BACKGROUND: Eczematous external otitis (EEO) is the most difficult-to-treat otitis externa, and characterized by the symptoms of inflammation with hypersensitivity of the external ear canal skin. It is acknowledged as a chronic skin inflammation primarily caused by dermatological and allergic reactions. Food allergens are also considered a cause to induce the inflammation. However, the role of food specific IgG4 in this disease is unclear yet.
METHODS: A 54-year-old woman complained of recurrent itching of the external auditory meatus for 3 years and nails chapping of hands for 2 years.
METHODS: She was diagnosed with EEO and underwent the therapeutic strategy as food elimination of egg, milk and wheat, guided by the result of food specific IgG4 together with probiotics on the basis of previous symptom controlling therapy.
RESULTS: After 17 months\' treatment, she was finally free of all the symptoms and the serum IgG4 specific to all foods are under normal limit.
CONCLUSIONS: To the best of our knowledge, it is the first report revealing the clinical significance of food specific IgG4 in EEO, and the successful treatment with diet elimination guided by food specific IgG4 threw a new light on the clinical management of refractory EEO.

UNASSIGNED: Ear disease is relatively important in veterinary medicine as it significantly affects the quality of life of pets. Two hundred and twenty-one cases of canine ear diseases were collected and collated at the Xi\'an Teaching Hospital of Northwest A&F University from 2012 to 2016. An epidemiological analysis was conducted to evaluate the prevalence and causes of various ear diseases in various breeds of dogs in Xi\'an.
UNASSIGNED: Data were collected and statistically analyzed by reviewing previous cases and obtaining medical history data and laboratory results. This study included the following experiments: systematic examination of the animals\' skin, auricular skin scraping test, ear canal endoscopy, and examination of ear canal secretion.
UNASSIGNED: The top three dog breeds most commonly afflicted with ear diseases in Xi\'an were Toy poodles, Cocker Spaniels, and Golden Retrievers, accounting for 18.5%, 10.4%, and 9.5% of the total cases, respectively. The prevalence was the highest in August and September, with male dogs having a higher prevalence rate than female dogs. Common ear diseases were categorized as otitis externa, otitis media, otitis interna, or ear hematoma.
UNASSIGNED: This study determined the prevalence of external otitis, ear hematoma, otitis media, and inner otitis in dogs in the Xi\'an area. These results can help expand the current understanding of the development and epidemiology of canine ear diseases and provide a reference for clinical diagnosis, treatment, and prevention.

UNASSIGNED: It is the challenging clinical issue of combining debridement of infected lesions and retaining the blood skin flap for auricle reconstruction in patients of Congenital Malformation of the Middle and Outer Ear with Infection (CMMOEI).
UNASSIGNED: To innovate and introduce an surgery incision to solve the challenging clinical issue of a combined debridement of infection yet retaining a well vascularized skin flap for auricle reconstruction in patients with CMMOEI.
UNASSIGNED: A combined innovated incision of ear sulcus and prefabricated earlobe was used for 23 cases (23 ears) with CMMOEI, The success in the management of the encountered infections, and the short and moderate-term outcome of the innovated incision to preserve a well-vascularized skin flap for subsequent auricle reconstruction were reviewed. The 23 cases include 10 males and 13 females, aged 4-14 years (mean 8.4 years), 7 left ears and 16 right ears. 14 ears stenosis and 9 ears atresia of the outer ear canals.
UNASSIGNED: In all 23 cases, the infections were successfully cleared without recurrence or complication with 2-year follow-up. The local skin flap and its blood supply were well preserved for subsequent auricle reconstruction.
UNASSIGNED: The new incision can facilitate clearance of infection in CMOMEI patients, and preserve the retroauricular tissues for subsequent harvesting of a well-vascularized skin flap for subsequent auricle reconstruction.

Most of malignant external otitis (MEO) cases reported in the literature are attributed to Pseudomonas aeruginosa. Fungal infections in MEO are also likely but extremely rare. And conventional microbiology tests is difficult to diagnose.
Two patients were diagnosed with Fungal malignant external otitis (FMEO) due to Aspergillus by metagenomic Next-Generation Sequencing (mNGS) and recovered after comprehensive treatment including operation and voriconazole. The antifungal treatment was delayed due to repeated cultures of secretions being negative and pathological examination showed granulation tissue proliferation with extensive neutrophil infiltration.
mNGS might be helpful for patients suspected with FMEO, especially when conventional microbiology tests were negative.

Necrotizing otitis externa is a progressive infectious disease involving the external auditory canal and even the skull base, which can lead to serious complications and even death if not treated in time. In this paper, the latest advances in etiology, pathogenesis, clinical manifestations, diagnosis and treatment were reviewed based on previous literature, providing reference for clinical diagnosis, treatment and future research.
摘要: 坏死性外耳道炎（necrotizing otitis externa，NOE）是一种罕见的累及外耳道甚至颅底的进行性感染性疾病，治疗不及时可导致严重的并发症，甚至死亡。本文结合目前国内外研究现状，将其病因、发病机制、临床表现、诊断和治疗等方面的最新进展进行综述，为临床诊治和未来研究提供参考。.

Skull base osteomyelitis is a rare, refractory, and potentially fatal disease primarily caused by otogenic and sino rhinogenic infections. At times, it can mimic neoplasia complicating the diagnosis. With the use of antibiotics, advancements in diagnostic methods, and skull base surgical techniques, the mortality rate has significantly improved. However, the successful diagnosis and treatment of the disease is still challenging due to delayed diagnosis, lengthy treatment course, a tendency for relapse and lack of guidelines. Therefore, this article aims to review the progress in the diagnosis and treatment of skull base osteomyelitis.
摘要: 颅底骨髓炎是罕见且难治的致死性疾病，其主要病因为耳源性和鼻源性感染，有时与恶性肿瘤不易区分。随着抗生素的应用，诊断方法和颅底外科手术技术的进步，死亡率较之前明显改善。然而，该病的成功诊治仍然充满挑战，其诊断易延误，治疗周期长、易反复，且缺乏相应指南。本文旨在系统地综述颅底骨髓炎的诊断治疗进展。.

OBJECTIVE: To determine the in vitro activity of the herbal formula Di Er You (DEY) and the single-herb Coptis against bacteria cultured from dogs with otitis externa.
METHODS: 32 client-owned dogs diagnosed with otitis externa.
METHODS: A sample of otic debris from each patient was collected and plated onto a fresh Sheep\'s Blood Agar plate in the hospital. After bacterial growth was confirmed, 4 wells were created, numbered randomly, and treated with saline (placebo), DEY, Coptis, and Zymox Otic Enzymatic Solution with 1% Hydrocortisone (Zymox). After 24 hours of incubation, the diameter of the zone of inhibition (dZOI) of each treatment was measured and recorded, and compared among treatments. A sample of the bacterial colonies grown was submitted to an outside lab for bacterial identification.
RESULTS: The mean ± SD dZOI values for saline, DEY, Coptis, and Zymox treated wells were 0.25 ± 1.41, 12.47 ± 3.92, 14.25 ± 7.12, and 3.22 ± 5.12, respectively. Post hoc multiple comparisons test revealed that (1) saline-treated wells had significantly smaller dZOI values than the other 3 groups (all P < .001), (2) Zymox treated wells had significantly smaller dZOI values than either herbal treated groups (both P < .001), and (3) DEY treated wells had significantly smaller dZOI values than those treated with Coptis (P = .0042).
CONCLUSIONS: The results from this in vitro study suggested that both DEY and Coptis could be effective treatments in inhibiting the growth of bacteria in dogs with otitis externa. Prospective randomized controlled clinical trials are warranted to confirm these findings.

Brachycephalic dogs are not only affected by brachycephalic obstructive airway syndrome (BOAS), but are also frequently referred to veterinary dermatologists for skin conditions, with English bulldogs and pugs particularly over-represented. Some skin diseases, such as skin fold dermatitis, are directly associated with the abnormal anatomic conformation of brachycephalic dogs, while for others, such as atopic dermatitis and viral pigmented plaques, there is an underlying genetic basis or a general predisposition. Anatomic alterations associated with brachycephaly, leading to fold formation of the skin and stenosis of the ear canal, together with primary immunodeficiencies described in some breeds, favor the development of pyoderma, Malassezia dermatitis, and otitis externa/media. In addition, the frequently neglected but often lifelong dermatological problems of brachycephalic dogs are an important consideration when discussing genetic and medical conditions affecting the welfare of those dogs. Here we review the current state of knowledge concerning dermatological problems in brachycephalic dogs and combine it with clinical experience in the management of these challenging disorders.

Vibrio alginolyticus, a Gram-negative rod bacterium found in marine environments, is known to cause opportunistic infections in humans, including ear infections, which can be difficult to diagnose. We investigated the microbiological and otopathogenic characteristics of a V. alginolyticus strain isolated from an ear exudate specimen obtained from a patient with chronic otitis externa to provide a basis for the future diagnosis of V. alginolyticus-associated infections. The identification of V. alginolyticus was accomplished using a combination of matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS), classical biochemical identification methods, and the use of Vibrio-selective media and advanced molecular identification methodologies. Antimicrobial susceptibility testing revealed that the strain was resistant to ampicillin and sensitive to β-lactam, aminoglycosides, fluoroquinolones, and sulfonamide antibiotics. The potential otopathogenic effects of V. alginolyticus were determined through the performance of cell viability, cell apoptosis, and cell death assays in tympanic membrane (TM) keratinocytes and HEI-OC1 cells treated with V. alginolyticus-conditioned medium using cell-counting kit (CCK)-8 assay, a wound-healing migration assay, Annexin V/propidium iodide (PI) flow cytometric analysis, and terminal deoxynucleotidyl transferase deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL staining). The results indicated that the identified V. alginolyticus strain exerts cytotoxic effects on keratinocytes and HEI-OC1 cells by inhibiting cell proliferation and migration and inducing apoptosis and cell death. To evaluate the ototoxicity of V. alginolyticus, the cell density and morphological integrity of hair cells (HCs) and spiral ganglion neurons (SGNs) were analyzed after exposing cochlear organotypic explants to the bacterial supernatant, which revealed the pre-dominant susceptibility and vulnerability of HCs and SGNs in the basal cochlear region to the ototoxic insults exerted by V. alginolyticus. Our investigation highlights the challenges associated with the identification and characteristic analysis of the Vibrio strain isolated in this case and ultimately aims to increase the understanding and awareness of clinicians and microbiologists for the improved diagnosis of V. alginolyticus-associated ear infections and the recognition of its potential otopathogenic and ototoxic effects.

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