when both CET and DT morphology mature, coinciding with clinically reported drop-off in ear infections. This article is protected by copyright. All rights reserved.

1. Yixian Li, MD* 2. Samuel J. Huang, MD* 3. Michael J. McManus, MD* 1. *Department of Pediatrics, Marshfield Clinic Health System, Marshfield, WI 1. Address correspondence to Michael J. McManus, MD, Department of Pediatrics, Marshfield Clinic Health System, 1000 North Oak Ave, Marshfield, WI 54449. E-mail: mcmanus.michael{at}marshfieldclinic.org An 18-month-old previously healthy girl presents to her pediatrician’s office with fever, rhinorrhea and cough for 4 days. Her highest temperature at home was 102.4°F (39.1°C). Parents notice that her right eye is not closing as tightly as her left eye. This is particularly apparent when she cries. Otoscopic examination reveals that her right ear canal is occluded by “hard cerumen.” Removing the cerumen in the office causes minimal bleeding. The right tympanic membrane is partially visualized, appearing injected and bulging with purulent effusion. Examination confirms that the right eye does not close as tightly as the left eye when she cries. However, when the patient is calm, her facial expression appears symmetric. She is diagnosed with right acute otitis media and questionable right facial nerve palsy (Bell’s palsy). Parents are instructed to observe her symptoms of facial nerve palsy at home and return to clinic for evaluation if the symptom does not resolve spontaneously. She is treated with a course of amoxicillin for 10 days with apparent resolution of illness. Two weeks later, the patient is seen by another pediatrician for a well-child visit and is further treated with amoxicillin clavulanate for a persistent right ear infection. And 4 weeks after initial presentation, she is evaluated for intermittent bleeding from her right ear. Parents express concern for a foreign body in the ear canal. No concern for right eye closing is mentioned by parents during those visits, nor do pediatricians notice any facial asymmetry. A fleshy mass is noted in the …

The eye, nose, and throat (ENT)-related diseases are a great problem in the pediatric population, but the mortality is low, whereas complication rates are increasing in spite of the improvements in health care facilities. In children, middle ear infection is the most common disease, the reason being alterations in the eustachian tube anatomy, being straighter in children than adults. Nearly 42 million people (age >3 years) are facing a hearing loss, mainly because of otitis media, second only to the common cold as a cause of infection in kids, also the commonest cause of mild-to-moderate hearing impairment in industrializing countries. In the population above 5 years of age, nearly 16% suffer from this disorder and more than 55% of these cases occur in school-going children, generally from the lower socioeconomic class (Idu et al. 2008; Baldry and Hind 2008; Zumbroich 2009; Nepali and Sigdel 2012). Respiratory tract symptoms such as cough, sore throat, and earache are also frequent in children. Upper respiratory tract infections predispose a child to complications such as otitis media, tonsillitis, and sinusitis. Tonsillitis most often occurs in children, a condition rarely appreciated in kids below 2 years. Viral tonsillitis is more common in younger children, while tonsillitis caused by Streptococcus species typically occurs in children aged 5–15 years (Nepali and Sigdel 2012).

The study highlights the presence of pathogenic strains of microorganisms in two swimming pools, highly frequented in the city of Yaounde. Thus, the water samples from these swimming pools have undergone physicochemical and biological treatments using conventional techniques. Three groups of microorganisms (Bacteria, Protozoa, and Helminths) were identified and quantified in these swimming pools with weakly acidic waters (6.79 ± 0.35) with an average temperature of 26.63 ± 0.53 °C and suspended matter ranging from 2 to 150 mg.l−1. The total bacterial load varies between 8 × 103 and 6000 × 103 CFU/100 ml. It consists of mesophilic aerobic heterotrophic bacteria, fecal coliforms, total coliforms, fecal streptococci, Staphylococcus aureus, and Pseudomonas aeruginosa. Protozoan cysts and oocysts range from 122 to 505 per liter of water. These values are slightly lower for helminth eggs and larvae (0 to 108 eggs and larvae/l). In both swimming pools, significant correlations were observed between some abiotic and biotic parameters. The waters of the studied swimming pools are subject to fecal pollution. Swimmers would therefore be exposed to biological contaminations, responsible for pathologies. The most common diseases are linked to gastroenteritis (diarrhea), but infections of all kinds may be overgrown (conjunctivitis, ear infections, dermatitis, respiratory infections).

Background: Acute otitis media (AOM) is the most common disease in young children requiring antibiotic treatment. Information on AOM-related determinant risk factors in primary school children is still limited, particularly in Indonesia. This study aims to identify risk factors related to AOM in primary school children in Banyumas Regency, Central Java, Indonesia. Design and Methods: This is an analytical study with a casecontrol design in Banyumas Regency, Indonesia. 3574 children from 6 regions of the Banyumas Regency were recruited for the screening of AOM detection, and confirmation of AOM diagnosis was determined by Otolaryngologist. One hundred and twentyfive cases and 125 control were involved in this study. Data collection was carried out using a structured questionnaire focusing on several variables such as household cooking fuel, house environment, smoking exposure, knowledge of parents, and nutrition status. Univariate, bivariate using chi-square and multivariate with regression logistic was conducted for data analysis. Results: This study highlights the risk of household firewood use (p=0.003), poor nutritional status (p=0.009), and a family history of ear infections (p=0.015) with an increased risk of otitis media. Conclusions: Household firewood use, poor nutritional status and family history of ear infection are factors associated with the occurrence of acute otitis media. It is necessary to provide public health education to prevent exposure to fuel at risk for children and to improve their nutritional status. Significance for public health This study has important public health benefits because it offers valuable information about Acute Otitis Media (AOM) that is still limited in previous studies, particularly in Indonesia. This study confirms that problems related to AOM are still important because cases are still present in the community, particularly among primary school children. The basic advantage of this paper is the information that household firewood use, poor nutritional status and family history of ear infection are factors associated with acute otitis media in primary school children. This critical knowledge should be followed up by related parties to prevent the incidence of AOM cases in the community.

Background The hearing function at a given age seems to have improved in more recent born cohorts in industrialized countries. But the reasons for the improvement have not yet been explained. Methods We investigated the extent to which better hearing in Norway is attributed to modifiable risk factors by using representative demographic and audiometric data from two cohorts of the Trøndelag Health Study, HUNT2 (1996–1998) and HUNT4 (2017–2019). We estimated natural indirect effects using causal inference methods in order to assess whether cohort improvement in hearing thresholds (HTs) was mediated by occupational noise exposure, recurrent ear infections, smoking and education. Results The improvement in HTs from HUNT2 to HUNT4 was 2.8 and 3.0 dB at low respectively high frequencies. Together all risk factors mediated this improvement by 0.8 dB (95% CI 0.7–0.9) and 0.8 dB (95% CI 0.7–0.9) respectively, corresponding to mediated proportions of 27 and 28%. Substantial mediation was specifically found for occupational noise in men and recurrent ear infections in women (mediated proportions of 11 and 17% at high frequencies, respectively). Conclusions Increased education, less occupational noise exposure, ear infections and smoking contributed considerably to better hearing in Norway the last two decades.

Aim Most prescribed medicines during pregnancy are antibiotics, with unknown effects on a fetus and on the infant's acquired microbiome. This study investigates associations between in utero antibiotic exposure and ear infection trajectories over the first decade of life, hypothesising effects on early or persistent, rather than later-developing, ear infections. Methods Design and participants: The Longitudinal Study of Australian Children birth cohort recruited a nationally-representative sample of 5107 infants in 2004. Measures Mothers reported antibiotic use in pregnancy when a child was 3-21 months old (wave 1), and ongoing problems with ear infection every 2 years spanning ages 0-1 to 10-11 years (waves 1-6). Analysis Latent class models identified ear infection trajectories, and univariable and multivariable multinomial logistic regression determined odds of adverse trajectories by antibiotic exposure. Results A total of 4500 (88.1% of original sample) children contributed (mean baseline age 0.7 years; 51.3% boys); 10.4% of mothers reported antibiotic use in pregnancy. Four probability trajectories for ear infection emerged: 'consistently low' (86.2%), 'moderate to low' (5.6%), 'low to moderate' (6.7%) and 'consistently high' (1.4%). Antibiotic use in pregnancy was associated with children following 'consistently high' (adjusted odds ratio 2.04, 95% confidence interval 1.08-3.88, P = 0.03) and 'moderate to low' (adjusted odds ratio 1.78, 95% confidence interval 1.25-2.53, P = 0.001) trajectories. Conclusions Antibiotic use in pregnancy is associated with an increased risk of persistent and early childhood ear infections. This highlights the wisdom of cautious antibiotic use during pregnancy, and the need for the study of potential mechanisms underlying these associations.

Ankylosis of the temporomandibular joint (TMJ) is defined as the emergence of a bony or fibrous compound between the condyle and the cranial base. It can result in divergent craniofacial characteristics. The aim of this study was to present an orthodontic-surgical approach in a case series of 4 patients with a diagnosis of TMJ ankylosis as a complication of otomastoiditis. The patient characteristics of 4 patients in whom TMJ ankylosis was diagnosed as a complication of otomastoiditis were described. All patients were treated with gap arthroplasty with costochondral graft, physiotherapy, and orthodontic therapy to achieve acceptable mouth opening and function. All reacted differently to this therapy, and additional interventions were required during childhood. In early-onset ankylosis, however, guiding the mandibular growth orthodontically can prevent increasing facial asymmetry and canting of the occlusal plane. After the pubertal growth spurt is finished, orthodontic treatment combined with surgical intervention may be considered to correct facial asymmetry and provide good dental occlusion. Orthodontic and surgical treatments showed themselves to be fundamental for patients with TMJ ankylosis as a complication of otomastoiditis, although continual monitoring until the end of growth is necessary to achieve the most functional recovery possible. ispartof: JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY vol:78 issue:12 pages:2235-2246 ispartof: location:United States status: published

An ear infection (EI) is one of the most common pediatric illnesses. This study aimed to assess parental knowledge, care-seeking practices, and factors associated with them. A cross-sectional study involved a sample of parents attending hospitals in three selected cities in Iraq. Data were collected with a questionnaire composed of three parts: i) Sociodemographic characteristics, ii) Questions related to knowledge of symptoms, risk factors, and complications of an EI, and iii) Questions related to care-seeking practices. The mean age of respondents was 34.99 (±9.85) years. Females made up 58.90% of the sample. More than half reported holding tertiary education. Most participants showed satisfactory knowledge of EI symptoms (88.10%) and proper practices of seeking medical attention from a doctor or other medic (95.80%). Respondents with tertiary education had higher odds of having satisfactory knowledge (OR 4.63, 95% CI 1.18-18.19) and proper care-seeking practices (OR 14.96, 95% CI 1.12-28.80) than those with primary education and below. Current smokers had higher odds of having unsatisfactory knowledge (OR 0.12, 95% CI 0.02-0.70) than non-smokers. In conclusion, respondents had sufficient knowledge and care-seeking practices. Educational level was associated with adequate knowledge and care-seeking practices, and former smoking status was associated with unsatisfactory knowledge.

Introduction: The daily escalation in incidence and mortality caused by Coronavirus disease (COVID-19) has mandated forced curfew in our country (same as many other countries) to limit the spread of infection. This is predicted to have a more negative impact on cochlear implant (CI) patients since this group of patients needs a unique type of psychological, medical, and technical care in addition to a daily rehabilitation program. Methods: A cross-sectional study based on Arabic questionnaire that looked into the collateral consequences of COVID-19 on the pediatric CI patients. The questionnaire was designed to highlight different problems such as exposure to head trauma or ear infection, difficulties in device maintenance and getting spare parts, impacts of the delay of programing or switch on appointments, and the impacts of missing rehabilitation sessions. Different ways of management of these problems are presented and discussed. Results: A total of 174 parents responded to the questionnaire. The main problem met by the patients was missing their device programing and rehabilitation sessions. Many children had device maintenance and spare parts problems. Virtual clinics were helpful in solving different problems. Additionally, children who needed device programing were scheduled for remote programing sessions. Conclusion: Although the inevitable consequences of the COVID-19 pandemic are catastrophic, they are forcing the medical field to explore new opportunities by sitting up an infrastructure for future usage of telemedicine. Telemedicine is cost-effective and more convenient and enables health-care providers to be immune to future circumstances.

Background. Ear infections in children often cause abnormal postural stability. However, the long-term effects of recurrent ear infections on postural stability have not been investigated. Purpose. The purpose of this study was to examine the long-term effects of multiple ear infections on pediatric postural stability. Methods. Forty children aged 10-12 years were divided into two groups (18 participants with a history of tympanostomy tubes and/or 3 or more ear infections prior to age five and 22 participants without a history of tympanostomy tubes and/or 0-2 ear infections prior to age five). Computerized Stability Evaluation Test (SET) and noncomputerized postural stability were measured for all participants. Results. A significant difference was found in median postural stability scores in the SET during a tandem stance on an unstable surface between the two groups (median (minimum, maximum) of 9.1 (1.4, 11.4) versus 5.8 (1.7, 12.8), p = 0.04 ). In addition, there was a significant difference in median Pediatric Balance Scale scores between participants with versus without ear infection (54 (47, 56) versus 56 (55, 56), p = 0.001 ). Conclusions. Results suggest that children ages 10-12 with a history of tympanostomy tubes and/or 3 or more ear infections prior to age five have decreased postural stability.

There is substantial experimental evidence to indicate that Leishmania infections that are transmitted naturally by the bites of infected sand flies differ in fundamental ways from those initiated by needle inocula. We have used flow cytometry and intravital microscopy (IVM) to reveal the heterogeneity of sand fly transmission sites with respect to the subsets of phagocytes in the skin that harbor L. major within the first hours and days after infection. By flow cytometry analysis, dermis resident macrophages (TRMs) were on average the predominant infected cell type at 1 hr and 24 hr. By confocal IVM, the co-localization of L. major and neutrophils varied depending on the proximity of deposited parasites to the presumed site of vascular damage, defined by the highly localized swarming of neutrophils. Some of the dermal TRMs could be visualized acquiring their infections via transfer from or efferocytosis of parasitized neutrophils, providing direct evidence for the “Trojan Horse” model. The role of neutrophil engulfment by dermal TRMs and the involvement of the Tyro3/Axl/Mertk family of receptor tyrosine kinases in these interactions and in sustaining the anti-inflammatory program of dermal TRMs was supported by the effects observed in neutrophil depleted and in Axl-/-Mertk-/- mice. The Axl-/-Mertk-/- mice also displayed reduced parasite burdens but more severe pathology following L. major infection transmitted by sand fly bite., Author Summary Sand flies transmit Leishmania major which causes cutaneous leishmaniasis in humans and in non-human hosts. Our analyses of sand fly transmission sites of L. major in the mouse skin revealed that dermis resident macrophages (TRM) were the predominant phagocytes to take up the parasite within the first 24 hr post-bite. The early involvement of neutrophils varied depending on the proximity of deposited parasites to the site of tissue damage around which the neutrophils coalesced. By intra-vital microscopy, some of the dermal TRMs could be visualized acquiring their infections by direct transfer from or phagocytosis of parasitized neutrophils. The involvement of the Tyro3/Axl/Mertk family of receptor tyrosine kinases in these cellular interactions and in sustaining the anti-inflammatory functions of dermal TRMs was supported by the reduced parasite burdens but more severe pathology observed in Axl-/-Mertk-/- mice. The heterogeneity of sand fly transmission sites with respect to the dose of parasites and the early cellular interactions described here likely contribute to the wide range of infection outcomes that are associated with natural transmission of L. major observed in mouse models and possibly humans.

A growing number of vaccines are administered at the same time or in close succession, increasing the complexity of assessing vaccine safety. Individual vaccines are assumed to have no other effect than protection against the targeted pathogen, but vaccines also have nonspecific and interactive effects, the outcomes of which can be beneficial or harmful. To date, no controlled trials and very few observational studies have determined the impact of vaccination schedules on overall health. The balance of the risks and benefits from mass vaccination therefore remains uncertain. Recent studies worryingly suggest links between multiple vaccinations and increased risks of diverse multisystem health problems, including allergies, infections, and neuropsychiatric or neurodevelopmental disorders. Here, we propose that, in susceptible persons, multiple vaccinations activate the retinoid cascade and trigger apoptotic hepatitis, leading to cholestatic liver dysfunction, in which stored vitamin A compounds (retinyl esters and retinoic acid) enter the circulation in toxic concentrations; this induces endogenous forms of hypervitaminosis A, with the severity of adverse outcomes being directly proportional to the concentration of circulating retinoids. In very low concentrations, vitamin A and its major metabolite retinoic acid contribute to immune function and to the process of immunization, whereas excess vitamin A increases the risk of adverse events, including common “side-effects” as well as chronic adverse outcomes. The increasing rates of allergy, ear infections, and neurodevelopmental disorders (NDDs) in countries with high rates of vaccination could be related to mass vaccination and to its impact on liver function and vitamin A metabolism, collectively representing endogenous manifestations of hypervitaminosis A. Further studies of health outcomes in vaccinated and unvaccinated groups are urgently needed, to increase understanding of the pathophysiology and treatment of vaccine injury, to identify the risk factors and screen for vaccine injury, to inform public health policy on potential hazards related to vaccination schedules, and to optimize the safety and benefits of vaccines.

Primary immunodeficiencies (PID) are found in around 1 in 10,000 American children and 1 in 20,000 children in Europe. Given the difficulty in recognising the condition, clinicians need to be alert to the possibility of PID, if they are to identify it at an early stage. Groups representing both patients and their families have identified a 10-point checklist of warning signs showing PID. The signs include the following: (1) at least four separate ear infections within 12 months; (2) at least two grave sinusal infections within 12 months; (3) antibiotic treatment by mouth with a duration of 2 months minimum, with minimal benefit; (4) pneumonia at least twice within 12 months; (5) an infant fails to achieve expected growth; (6) a deep cutaneous abscess, or abscess within an organ, that recurs; (7) oral candidiasis that persists or mucocutaneous fungal infections; (8) only when antibiotics are given parenterally do they resolve infections; (9) firmly entrenched infection, e.g. septicaemia, on at least two occasions; and (10) PID in a genetic relative. In this chapter, immunodeficiency and ENT diseases are discussed in detail.

Myiasis is the infestation of live vertebrates with dipterous larvae. It is a rare entity in the otolaryngology and is more common to occur in patients with mental or physical disabilities. There are only few cases reported in the literature, and most cases are seen in tropical and rural areas. In this case report, we present a 65-year-old patient, with a history of parotid malignancy, who presented with aural myiasis with extension to the mastoid. We discuss the clinical presentation, the further examinations, and the treatment for early- and late-stage infection.

Background: β-lactam antibiotics are one of the most used medications for treatment of bacterial infections, mainly those involving the upper and lower respiratory tract. However, the development of antibiotic resistances largely reduced their effectiveness. Aims and Objectives: To compare β-lactam antibiotics in terms of treatment failure, which was evaluated as switch from one antibiotic to another β-lactam or another antibiotic class for the same indication. Methods: Using Health Search Database, we identified a cohort of patients with an incident prescription of β-lactam antibiotics. Patients were followed until the occurrence of switch to another antibiotic. Results: 178,256 incident users of β-lactams were identified and 1,172 (0.65%) of them were switched to another antibiotic within 30 days. Overall, amoxicillin-clavulanate reported the lowest (0,42%) degree of switching among β-lactams. Using multivariate logistic regression model and excluding incident users of parenteral antibiotics, amoxicillin-clavulanate showed the lowest risk of treatment failure compared to the other β-lactams, namely amoxicillin (odds ratio (OR) as compared to amoxicillin-clavulanate: 1.67 (95% CI 1.39-2.01)) and cefuroxime (OR: 3.05 (95% CI 2.16-4.29)). Estimating the switch rate stratified by indication of use, amoxicillin-clavulanate was associated with lowest rate of switch for lower respiratory tract infections (LRTIs), dental infections and middle ear infections. Conclusions: Our findings indicate that amoxicillin-clavulanate was associated to a lower rate of treatment failure when compared to other β-lactam antibiotics prescribed for LRTIs, dental infections and ear infections

Key Points Questions Among middled-aged adults, are self-reported measures of hearing concordant with audiometry findings, and is potential discordance associated with age or lifestyle factors? Findings In this cross-sectional study of 9666 participants in the English Longitudinal Study of Ageing, self-report measures of hearing had limited accuracy and were not sufficiently sensitive to detect hearing loss. Hearing loss went undetected by the self-reported measures. Meaning These findings may inform public health policies relevant to selection of appropriate and validated tools for detecting hearing problems among middle-aged and older adults., Importance An effective and sustainable hearing loss (HL) screening strategy for the early detection of and intervention for HL in older adults is needed. Objectives To examine the concordance of self-reported measures of hearing difficulty with objective hearing data and the factors associated with the potential discordances among these measures across different population subgroups of a representative sample of people 50 years and older in England. Design, Setting, and Participants This study was a cross-sectional analysis of wave 7 of the English Longitudinal Study of Ageing (ELSA), a large, population-based, prospective cohort study that provides a unique resource for exploring issues associated with aging in England in the 21st century. The full analytic cohort was composed of 9666 individuals participating in the ELSA wave 7, which collected information from June 1, 2014, to May 31, 2015. This study further analyzed a sample of 8529 adults 50 to 89 years of age who had an assessment of their hearing by self-reported measures, and consented to assessment by a qualified nurse via a hearing screening device, and did not have an ear infection or a cochlear implant. Bivariate analyses were performed from July 1 to December 30, 2018, and multivariate analysis from January 1 to June 30, 2019. Multiple logistic regression models examined factors associated with misclassification of hearing difficulties across several categories among those with objectively identified HL. Exposures The study examined whether age, marital status, retirement status, indicators of socioeconomic position, and lifestyle factors (such as body mass index, physical activity, and tobacco and alcohol consumption) were associated with the concordance between self-reported hearing problems and manual audiometry among older adults. Main Outcomes and Measures Self-reported hearing measures, including hearing in background noise, compared with objective audiometric assessments. Results A total of 9666 study participants (5368 female [55.5%]; mean [SD] age, 67.4 [14.4] years) provided responses regarding their hearing difficulties, hearing in noise, quality of care in hearing, and hearing aid recommendation in ELSA wave 7. Within the cohort, 684 individuals (30.2%) with objectively measured HL greater than 35 dB HL at 3.0 kHz went undetected by the self-report measure, whereas the new constructed categories for moderate and moderately severe or severe HL resulted in 9.3% increased sensitivity. Factors associated with misreporting hearing difficulties (while they had objectively measured HL >35 dB HL at 3.0 kHz, in the better-hearing ear) were as follows: female sex (odds ratio [OR], 1.97; 95% CI, 1.18-3.28), no educational qualifications (OR, 1.37; 95% CI, 1.26-2.55), routine or manual occupation (OR, 1.43; 95% CI, 1.28-2.61), tobacco consumption (OR, 1.14; 95% CI, 1.08-1.90), alcohol intake above the low-risk-level guidelines (OR, 1.13; 95% CI, 1.11-2.34), and lack of moderate physical activity (OR, 1.25; 95% CI, 1.03-1.42). Age was largely associated with misreporting of moderately severe to severe HL; the odds were 5.75 (95% CI, 1.17-8.13) higher for those 65 to 74 years of age and 7.08 (95% CI, 1.41-9.30) higher for those 75 to 89 years of age to not report their hearing difficulties compared with those 50 to 64 years of age. In addition, socioeconomic indicators, such as educational level (OR, 1.95; 95% CI, 1.63-6.01) and occupation (OR, 2.07; 95% CI, 1.78-5.40), along with lifestyle factors, such as smoking (OR, 1.46; 95% CI, 1.25-2.48) and alcohol intake above the low-risk-level guidelines (OR, 1.86; 95% CI, 1.67-5.12), were factors associated with misreporting moderately severe or severe HL. Conclusions and Relevance The use of a screening measure for audiometric testing and a self-report measure is essential for accurately identifying older people with HL. The results of this study should be considered by HL researchers who analyze self-reported hearing data as a surrogate measurement of audiometric hearing to identify bias in their observed analytic research results., This cross-sectional study examines the concordance of self-reported measures of hearing difficulty with objective hearing data and the factors associated with the potential discordances among these measures in people 50 years and older in England.

Objective Chronic otorrhoea is a disease of the ear that lasts for more than 6-12 weeks, through a perforated tympanic membrane. We sought to determine the cause of chronic suppurative otitis media (CSOM) at our institute. Methodology Ear swabs taken from enrolled patients (n=139) were sent for culture and sensitivity. Statistical analysis was done using Statistical Package for Social Sciences (SPSS), version 26 (IBM Corp., Armonk, NY) Results Common pathogenic bacteria in chronic otitis media observed were Pseudomonas aeruginosa 81 (58%) while Klebsiella pneumoniae was found in 58 (42%) of cases. Conclusion We concluded that Pseudomonas aeruginosa was the most common causative agent of CSOM at our institute.

Over 5% of the world's population has disabling hearing loss, which affects approximately one third of individuals over 65 years. Hearing aids are commonly used in this population group, but prolonged use of these devices may cause ear infections. We describe for the first time, the use of 3D printing to fabricate hearing aids loaded with two antibiotics, ciprofloxacin and fluocinolone acetonide. Digital light processing 3D printing was employed to manufacture hearing aids from two polymer resins, ENG hard and Flexible. The inclusion of the antibiotics did not affect the mechanical properties of the hearing aids. All multi-drug-loaded devices exhibited a hydrophilic surface, excellent blood compatibility and anti-biofilm activity against P. aeruginosa and S. aureus. Hearing aids loaded with ciprofloxacin (6% w/w) and fluocinolone acetonide (0.5% w/w) sustained drug release for more than two weeks and inhibited biofilm formation on the surface of the devices and bacteria growth in the surrounding medium. In summary, this work highlights the potential of vat photopolymerization 3D printing as a versatile manufacturing approach to fabricate high-fidelity patient-specific medical devices with anti-bacterial properties.