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Background: Otitis media (OM) is the most frequent and complex middle ear condition with multifactorial etiology including genetic predisposition. OM depicts a variable clinical spectrum, leading to speech, developmental delay, and hearing loss. Here, we report the clinical and genetic findings of chronic suppurative otitis media (CSOM) segregating in a six‐generation consanguineous Pakistani family PKOM08. Methods: Clinical evaluations, including audio and tympanometry, were conducted to assess OM manifestation and their impact on hearing function. Exome sequencing was performed to identify potential genetic variants underlying CSOM in the study participants. Results: Clinical evaluation of participating individuals revealed varying degrees of disease severity, with mild to moderate hearing loss. All the affected individuals had CSOM with no other apparent comorbidity. Whole exome followed by Sanger sequencing revealed two rare heterozygous variants [c.1867C>T, p.(Pro623Ser) and c.11015G>A, p.(Arg3672Gln)] of BSN gene in most of the affected individuals of family PKOM08. BSN encodes a scaffold bassoon protein involved in synaptic vesicle trafficking. The identified variants replaced evolutionary conserved amino acid residues in the encoded protein and are predicted to impact the ionic interactions in the secondary structure. Conclusion: A deep intronic variant of BSN has been previously implicated in the etiology of childhood ear infections. Our study further supports a link between BSN‐impaired function and ear infection and CSOM in children. [ABSTRACT FROM AUTHOR]

Ear infections are a common health problem, the most common microorganism which cause of infection is Pseudomonas aeruginosa. The study aimed to detection for bacterium ability of virulence factors production, molecular detection on that Exoenzyme effectors. The results of P. aeruginosa is the most type at18.62%. This bacterium was had a high level of resistance to the Ticarcillin antibiotic at 73.69%, were 10% of isolates (MDR), 42% (XDR) and 5% (PDR), production was each of the biofilm at 89.47%, protease enzyme at 79.94%, and Metallo betalactamase at 47.36%. Presence of exoenzyme genes (exoS:57.89%, exoT: 84.21%, exoU: 73.68% and exoY: 89.47%). [ABSTRACT FROM AUTHOR]

Abstract Background Otitis media (OM) is the most frequent and complex middle ear condition with multifactorial etiology including genetic predisposition. OM depicts a variable clinical spectrum, leading to speech, developmental delay, and hearing loss. Here, we report the clinical and genetic findings of chronic suppurative otitis media (CSOM) segregating in a six‐generation consanguineous Pakistani family PKOM08. Methods Clinical evaluations, including audio and tympanometry, were conducted to assess OM manifestation and their impact on hearing function. Exome sequencing was performed to identify potential genetic variants underlying CSOM in the study participants. Results Clinical evaluation of participating individuals revealed varying degrees of disease severity, with mild to moderate hearing loss. All the affected individuals had CSOM with no other apparent comorbidity. Whole exome followed by Sanger sequencing revealed two rare heterozygous variants [c.1867C>T, p.(Pro623Ser) and c.11015G>A, p.(Arg3672Gln)] of BSN gene in most of the affected individuals of family PKOM08. BSN encodes a scaffold bassoon protein involved in synaptic vesicle trafficking. The identified variants replaced evolutionary conserved amino acid residues in the encoded protein and are predicted to impact the ionic interactions in the secondary structure. Conclusion A deep intronic variant of BSN has been previously implicated in the etiology of childhood ear infections. Our study further supports a link between BSN‐impaired function and ear infection and CSOM in children.

Reductions in all-cause otitis media (OM) following widespread pneumococcal conjugate vaccine use have plateaued. Granular burden of disease data are needed to guide evaluation and implementation of new measures targeting OM prevention. We conducted a retrospective study to assess the incidence and treatment costs of OM, tympanostomy tube placement (TTP), and hearing loss in children aged

Chamomile (Matricaria chamomilla) is a plant with known antimicrobial, anti-inflammatory, and analgesic properties. Homeopathic drops containing chamomile extract are often used for ear pain and chronic ear infections. We aimed to evaluate the antimicrobial effect of over-the-counter eardrops containing chamomile against organisms causing bacterial conjunctivitis and otitis externa. Liquid cultures of Streptococcus aureus and Pseudomonas aeruginosa were exposed to increasing concentrations of eardrops containing chamomile extract. Liquid cultures of S. aureus and Streptococcus pneumoniae were exposed to increasing concentrations of chamomile eye drops for 5, 10, 15, and 45 min. Colony forming units (CFUs) were assessed after 18 h. Viability assays for these organisms were performed using the resazurin microdilution assay. We observed a reduction in the number of P. aeruginosa CFUs when the bacteria were exposed to any of the three concentrations of the chamomile drops as early as 5 min, with maximal reduction upon exposure to the 30% concentration at 45 min. Reduction in S. aureus CFUs, on the other hand, was observed for all three concentrations as maximal in the 5 min of exposure. We observed a marked reduction in the number of S. aureus CFUs upon exposure to any of the three preparations of chamomile-containing eye drops, which was almost immediate at 10% concentration. Streptococcus pneumoniae reduction happened at 5 min and continued through the 45-min observation period for all three concentrations. Our findings suggest that over-the-counter ear drops containing chamomile extract could potentially be used as a non-prescription treatment for mild cases of otitis externa and bacterial conjunctivitis. [ABSTRACT FROM AUTHOR]

Objective: In the tropical and subtropical areas otomycosis is a very common fungal infection of the ear worldwide. Aim of our study is to identify the role of occupation in causing otomycosis and to see the status of opposite ear of the patients. Materials and Methods: Here the patients who met the inclusion criteria for this crosssectional study are included and examined after taking written informed consent. After obtaining a thorough medical history, ear swabs from affected ear and opposite ear collected for culture, sensitivity, and potassium hydroxide were provided. Patients with positive culture results were studied between September 2019 and March 2021. Results: • Among 103 cases observed for 18 months in the Department of ENT, Rajarajeswari Medical College, and Hospital, Bengaluru, India, we found that males (56.31%) were more affected than females (43.68%). • The most common predisposing factor was the usage of earbuds (26.21%) followed by water in the ear (23.3%) and oil in the ear (16.50%). • Unilateral infection was most common (96%), and the left ear was most affected (64.07%). • 36 (34.95%) were farmers, 31 (30.097%) were homemakers, 16 (15.53%) were labourers, 12 (11.65%) were students, 8 (7.76%). • 93 patients (90.29%)) had normal opposite ear followed by 9(8.73%) safe type CSOM opposite ear and one unsafe ear. Conclusion: • The most common predisposing factor of otomycosis is the usage of earbuds in the ear followed by water entry in the ear. • Farmers are the first to get otomycosis followed by homemakers • Status of the opposite ear is normal in most of the cases. [ABSTRACT FROM AUTHOR]

To determine the bacterial pathogens in chronic suppurative otitis media (CSOM) & the antibiotic susceptibility patterns of isolates among patients. A total of 400 patients clinically diagnosed with CSOM were interviewed &middle-ear effusion samples were collected using sterile swabs. All bacterial isolates were identified by conventional microbiological methods. Antibiotic susceptibility patterns of the isolates were determined by Kirby–Bauer disc diffusion. Pseudomonas aeruginosa (30.25%) were the most prevalent bacteria isolated, followed by S. aureus (MSSA) (18.5%) & MRSA (8.25%). The most effective antibiotic for treatment of bacterial CSOM was amikacin & ciprofloxacin. Statistical analysis showed no significant difference in bacterial infestations among CSOM patients & the antimicrobial susceptibility patterns of the bacterial isolates based on age (p > 0.05). The importance of a continuous & annual evaluation of bacteriological profile & antibiotic susceptibility patterns in CSOM patients is highlighted in our study. [ABSTRACT FROM AUTHOR]

Background: Chronic otitis media is recurrent infection of the middle ear and mastoid air cells in the setting of perforation of the tympanic membrane. Risk factors for chronic otitis media include predisposing characteristics such as gender, allergies, Eustachian tube dysfunction, history of acute otitis media, and upper respiratory tract infection. The purpose of this study was to evaluate the potential relationship between chronic otitis media and epitympanic recess volume. Materials and Methods: A total of 197 patients with chronic otitis media had their epitympanic recess volume compared to the epitympanic volume of 99 healthy controls. The epitympanic recess volume was measured via the 3D volumetric measurement tool of the local PACS. Epitympanic recess volume measurement was performed using axial sections in a plane starting from the level of the malleus head–anvil body in the craniocaudal direction to the tegmen tympanum. Results: It was shown that patients with bilateral involvement had an epitympanic recess volume of 75.00 mm3, compared to 72.30 mm3 in those with unilateral chronic otitis media. The healthy control group’s median value for the epitympanic recess was 74.73 mm3. Conclusions: Epitympanic volume values did not differ substantially between patients with chronic otitis media and healthy persons, and epitympanic volume was not recognized as a predisposing factor (p = 0.686).

Background: Data from the onset of the Coronavirus Disease 2019 (COVID-19) pandemic has revealed a broad spectrum of clinical conditions and comorbidities. Secondary infections, such as sinonasal mucormycosis, have become more frequent due to COVID-19-related immunosuppression and its subsequent treatments. Skull base osteomyelitis is another potentially fatal infection that is prevalent among immunocompromised individuals. Angiotensin-Converting Enzyme 2 (ACE2) receptors in the external auditory canal may also be implicated in cases of external otitis linked to COVID-19. Case Report: This report discusses two cases of treatment-resistant external otitis and skull base osteomyelitis in two elderly, immunosuppressed patients (with diabetes mellitus and chronic renal failure) who had previously been treated for COVID-19. In both cases, neither topical nor intravenous antibiotic treatments were effective, leading to referrals for hyperbaric oxygen therapy. Conclusion: For patients exhibiting persistent ear discharge and a history of COVID-19, it is imperative to avoid underestimating a potential diagnosis of skull base osteomyelitis and to pursue early imaging. [ABSTRACT FROM AUTHOR]

Ear infections are extremely common and widespread otological disorders in children and adults. Accordingly, it is critical to identify the etiological factors and determine their antimicrobial susceptibility to achieve successful clinical outcomes. Ear swab samples were collected from patients aged 10-69 years at the Al-Sadar Teaching Hospital in Al-Amara city and cultured using the standard microbiological methods. The VITEK 2-compact system was used to analyze the bacterial isolates. A total of 100 samples were obtained; ear infection was slightly elevated in men (58%), but this was not significant. A significantly higher incidence of ear infection was observed in the patients aged 10–19 years (P≤ 0.05). Of the 100 examined ear swab samples, 76 yielded positive culture results, and of these, 61 were axenic and 15 were mixed. Among the 91 retrieved bacterial isolates, Pseudomonas aeruginosa (24/91, 26.3%) and Staphylococcus aureus (21/91, 23%) were the common causative agents of ear infection, while Haemophilus influenzae (2/91, 2.19%) and Staphylococcus hominis (1/91, 1.09%) were less common. Most bacterial isolates showed high sensitivity to imipenem and amikacin (87.9% and 79.1%, respectively; P≤ 0.01), followed by ciprofloxacin and gentamicin (67% and 60.4%, respectively; P≤ 0.05), and low sensitivity to amoxicillin/clavulanic acid and ampicillin (15.3% and 6.6%, respectively). Multidrug resistance was observed in most of the isolates.

Bacterial infection of the ear, especially amongst children from low-income countries, is a major cause of hospitalization, presenting in different forms and severity. The prevalence and antibiotic profile of bacteria associated with ear infection amongst children between the ages 0–10years presenting with symptoms was determined using standard microbiological procedures and Kirby-Bauer disk diffusion methods. The results showed an 89.6% prevalence rate of bacterial ear infections, with males and children aged 0–1 years accounting for 53.7% and 28.9% of cases respectively. Pseudomonas spp. was the most prevalent (32.6%) bacteria isolated, while Klebsiella spp. was the least prevalent (8.9%). Male children had higher distribution and presence of bacterial growths than their female counterparts. Antimicrobial assay revealed high susceptibility rates as well as multidrug resistance of the bacterial isolates to the antibiotics tested. Cefuroxime and Augmentin were most effective against all isolates. This study showed a high prevalence of bacterial-associated ear infections dominated by Pseudomonas spp. and more prevalent in males and children between 0 and 3 years old. This calls for improved postnatal care education and child hygiene by nursing mothers, midwives and nannies to forestall and prevent any public health challenge that might arise from the uncontrolled spread and increase in pathogenicity of infections caused by the isolates.

Background: Chronic otitis media is recurrent infection of the middle ear and mastoid air cells in the setting of perforation of the tympanic membrane. Risk factors for chronic otitis media include predisposing characteristics such as gender, allergies, Eustachian tube dysfunction, history of acute otitis media, and upper respiratory tract infection. The purpose of this study was to evaluate the potential relationship between chronic otitis media and epitympanic recess volume. Materials and Methods: A total of 197 patients with chronic otitis media had their epitympanic recess volume compared to the epitympanic volume of 99 healthy controls. The epitympanic recess volume was measured via the 3D volumetric measurement tool of the local PACS. Epitympanic recess volume measurement was performed using axial sections in a plane starting from the level of the malleus head–anvil body in the craniocaudal direction to the tegmen tympanum. Results: It was shown that patients with bilateral involvement had an epitympanic recess volume of 75.00 mm3, compared to 72.30 mm3 in those with unilateral chronic otitis media. The healthy control group's median value for the epitympanic recess was 74.73 mm3. Conclusions: Epitympanic volume values did not differ substantially between patients with chronic otitis media and healthy persons, and epitympanic volume was not recognized as a predisposing factor (p = 0.686). [ABSTRACT FROM AUTHOR]

Background: Otitis media is the second most common pediatric disease in the world and family, especially mothers, play an important role in prevention of this disease in children. The present study aimed to determine the knowledge, attitude, and performance of mothers regarding preventive behaviors of otitis media in infants. Methods: This analytical cross-sectional study was conducted by random sampling method on 240 mothers of infants referring to health centers of Arak City, Iran, in 2021. Data were collected by a questionnaire whose reliability and validity were previously confirmed and were analyzed with SPSS software using descriptive and analytical statistical tests including Spearman correlation coefficient and independent t-test. P < 0.05 was considered as the significance level. Findings: The mean age of children was 11.40 ± 6.05 months and 194 (80.8%) mothers were housewives. 16.2% of mothers had desirable knowledge about otitis media and 67.1% had moderate knowledge. 92.5% of mothers had desirable attitude and 7.5% had moderate attitude. Besides, performance score was desirable in 58.3% of mothers, moderate in 39.2%, and weak in 2.5%. There was a significant relationship between knowledge score with attitude of mothers (r = 0.320, P < 0.001) and performance (P < 0.050). The demographic variables including mother’s education, number of children, family income, knowledge, and attitude predicted 0.118% of maternal performance variance in prevention of otitis media in infants. Conclusion: Most mothers had weak or moderate knowledge and performance about prevention of otitis media in infants. Mother's background factors including education and household income are effective in this field. Therefore, educational planning is necessary to improve the knowledge and performance of mothers.

Objective: Otomycosis is a common fungal ear infection in tropical and subtropical regions worldwide. This study aimed to perform mycological analysis on fungal debris from the external auditory canals of the patients to study the most common clinical presentation and fungal species distribution in otomycosis. Materials and Methods: Patients who met the inclusion criteria for this cross-sectional study were included and evaluated after providing written informed consent. After obtaining a thorough medical history, ear swabs for culture, sensitivity, and potassium hydroxide were provided. Patients with positive culture results were studied between September 2019 and March 2021. Results: Among 103 cases observed for 18 months in the Department of ENT, Rajarajeswari Medical College, and Hospital, Bengaluru, India, we found that males (56.31%) were more affected than females (43.68%). Itching (67.96%) was the most primary and common symptom that was observed, followed by pain (20.38%), and the most common predisposing factor was the usage of earbuds (26.21%) followed by water in the ear (23.3%) and oil in the ear (16.50%). Unilateral infection was most common (96%), and the left ear was most affected (64.07%). Aspergillus niger was the most common fungal isolate (60.19%), and otomycosis was very common in postmonsoon (October–December) (58.25%). Conclusion: The most frequent fungal isolates in otomycosis are from the Aspergillus and Candida species. The left ear was typically affected by otomycosis, which frequently had a unilateral predominance. The most common clinical symptoms were itching and pain.

Ear infections are extremely common and widespread otological disorders in children and adults. Accordingly, it is critical to identify the etiological factors and determine their antimicrobial susceptibility to achieve successful clinical outcomes. Ear swab samples were collected from patients aged 10-69 years at the Al-Sadar Teaching Hospital in Al-Amara city and cultured using the standard microbiological methods. The VITEK 2-compact system was used to analyze the bacterial isolates. A total of 100 samples were obtained; ear infection was slightly elevated in men (58%), but this was not significant. A significantly higher incidence of ear infection was observed in the patients aged 10-19 years (P≤ 0.05). Of the 100 examined ear swab samples, 76 yielded positive culture results, and of these, 61 were axenic and 15 were mixed. Among the 91 retrieved bacterial isolates, Pseudomonas aeruginosa (24/91, 26.3%) and Staphylococcus aureus (21/91, 23%) were the common causative agents of ear infection, while Haemophilus influenzae (2/91, 2.19%) and Staphylococcus hominis (1/91, 1.09%) were less common. Most bacterial isolates showed high sensitivity to imipenem and amikacin (87.9% and 79.1%, respectively; P≤ 0.01), followed by ciprofloxacin and gentamicin (67% and 60.4%, respectively; P≤ 0.05), and low sensitivity to amoxicillin/clavulanic acid and ampicillin (15.3% and 6.6%, respectively). Multidrug resistance was observed in most of the isolates. [ABSTRACT FROM AUTHOR]

This is a report of Kodamaea ohmeri isolated from a 2-year-old febrile child with stable vitals. Frank discharge of pus was present. Microbial culture testing revealed the presence of K. ohmeri. Antifungal susceptibility was performed along with intravenous antibiotic administration and antifungal ear drops in view of the discharge.

Childhood ear infections are highly prevalent and diagnosed with the otoscope, a simple tool that illuminates and magnifies the eardrum to subjectively assess color, translucency and presence of any middle ear fluid. Frequently, however, this view is obstructed by cerumen, complicating clinician assessment and appropriate and effective management. An optical coherence tomography (OCT)‐otoscope capable of capturing both depth‐resolved OCT images and digital color surface images was used to compare OCT against otoscopy for imageability and readability despite cerumen obstruction. Image data were collected from 26 human subjects and read by 12 blinded clinicians and 5 blinded OCT experts. An average of 64.6% of otoscopy views were obstructed. For cases with >75% otoscopy view obstruction, OCT imageability was 84.6%, while otoscopy imageability was 37.5%, excluding complete obstruction cases. OCT‐otoscopy is a promising technology to improve practical middle ear assessment despite the presence of obstructions that frequently render current diagnostic assessments ineffective. [ABSTRACT FROM AUTHOR]

Abstract 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 (r s = − 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.

Nocardia belongs to the order Actinomycetales suborder Corynebacteriaceae, family Nocardiaceae. It causes infections mostly in immunocompromised individuals. It primarily causes pulmonary infections, followed by central nervous system infections, cutaneous and disseminated infections. Cutaneous infections are reported in immunocompetent individuals also. Because of the growth characteristics, it is difficult to recover the organisms in culture. The recent advanced molecular technology has made identification of the organism to species level possible. Chronic Suppurative Otitis Media (CSOM) due to Nocardia spp is rarely reported. Here, authors report a case of CSOM caused by Nocardia farcinica in a 47-year-old female. The patient was on steroid therapy for bronchial asthma. Culture of ear discharge isolated Nocardia spp, identified as Nocardia farcinica by mass spectrometry. Appropriate antibiotic treatment was administered and good treatment response was obtained. Early diagnosis and appropriate antibiotic treatment is critical for nocardial infections. Difficulty in recovering and identifying the organism, with delay in initiating appropriate treatment can result in poor prognosis and treatment failure.

Abstract Childhood ear infections are highly prevalent and diagnosed with the otoscope, a simple tool that illuminates and magnifies the eardrum to subjectively assess color, translucency and presence of any middle ear fluid. Frequently, however, this view is obstructed by cerumen, complicating clinician assessment and appropriate and effective management. An optical coherence tomography (OCT)‐otoscope capable of capturing both depth‐resolved OCT images and digital color surface images was used to compare OCT against otoscopy for imageability and readability despite cerumen obstruction. Image data were collected from 26 human subjects and read by 12 blinded clinicians and 5 blinded OCT experts. An average of 64.6% of otoscopy views were obstructed. For cases with >75% otoscopy view obstruction, OCT imageability was 84.6%, while otoscopy imageability was 37.5%, excluding complete obstruction cases. OCT‐otoscopy is a promising technology to improve practical middle ear assessment despite the presence of obstructions that frequently render current diagnostic assessments ineffective.

This is a report of Kodamaea ohmeri isolated from a 2-year-old febrile child with stable vitals. Frank discharge of pus was present. Microbial culture testing revealed the presence of K. ohmeri. Antifungal susceptibility was performed along with intravenous antibiotic administration and antifungal ear drops in view of the discharge. [ABSTRACT FROM AUTHOR]

Alem Getaneh, Getnet Ayalew, Debaka Belete, Mohabaw Jemal, Sirak Biset Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Sirak Biset 196 Tel +251-911-598-568Email serbis33@gmail.comBackground: An ear infection is responsible for up to 40% of preventable hearing impairment; one of the reasons for frequent and unwise antibiotic usage, especially in the developing world. Since the incidence of antibiotic resistance is increasing, especially in resource-limited countries, up-to-date knowledge on the susceptibility of ear-discharge isolates to antibiotic is important for better patient treatment. Therefore, this study aimed at determining the bacterial etiologies and their antibiotic susceptibility profiles among patients suspected with ear infections.Methods: We collected retrospective data from bacteriological results of ear discharge samples from 2013 to 2018. Sample collection, culture preparation, and bacterial identification were performed using standard microbiological techniques. Antimicrobial susceptibility testing was performed following Clinical and Laboratory Standard Institute (CLSI) guidelines. We extracted and inputted the data using Epi-info version 7 and exported it to SPSS version 20 for analysis.Results: The overall ear-discharge culture positivity rate was 283/369 (76.7%) (95% CI = 72.4– 81.3), with 14/283 (4.95%) mixed infections. Staphylococcus aureus (27.9%), Proteus spps (20.8%), Streptococcus spps (10%), and Pseudomonas spps (8.92%) were the main isolates. High-level resistance rates for tetracycline (77.6%), penicillins (67.2%), erythromycin (52.6%), and co-trimoxazole (52%), and low-level resistance rates for fluoroquinolones (23.3%), aminoglycosides (23.7%), and cephalosporins (29.8%) were observed. More than 45% of isolates, with 50.9% of Gram-negative and 37.3% of Gram-positive, were multidrug-resistant.Conclusion: Staphylococcus aureus, Proteus mirabilis, Proteus vulgaris, Escherichia coli, and Pseudomonas aeruginosa were the leading cause of ear infections. The presence of high number of multidrug-resistant strains calls for the need for periodic and continuous follow-up of antibiotic usage in the study area. Further studies are recommended to explore the types of ear infections, with their etiologic agents and possible risk factors.Keywords: ear infection, bacterial etiologies, antibiotic susceptibility, Gondar, Ethiopia

Feifei Yang,1,2,&ast; Chunhong Liu,3,&ast; Jian Ji,3 Wenjun Cao,3 Baixing Ding,1,2 Xiaogang Xu1,2 1Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People’s Republic of China; 3Department of Clinical Laboratory, Eye and ENT Hospital, Fudan University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Wenjun CaoDepartment of Clinical Laboratory, Eye and ENT Hospital, Fudan University, Shanghai, People’s Republic of ChinaEmail wgkjyk@aliyun.comBaixing DingInstitute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaEmail dingbaixing@163.comPurpose: To investigate molecular characteristics, antimicrobial resistance, and biofilm formation ability of Pseudomonas aeruginosa strains isolated from patients with aural infections.Methods: Isolates (n = 199) were collected from ear discharges of patients with aural infections from January 2019 to December 2020. Antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines. All isolates were subjected to multilocus sequence typing (MLST) with amplification and sequencing of seven housekeeping genes. Biofilm formation and eradication were quantitatively assessed in microtiter plates. Genes associated with biofilm formation and the quinolone-resistance-determining region (QRDR) of genes gyrA and parC were investigated using polymerase chain reaction amplification and sequencing.Results: Of the 199 P. aeruginosa strains isolated, 109 (54.77%) were from females and 90 (45.23%) were from males. The isolates exhibited very low rates of resistance to most antibiotics tested, including piperacillin (1.51%), ceftazidime (0.50%), and imipenem (3.52%); however, the quinolones ciprofloxacin (80.40%) and levofloxacin (82.91%) were notable exceptions. The QRDR sequence results of the quinolone-resistant P. aeruginosa isolates showed Thr83Ile (n = 155) was the most common amino acid mutation in gyrA (n = 165), while Ser87Leu (n = 157) was widely detected in parC (n = 165). MLST analysis identified 34 sequence types (STs) with most isolates belonging to ST316 (73.87%). Almost all of the P. aeruginosa isolates (96.98%) produced biofilms and biofilm-forming genes algD (98.49%), pslD (96.98%), and pelF (96.48%) were highly prevalent.Conclusion: The P. aeruginosa strains isolated from aural discharges in this study exhibited very low rates of resistance to most antibiotics tested, except for the resistance rates to quinolones, which were relatively high. The isolates also exhibited a strong biofilm formation ability and low susceptibility to eradication, indicating that more effective drugs and treatment methods are needed to combat these infections.Keywords: Pseudomonas aeruginosa isolate, ear infection, antimicrobial resistance, ST316, biofilm

This study was carried out to indicate the number of infected individuals with ear infection from different genders and ages determine the antibiotic sociability for the ear swab bacterial isolates. A total of 82 ear swabs were obtained in Erbil City from various hospitals and laboratories. Males made up 48 (59%) of the 81 samples, while females made up 33 (41%). 0-10 years had the most bacteria isolated from ear swabs, followed by 11-20 years and then 21-40 years. Pseudomonas spp. was the most prevalent bacteria found in all of the swabs (43%). Pathogenic bacteria were found in 70% of the samples, while no growth was seen in 30% of the swabs. Many bacterial isolates were found to be sensitive to the antibiotic Amikacin, which was determined to have the best effect on 35 of them. Clotrimazole was shown to be the least effective antibiotic on numerous bacterial strains, with 19 being resistant. [ABSTRACT FROM AUTHOR]

Otitis media is the most frequent type of ear infection. It is a major health problem for both children and adults but the proportion is different in different countries. The current study was designed to determine the frequency of bacterial isolates causing otitis media and their antimicrobial resistance profile to assess the incidence of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pan drug resistance (PDR) among the isolated pathogens. Also, to determine the various risk factors (age, gender, type, and site of infection) associated with ear infection. A total of 200 ear discharge samples were collected from patients aged 1-77 years attending the Ear, Nose, and Throat (ENT) unit in Azadi Teaching Hospital in Duhok city from November 2018 to September 2019. The clinical samples were cultured and bacterial isolates were identified by standard microbiological methods then confirmed by VITEK® 2 Compact automated system. All gram-negative bacterial isolates were studied phenotypically for Extended Spectrum Beta Lactamase production. Out of 200 ear swabs, 95% confirmed positive culture; 85.8% were bacterial isolates. From the total bacterial isolates, 57% were gram-positive bacteria, while gram-negative bacteria were 43%; with predominant of Pseudomonas aeruginosa, (22%) followed by Staphylococcus aureus (19%) and Coagulase negative Staphylococci (18%). The prevalence of otitis media was not significantly affected by gender. The majority of patients belonged to the age group (1-10) years old. 64.1% of the isolates were characterized as MDR, 31.7% were XDR, with one (0.7%) as PDR. Among these, 60.7% isolates were ESBL producers, Pseudomonas aeruginosa was the most frequent ESBL- producing isolates (45.9%), followed by Proteus spp (18.9%). The in-vitro sensitivity results indicated that Gentamycin and Ciprofloxacin were effective antibiotics in the treatment of otitis media. Additionally, Meropenem, Imipenem, Cefepime, and Azetronam were also the most effective drug against Pseudomonas aeruginosa. We concluded that the drug resistant isolates were common, worryingly high, leaving only limited drugs as a treatment choice.

Erythemato-ceruminous otitis externa (ECOE) is the most common type of otitis in dogs and is generally associated with bacterial and/or yeast infections. The performance of an ear cleaner was assessed over two weeks in canine ECOE, associated with a mild or moderate secondary infection, in a prospective open-label study. Forty ear canals with ECOE that did not receive any type of aural treatment and were not cleaned for 7 days were included. Pruritus (PS), 0–3 Otitis Index Score (OTIS-3) and 0–4 scale cytology (CYTO) scores were assessed on Day (D) 0, D7 and D14. Concentrations of a panel of 13 cytokines on the ear canal surface and the lipid profile of the exudate were measured on D0 and D14. From D0 to D12 or D13, the dogs' ears were cleaned daily if the secretion score (SEC) was 3/3, every second day if the score was 2/3 and every third day if the score was 1/3. PS, OTIS-3, SEC and CYTO were significantly lower on D7 compared to baseline (−40%, −31%, −36%, −34%, respectively; p < 0.0001). The same parameters decreased further on D14 (−60%, −53%, −61%, −73%, respectively; p < 0.0001) and amounts of interleukin 8 and chemokine KC-like were also reduced compared to baseline (−45%, p < 0.01; −36%, p = 0.3, respectively). The lipid profile was also modified, with a decrease in free lipids and an increase in bound lipids. [ABSTRACT FROM AUTHOR]

Background: The association of SARS-CoV-2 with acute otitis media (AOM) in children is poorly understood. Methods: Cases were identified as a subpopulation within the NO TEARS prospective AOM study in Denver, CO from March to December 2020. Children enrolled were 6 to 35 months of age with uncomplicated AOM; those with AOM and SARS-CoV-2 were included. Data was obtained from electronic medical records and research case report forms. Results: A total of 108 patients enrolled in the NO TEARS study from May 2019 through December 2020 (all subsequently tested for SARS CoV-2). During the COVID-19 pandemic study period (March-December 2020), 16 patients enrolled, and 7 (43.6%) were identified with AOM/COVID-19 co-infection. Fever was present in 3 of 7 children (29%). Four children (57%) attended daycare. Only 2 children (29%) had SARS CoV-2 testing as part of their clinical workup. Mean AOM-SOS© scores were similar among SARS CoV-2 positive and negative patients with no statistical significance with two-sided t -tests: 13.6 (±4.5) versus 14.2 (±4.9) at enrollment, 1.4 (±1.8) versus 4.2 (±4.9) on Day 5, and 0.6 (±0.9) versus 2.5 (±6.1) on Day 14. Among the 7 cases, no child had an AOM treatment failure or recurrence within 3 to 14 or 15 to 30 days respectively. Of the 6 patients with completed bacterial and viral testing, a bacterial pathogen was identified in all 6, and a viral pathogen in 3 (50%). Conclusions: COVID-19 and AOM can co-exist. Providers should maintain a high index of suspicion for COVID-19 even in patients with clinical AOM and should not use a diagnosis of AOM to exclude COVID-19. [ABSTRACT FROM AUTHOR]

Reductions in all-cause otitis media (OM) following widespread pneumococcal conjugate vaccine use have plateaued. Granular burden of disease data are needed to guide evaluation and implementation of new measures targeting OM prevention. We conducted a retrospective study to assess the incidence and treatment costs of OM, tympanostomy tube placement (TTP), and hearing loss in children aged <5 years in the United States (US). OM episodes and TTP between 2016 and 2017 were identified in IBM MarketScan Commercial Claims and Encounters, Medicare Supplemental and Coordination of Benefits, and Multi-Medicaid databases using diagnosis codes (ICD-10). The incidence rate per 100,000 person-years (IR) of OM in <5-year-olds was 62,726 in Commercial/Medicare databases and 55,874 in Medicaid. IRs peaked at 9-<12 months (115,552 and 110,960, respectively). Approximately 5% and 4% of OM episodes in the respective databases had TTP (IR 3233 and 2404). Around 2% of children with OM had hearing loss (IR 1468 and 1109, respectively), of whom 41% had TTP. We estimated that there were 11.1 million OM episodes in 2020 costing USD 4.8 billion. 243,618 children were estimated to have OM with hearing loss at a direct total cost of USD 637 million, or 13% of the overall cost. The clinical and economic burden attributable to OM in the US was high in children aged <5 years during the study period. Novel approaches are needed to improve and broaden vaccine-induced protection against OM and its complications. The study results could guide policymakers considering age-specific interventions to reduce the OM burden.

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. [ABSTRACT FROM AUTHOR]

There is limited information on the volume of antibiotic prescribing that is influenza-associated, resulting from influenza infections and their complications (such as streptococcal pharyngitis and otitis media). Here, we estimated age/diagnosis-specific proportions of antibiotic prescriptions (fills) for the Kaiser Permanente Northern California population during 2010–2018 that were influenza-associated. The proportion of influenza-associated antibiotic prescribing among all antibiotic prescribing was higher in children aged 5–17 years compared to children aged under 5 years, ranging from 1.4% [95% CI (0.7–2.1)] in aged <1 year to 2.7% (1.9–3.4) in aged 15–17 years. For adults aged over 20 years, the proportion of influenza-associated antibiotic prescribing among all antibiotic prescribing was lower, ranging from 0.7% (0.5–1) for aged 25–29 years to 1.6% (1.2–1.9) for aged 60–64 years. Most of the influenza-associated antibiotic prescribing in children aged under 10 years was for ear infections, while for age groups over 25 years, 45–84% of influenza-associated antibiotic prescribing was for respiratory diagnoses without a bacterial indication. This suggests a modest benefit of increasing influenza vaccination coverage for reducing antibiotic prescribing, as well as the potential benefit of other measures to reduce unnecessary antibiotic prescribing for respiratory diagnoses with no bacterial indication in persons aged over 25 years, both of which may further contribute to the mitigation of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background: An ear infection is a common health problem in children. Parents' awareness about otitis media (OM) among children, varies across the world. We aimed to explore parents' knowledge, attitude, and practices toward OM among their children. Methods: A quantitative cross-sectional study was done from May 1, 2020 to June 30, 2020, in Qassim, Saudi Arabia. Results: This study comprised 703 participants; Mothers comprised the majority (77.1%), 43.2% of the participants were aged between 31 and 40 years of age, and 73% of them had Bachelor's degrees or diplomas. More than half of the participants had suboptimal knowledge of OM. Although the result showed that 56% of them had positive attitudes, 86.6% did not view vaccination as a prevention measure of acute OM (AOM). Besides, 81.8% of parents were willing to follow the watchful waiting approach, in case their child had OM. Conclusion: Most of the parents in the Qassim region have inadequate knowledge regarding OM among children. Based on our result findings, we recommend further education programs to enhance the knowledge regarding OM and AOM, among the Qassim population, Saudi Arabia including family members of patients and the healthcare workers.

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. [ABSTRACT FROM AUTHOR]

Background: Chronic suppurative otitis media (CSOM) is an inflammation of the middle ear irrespective of the etiology or pathogenesis. CSOM is a disease of multiple etiologies and is well known for its persistence and recurrence in spite of treatment. It is renowned for its arrival suffering disease. Aim: This study aims to study the bacterial pathogens and their antibiotic sensitivity pattern of ear infections in patients with chronic otitis media. Materials and Methods:This prospective study was conducted at the Department of ENT and Department of Microbiology, Medical College and Hospital, India, over a period of 1 year from January 2018 to December 2018. A total of 100 patients were included in this study. The ear discharge which is collected with sterile swabs is subjected to Gram’s staining and culture of the causative organism. Antibiotic sensitivity test of cultured bacterial growth is undertaken to know the susceptibility of the causative organism. Results: Of 100 samples, 72 were positive for microbial growth and 28 showed no growth. The most common bacteria causing CSOM was Pseudomonas aeruginosa in 43 (54.43%) of samples followed by Staphylococcus aureus 12 (15.19%), coagulase-negative staphylococci 9 (11.39%), Klebsiella pneumoniae 7 (8.86%), Escherichia coli 4 (5.06%), Proteus vulgaris 2 (2.53%), and Proteus mirabilis and Streptococcus pneumoniae 1 (1.27%) each. Susceptibility test was done for known the best antibiotic agents which can be used as a proper treatment to CSOM infection. Conclusions: In the present study, the most effective antibiotics agents for most of bacterial isolates were gentamicin, ciprofloxacin, amikacin, and chloramphenicol.

Seth Scott Bittker,1 Kathleen Roberta Bell21Interdisciplinary Center for Innovative Theory and Empirics (INCITE), Columbia University, New York, New York, US; 2Ontario College of Teachers, Toronto, Ontario, CanadaBackground: Celiac disease (CD) prevalence has increased significantly in recent decades in some developed countries. Yet the environmental factors in the existing literature do not appear to provide a satisfactory explanation for this increase.Objective: To determine whether nine variables are associated with CD in children. These variables are: incidence of ear infection before 2 years old, courses of antibiotics before 2 years old, duration of breastfeeding, vitamin D drop exposure in infancy, vitamin D supplement exposure between 2–3 years old, age at gluten introduction into the diet, fat content of cow’s milk consumed between 2–3 years old, quantity of cow’s milk consumed between 2–3 years old, and type of water consumed at 2 years old.Methods: An Internet-based survey was conducted among parents living in the US with at least one biological child between 3 and 12 years old. Potential participants were informed about the survey through social media, websites, electronic newsletters, and advertisements.Results: After exclusions, there remained 332 responses associated with children with CD (cases), and 241 responses associated with children who do not have CD (controls). In this data set, skim milk as the primary form of liquid cow’s milk consumed between 2–3 years old (adjusted odds ratio [aOR]=3.556, CI=1.430–10.22, P=0.010), vitamin D drops administered for more than 3 months (aOR=1.749, CI=1.079–2.872, P=0.025), courses of antibiotics (aOR=1.133, CI=1.037–1.244, P=0.007), and incidence of ear infection (aOR=1.183, CI=1.041–1.348, P=0.010) are all associated with CD in children.Conclusions: This study is the first to find an association between skim milk consumption and CD and vitamin D drop use for greater than 3 months and CD. It also adds to evidence that early life exposure to antibiotics and early life infection, specifically ear infection, are associated with CD.Keywords: coeliac, milk, vitamin D, antibiotic, ear infection, epidemiology, gluten

Erythemato-ceruminous otitis externa (ECOE) is the most common type of otitis in dogs and is generally associated with bacterial and/or yeast infections. The performance of an ear cleaner was assessed over two weeks in canine ECOE, associated with a mild or moderate secondary infection, in a prospective open-label study. Forty ear canals with ECOE that did not receive any type of aural treatment and were not cleaned for 7 days were included. Pruritus (PS), 0–3 Otitis Index Score (OTIS-3) and 0–4 scale cytology (CYTO) scores were assessed on Day (D) 0, D7 and D14. Concentrations of a panel of 13 cytokines on the ear canal surface and the lipid profile of the exudate were measured on D0 and D14. From D0 to D12 or D13, the dogs’ ears were cleaned daily if the secretion score (SEC) was 3/3, every second day if the score was 2/3 and every third day if the score was 1/3. PS, OTIS-3, SEC and CYTO were significantly lower on D7 compared to baseline (−40%, −31%, −36%, −34%, respectively; p < 0.0001). The same parameters decreased further on D14 (−60%, −53%, −61%, −73%, respectively; p < 0.0001) and amounts of interleukin 8 and chemokine KC-like were also reduced compared to baseline (−45%, p < 0.01; −36%, p = 0.3, respectively). The lipid profile was also modified, with a decrease in free lipids and an increase in bound lipids.

Objectives/hypothesisTo evaluate the prevalence, characteristics, and associated risk factors of tinnitus in U.S. adolescents.Study designCross-sectional analyses of U.S. representative demographic and audiometric data, the National Health and Nutrition Examination Survey (NHANES) 2005 to 2008.MethodsThe study population consisted of 3,520 individuals aged 12 to 19 years with complete tinnitus-related data. Tinnitus was defined as the presence of ringing or buzzing in the ears lasting for at least 5 minutes during the preceding 12 months. In addition, we defined a chronic tinnitus subgroup as being bothered by tinnitus for more than 3 months. Demographic and other data regarding tinnitus, smoking, body mass index (BMI), anemia, hypertension, history of ear infections, tympanostomy tube placement, otoscopy, tympanometry and hearing thresholds, history of firearm use, and recreational and occupational exposure to noise were extracted and analyzed.ResultsOverall, tinnitus lasting 5 minutes or more in the preceding 12 months was reported by 7.5% of the 12- to 19-year-old population. This represents about 2.5 million adolescents in the United States. The prevalence of chronic tinnitus was 4.7%, corresponding to about 1.6 million adolescents in the United States. Multivariable-adjusted analysis revealed that both overall and chronic tinnitus were associated with female gender, low income, exposure to passive smoking, type A tympanogram, and occupational and recreational noise exposure. History of ≥ 3 ear infections and history of tympanostomy tube placement were associated only with overall tinnitus.ConclusionsTinnitus afflicts a substantial portion of the youth population. Further investigation of the association between tinnitus and the identified risk factors is warranted.

ObjectiveTo evaluate and compare the efficacy of commercially available earplugs in preventing water intrusion in healthy individuals.Study designExperimental study.SettingTertiary care medical center.Subjects and methodsTen subjects (20 ears) were assessed. After insertion of the earplugs, subjects underwent 3 standardized head-wetting protocols, including (1) surface swimming for 10 minutes, which entailed no head submersion and moderate splashing; (2) head submersion at a 90-cm depth for 20 seconds with their head upright; and (3) head submersion at a 90-cm depth with head tilted 90 degrees left and then tilted 90 degrees right for 10 seconds on each side to apply vertical pressure. Color change of a wetness indicator was used to determine water intrusion after each protocol. The same protocol was repeated for all 9 earplugs.ResultsWater intrusion was observed in 44%, 67%, and 88% of ears after surface swimming, horizontal submersion, and vertical submersion, respectively. The results revealed a significant difference in the waterproofing qualities of the various types of earplugs. The soft silicone type (Pillow Soft) earplug had the lowest rate of water penetration during all 3 protocols (P < .001). The difference between the most effective earplugs, Pillow Soft and Aquaseal, were only significant during the horizontal submersion protocol (P = .008).ConclusionWater intrusion occurred even with the use of earplugs. The intrusion was more significant with horizontal or vertical head submersion. The soft silicone Pillow Soft earplug was the most effective earplug for preventing water intrusion in surface swimming.

Background: Otitis is a severe inflammation of the skin of the auditory canal which can impact animals of all ages. In sheep, this disease can occur in isolated cases or in the entire flock. Laser photobiomodulation can be used in combination with medication or as single therapy and the effects are analgesia, modulation of the inflammatory process, edema reduction, tissue restoration and stimulation of local microcirculation. Antimicrobial photodynamic therapy stands out as a promising alternative to antimicrobial drugs for the treatment of localized infections. This study aimed to report the use of laser phototherapies on a sheep with bacterial otitis. Case: A case of bacterial otitis in a 4-year-old sheep, Dorper, was treated at the Veterinary Hospital of the State University of Santa Cruz. In the anamnesis, the owner reported that the patient presented crusts in the auricular pavilions, and had been medicated with oxytetracycline 20%, administered intramuscularly, for two days and the crusts cleaned with iodine 10%, but the animal did not present clinical improvement. On physical examination, the animal presented constant head swaying, edema of the ears, otalgia, enlarged parotid lymph nodes and ear wounds. No ear discharge was observed, and the initial diagnosis was aural hematoma. The treatment prescribed was laser photobiomodulation for three consecutive days. The lesions were irradiated with a diode laser with a power of 0.1 W, irradiance of 3.5 W/cm2, continuous emission, spot area of 0.028 cm², wavelength of 808 nm, energy of 4J/point, and fluency/point of 142.8J/cm², with seven points on the external surface and four points on the internal surface of both ears. Two points were also targeted on the parotid lymph nodes with infrared laser (λ = 808 nm), with energy of 2J/point. On the fourth day of hospitalization, there was a reduction in lesions, decreased edema and absence of pain and on the sixth day of hospitalization, the patient presented mucopurulent otorrhea. The material from the auricular pavilions was collected for cytological examination, confirming the clinical diagnosis of bacterial otitis. Two sessions of Antimicrobial Photodynamic Therapy (aPDT) were performed with an interval of 48 hours, with application of 0.01 % methylene blue, pre-irradiation time of five minutes and irradiation with diode laser with a power of 0.1 W, 660 nm wavelength and 9J/point energy. On the 10 th day after the start of the treatment, there was no pain, healing of ear wounds, and no otorrhea. An additional photobiomodulation session was performed on the unhealed wounds in the auditory canal with red laser (λ = 660nm), on 5 points with an energy of 1J/point. On the 15th day, the left ear was healed and the right ear presented otorrhea, and a further session of aPDT was performed. On the 17th day after starting treatment there was no secretion and all lesions were healed. The patient was subsequently monitored for one month, showing no change or relapse. Discussion: Laser photobiomodulation treatment and antimicrobial photodynamic therapy were efficient in treating bacterial otitis without the use of antibiotics, promoting clinical improvement and patient well-being, making it an alternative to conventional treatment. After searches on the Pubmed, Scielo and Escopus databases using photobiomodulation and antimicrobial photodynamic therapy in sheep otitis as descriptors, this is believed to be the first report on the use of laser phototherapy in sheep otitis. Further studies are needed to establish the dosimetry and frequency of the sessions, as, besides considering animal well-being, this species is an excellent model for human experimentation. [ABSTRACT FROM AUTHOR]

The increasing prevalence of antimicrobial resistance among bacterial pathogens necessitates novel treatment strategies, particularly in veterinary medicine where otitis in dogs is very common in small animals' clinical routines. Considering this challenge, this study explores the efficacy of aromatic plant compounds (APC), including eugenol (EUG), trans-cinnamaldehyde (TC), and geraniol (GER), and their synergistic potential when combined with the antiseptic agent chlorhexidine (CLX), offering insight into alternative therapeutic approaches. The disk diffusion assay revealed differential sensitivity of Staphylococcus spp. strains to the tested compounds, with EUG and GER showing moderate inhibition zones and TC displaying considerably larger inhibition zones. Further analysis through MIC and MBC determinations suggested that EUG required the highest concentrations to inhibit and kill the bacteria, whereas TC and GER were effective at lower concentrations. Combined with CLX, all three plant-derived compounds demonstrated a significant enhancement of antibacterial activity, indicated by reduced MIC values and a predominantly synergistic interaction across the strains tested. GER was the most potent in combination with CLX, presenting the lowest mean FICi values and the highest fold reductions in MIC. This study emphasizes the APC's potential as an adjunct to conventional antimicrobial agents like CLX. The marked synergy observed, especially with GER, suggests that such combinations could be promising alternatives in managing bacterial otitis in dogs, potentially mitigating the impact of antibiotic resistance., Competing Interests: Declaration of competing interest No potential conflict of interest was reported., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Chamomile ( Matricaria chamomilla ) is a plant with known antimicrobial, anti-inflammatory, and analgesic properties. Homeopathic drops containing chamomile extract are often used for ear pain and chronic ear infections. We aimed to evaluate the antimicrobial effect of over-the-counter eardrops containing chamomile against organisms causing bacterial conjunctivitis and otitis externa. Liquid cultures of Streptococcus aureus and Pseudomonas aeruginosa were exposed to increasing concentrations of eardrops containing chamomile extract. Liquid cultures of S. aureus and Streptococcus pneumoniae were exposed to increasing concentrations of chamomile eye drops for 5, 10, 15, and 45 min. Colony forming units (CFUs) were assessed after 18 h. Viability assays for these organisms were performed using the resazurin microdilution assay. We observed a reduction in the number of P. aeruginosa CFUs when the bacteria were exposed to any of the three concentrations of the chamomile drops as early as 5 min, with maximal reduction upon exposure to the 30% concentration at 45 min. Reduction in S. aureus CFUs, on the other hand, was observed for all three concentrations as maximal in the 5 min of exposure. We observed a marked reduction in the number of S. aureus CFUs upon exposure to any of the three preparations of chamomile-containing eye drops, which was almost immediate at 10% concentration. Streptococcus pneumoniae reduction happened at 5 min and continued through the 45-min observation period for all three concentrations. Our findings suggest that over-the-counter ear drops containing chamomile extract could potentially be used as a non-prescription treatment for mild cases of otitis externa and bacterial conjunctivitis., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Infection of external or internal ear leads to hard and annoys pain, which cause a disturb in the patient life, the reasons of these infection mostly due to different type of pathogens, the aim of the current research is to identify the most common pathogens that cause the Otitis among adult & children, where the sample of the research comprises 100 patients from who admitted Educational Rezgary hospital, Erbil Iraq, their age ranging between 4-60 years old, the traditional isolation method has been used, then (PCR) technique was used to identify pathogen bacteria in the negative isolates,, the research concluded to many results from which the most common pathogen bacteria for Otitis are P.aeruginosa by percentage (31.2%) followed by Staphylococcus aureus 20 (25%).while Proteus spp has been observed in 16 cases (20%), Streptococcus spp was recorded in 14 cases (17.5%). The detected pathogenic bacteria varied in their sensitivity towards antibiotics, gram negative bacteria for example Pseudomonas aeruginosa has a high sensitivity to Ciprofloxamin and Gentamycin, while gram positive ones for example Staphylococcus aureus and Streptococcus pygogenes have high sensitivity towards Amoxcillin by percentage 90,100 respectively. The research concluded that PCR is a valid, fast, easy, and accurate method for identification of pathogen microbes. [ABSTRACT FROM AUTHOR]

Background: An ear infection is a common health problem in children. Parents' awareness about otitis media (OM) among children, varies across the world. We aimed to explore parents' knowledge, attitude, and practices toward OM among their children. Methods: A quantitative cross-sectional study was done from May 1, 2020 to June 30, 2020, in Qassim, Saudi Arabia. Results: This study comprised 703 participants; Mothers comprised the majority (77.1%), 43.2% of the participants were aged between 31 and 40 years of age, and 73% of them had Bachelor's degrees or diplomas. More than half of the participants had suboptimal knowledge of OM. Although the result showed that 56% of them had positive attitudes, 86.6% did not view vaccination as a prevention measure of acute OM (AOM). Besides, 81.8% of parents were willing to follow the watchful waiting approach, in case their child had OM. Conclusion: Most of the parents in the Qassim region have inadequate knowledge regarding OM among children. Based on our result findings, we recommend further education programs to enhance the knowledge regarding OM and AOM, among the Qassim population, Saudi Arabia including family members of patients and the healthcare workers. [ABSTRACT FROM AUTHOR]

Background: Chronic suppurative otitis media is a destructive disease of middle ear cleft that can progress rapidly. Medical treatment which depend on proper antibiotic selected from culture and sensitivity were prescribed, otherwise process goes to intra or extracranial complication. Objective: Relation of certain clinical features to each isolated bacteria. The types of bacteria in chronic suppurative otitis media. Drug sensitivity for each isolated bacteria. Patients and Methods: Forty-six patients enrolled in the current study, 41 patients have unilaterally discharged ears and 5 bilaterally discharged ears. The total ears are 51 ears were taken for examination, microorganism isolation, biochemical tests and then culture and sensitivity tests. Regarding ear examination, it involved clinical picture. Regarding laboratory tests certain types of biochemical test, 4 types of media were used for isolation of bacteria and in culture and sensitivity tests. 16 types of drugs used for culture and sensitivity test. All collected data putted in a questionnaire, tables and histograms. Results: 55% of patients with profuse discharge while 45% scanty amount of ears discharge. Mucosal type of chronic suppurative otitis media were 53% while 47% of squamous type. Regarding types of bacteria, Pseudomonas aeruginosa of 41.2%, Staphylococcus aureus of 11.6% are the most common isolated bacteria. Regarding drug sensitivity, Imipenem, Meropenem of 100% sensitivity, Amikacin of 92% sensitivity while Cefixime of 62% resistance. Conclusion:There was a relation between particular suppurative chronic otitis media causing microorganisms and specific discharge.Pseudomonas aeruginosa and Staphylococcus respectively are the most common pathogens. Imipenem and Meropenem are the most effective drugs. [ABSTRACT FROM AUTHOR]

To reduce antibiotic use, clinical guidelines recommend treating many pediatric ear infections with watchful waiting (WW), which entails parents managing children's symptoms while waiting to see if the infection will resolve without antibiotics. This study examines providers' WW advice in recorded medical visits (n = 28), focusing on five communication elements specified by guidelines and consistent with advice response theory. Results suggest directions for improving providers' delivery of WW advice and are discussed with regard to theory. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pneumococcal infection is a significant public health problem and leading cause of death among young children in developing countries. In most of the cases, "Streptococcus pneumonia" is the common human pathogenic bacterium. It further increases the risk of otitis media, meningitis, sepsis, paranasal sinuses, and upper respiratory infections. To fight against this condition advanced antibiotic therapies are available, but due to less awareness and knowledge people are unable to access. AIM: The present study aims to measure the level of awareness and knowledge among the population of North Delhi about pneumococcal infection and vaccination. MATERIALS AND METHODS: To conduct the survey, questionnaire was developed. The questionnaire consists of 17 questions, which are divided into three sections such as awareness, knowledge, and attitude. A total of 281 (males: 105; females: 176) participants participated in the present survey. RESULTS: The present study revealed that only 46.02% of females have seen advertisements related to pneumococcal, whereas 60% of males said that they have never seen any advertisement. A total of 43 (40.95%) males and 57 (32.38%) females reported that pneumococcal vaccination (PCV) may help in curing pneumococcal disease; however, only 8.57% males and 19.09% females agreed that PCV can cure the pneumococcal disease. Only 29.89% population knew that pneumococcal can also cause ear infection, whereas only 29.89% were aware of the fact that pneumococcal infection can be fatal for neonates. CONCLUSION: From the present study, we can conclude that after all the initiatives taken by government, general population still has low level of awareness about the PCV. We suggest that more campaigns, street play, advertisement, and other methods need to introduce to increase the level of awareness. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this case-control study was to assess the association between ear infection and dental caries.Materials and Methods: The sample consisted of 126 children (range: two to five years) with no major medical problems or craniofacial anomalies. Ear infection history, demographic, dental, health and diet history of each child was determined using a questionnaire administered to the parent/guardian of the child. Dental charts were used to abstract dmft (decayed, missing and filled teeth) scores for children with dental caries (DC: dmft > or = 1) and without caries (NDC: dmft = 0), and oral hygiene index (OHI) scores.Results: Chi-square analysis indicated no differences in ear infection history between the 71 DC and 55 NDC (past year: 35% vs. 40%; lifetime: 30% vs. 31%) children. However, there was a trend (p = 0.07) for the mean number of ear infections to be higher in DC versus the NDC group. Baby bottle use was highest among those who had both ear infection and caries. Multivariate regression model revealed that OHI scores, reason for dental visit, and frequency of visits were the best predictors of dmft scores.Conclusion: An association between dental caries and ear infection was not observed in this sample. Future investigations should explore common risk factors in increasing the risk of both diseases simultaneously. [ABSTRACT FROM AUTHOR]