Otitis Externa

Definition of Otitis Externa

Otitis Externa is an inflammation of the ear canal caused by infection with bacteria or fungus.

Description of Otitis Externa

Otitis externa, or swimmer's ear, usually starts out as a nagging itch, brought on by a softening of the protective lining of the ear canal. However, it can blossom into as painful an infection as you will ever experience.

For adults, swimmer's ear is the second most common cause of ear pain after TMJ (temporo-mandibular joint) syndrome. With a few simple preventive measures it can be kept in check, never developing into a full-blown infection.

When swimmer's ear is unchecked and advances into an infection, extreme pain, yellowish pus, and even temporary hearing loss can occur. At this point, it must be treated by a physician who will clean out the ear, administer antibiotic eardrops or pain medication, or both.

Causes and Risk Factors of Otitis Externa

Swimmer's ear is a problem that affects anyone who spends time in water, lives in a humid environment, or sweats profusely. Water and excessive moisture wash away the ear canal's protective skin and earwax barrier and create a medium for bacterial growth.

Contrary to popular belief, swimming in dirty water does not necessarily bring on swimmer's ear. When the skin-and-wax barrier is intact, it repels bacteria.

Pool swimmers are particularly at risk because the water-chlorine combination changes ear chemistry from an acidic medium to an alkaline one. Once again, this creates a perfect breeding ground for bacteria and fungus.

Surprisingly, using cotton-tip applicators to clean the ears is the leading cause of otitis externa. A few twists with an applicator is all that it takes to rub away the protective skin and earwax in the canal.

Symptoms of Otitis Externa

The major symptoms are: itching in the ear canal in the early stages; ear pain that may worsen when pulling the earlobe; discharge of pus or fluid from the ear canal; redness and swelling of the skin of the ear canal; a small, painful lump or boil in the ear canal; eczema (patches of broken, flaky, itchy, red, oozing skin); temporary hearing loss due to pus accumulation in the ear canal; and fever.

Diagnosis of Otitis Externa

Before you are treated for otitis externa, be sure to rule out the following conditions that may closely mimic the infection: Eczema (red and scaly skin disease), Folliculitis (inflammation of hair follicles causing a boil), Ramsey Hunt Syndrome (herpes zoster infection of the geniculate ganglion) or Otitis Media.

Treatment of Otitis Externa

The best way to combat the itch of swimmer's ear is with strict aural hygiene. Other methods of treatment are:

• Over-the-counter pain relievers - acetaminophen or ibuprofen
• Use of a small suction device by the doctor to remove excess fluid and pus from the ear canal
• Topical antibiotics or antifungal eardrops may be prescribed to treat infection, in addition to corticosteroid drops to reduce inflammation
• Oral antibiotics may be given for severe infection
• Surgical removal of dead tissue may be required to treat malignant otitis externa
• Codeine or narcotics may be prescribed to relieve severe pain

After symptoms disappear, avoid getting water into the ear canal for up to three weeks. During this period, protect your ears when showering or washing your hair, and avoid swimming.

Prevention of Otitis Externa

Use antiseptic eardrops whenever the water is trapped in the ears. Such eardrops are inexpensive and sold without prescription under various trade names such as Aqua Ear, Ear magic or Swim Ear.

Or

Use rubbing alcohol. It absorbs the water, helps dry out the ear, and may even kill the bacteria and funguses that cause otitis externa.

Or

Use white vinegar. Mix the vinegar with the rubbing alcohol.

Questions To Ask Your Doctor About Otitis Externa

What is the probable cause?

What treatment do you suggest?

Is there evidence of an infection?

Will eardrops help?

Will you be recommending corticosteroids to reduce the inflammation?

What preventive measures should be taken?

Cervical cancer

Cervical cancer is malignant cancer of the cervix uteri or cervical area. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stages.Treatment consists of surgery (including local excision) in early stages and chemotherapy and radiotherapy in advanced stages of the disease.

Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes can prevent the development of cancer. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more.

Human papillomavirus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. HPV vaccine effective against the two strains of HPV that cause the most cervical cancer has been licensed in the U.S. and the EU. These two HPV strains together are currently responsible for approximately 70% of all cervical cancers. Since the vaccine only covers some high-risk types, women should seek regular Pap smear screening, even after vaccination.

Signs and symptoms

The early stages of cervical cancer may be completely asymptomatic.^[1][8] Vaginal bleeding, contact bleeding or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be present in the abdomen, lungs or elsewhere.

Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, single swollen leg, heavy bleeding from the vagina, leaking of urine or faeces from the vagina, and bone fractures.

Staging

Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs and skeleton, and cervical conization.

The TNM staging system for cervical cancer is analogous to the FIGO stage.

• Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)
• Stage I - limited to the cervix
  • IA - diagnosed only by microscopy; no visible lesions
    • IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread
    • IA2 - stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less
  • IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm
    • IB1 - visible lesion 4 cm or less in greatest dimension
    • IB2 - visible lesion more than 4 cm
• Stage II - invades beyond cervix
  • IIA - without parametrial invasion, but involve upper 2/3 of vagina
  • IIB - with parametrial invasion
• Stage III - extends to pelvic wall or lower third of the vagina
  • IIIA - involves lower third of vagina
  • IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney
• IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis
• IVB - distant metastasis

Treatment

Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure (LEEP) or cone biopsy.^[21]

If a cone biopsy does not produce clear margins,^[22] one more possible treatment option for patients who want to preserve their fertility is a trachelectomy This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care, as few doctors are skilled in this procedure. Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the patient has given prior consent. Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the uterus for pathologic evaluation.

A radical trachelectomy can be performed abdominally or vaginally and there are conflicting opinions as to which is better. A radical abdominal trachelectomy with lymphadenectomy usually only requires a two to three day hospital stay, and most women recover very quickly (approximately six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage. It is generally recommended to wait at least one year before attempting to become pregnant after surgery^. Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy.Yet, it is recommended for patients to practice vigilant prevention and follow up care including pap screenings/colposcopy, with biopsies of the remaining lower uterine segment as needed (every 3-4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive.

Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy (internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse.

Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy.

Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy.

On June 15, 2006, the US Food and Drug Administration approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical cancer treatment. Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects. Hycamtin is manufactured by GlaxoSmithKline.

Prevention

Awareness

According to the US National Cancer Institute's 2005 Health Information National Trends survey, only 40% of American women surveyed had heard of human papillomavirus (HPV) infection and only 20% had heard of its link to cervical cancer. In 2008 an estimated 3,870 women in the US will die of cervical cancer, and around 11,000 new cases are expected to be diagnosed^.

screening

The widespread introduction of the Papanicolaou test, or Pap smear for cervical cancer screening has been credited with dramatically reducing the incidence and mortality of cervical cancer in developed countries.^[8] Abnormal Pap smear results may suggest the presence of cervical intraepithelial neoplasia (potentially premalignant changes in the cervix) before a cancer has developed, allowing examination and possible preventive treatment. Recommendations for how often a Pap smear should be done vary from once a year to once every five years. The American Cancer Society (ACS) recommends that cervical cancer screening should begin approximately three years after the onset of vaginal intercourse and/or no later than twenty-one years of age. Guidelines vary on how long to continue screening, but well screened women who have not had abnormal smears can stop screening about age 65 (USPSTF) to 70 (ACS). If premalignant disease or cervical cancer is detected early, it can be monitored or treated relatively noninvasively, and without impairing fertility.

Until recently the Pap smear has remained the principal technology for preventing cervical cancer. However, following a rapid review of the published literature, originally commissioned by NICE liquid based cytology has been incorporated within the UK national screening programme. Although it was probably intended to improve on the accuracy of the Pap test, its main advantage has been to reduce the number of inadequate smears from around 9% to around 1%. This reduces the need to recall women for a further smear.

Automated technologies have been developed with the aim of improving on the interpretation of smears, normally carried out by cytotechnicians. Unfortunately these on the whole have proven less useful; although the more recent reviews suggest that generally they may be no worse than human interpretation .

The HPV test is a newer technique for cervical cancer triage which detects the presence of human papillomavirus infection in the cervix. It is more sensitive than the pap smear (less likely to produce false negative results), but less specific (more likely to produce false positive results) and its role in routine screening is still evolving. Since more than 99% of invasive cervical cancers worldwide contain HPV, some researchers recommend that HPV testing be done together with routine cervical screening. But, given the prevalence of HPV (around 80% infection history among the sexually active population) others suggest that routine HPV testing would cause undue alarm to carriers.

HPV testing can reduce the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cervical cancer detected by subsequent screening tests among women 32-38 years old according to a randomized controlled trial.^[37] The relative risk reduction was 41.3%. For patients at similar risk to those in this study (63.0% had CIN 2-3 or cancer), this leads to an absolute risk reduction of 26%. 3.8 patients must be treated for one to benefit (number needed to treat = 3.8). Click here to adjust these results for patients at higher or lower risk of CIN 2-3.

Preventive Vaccination

Hand-Washing in Public BathroomsCan soap get dirty? Or is it "self-cleaning," since it's soap?

President Obama gave some advice last night to those worried about the spread of swine flu around the world: "Wash your hands when you shake hands, cover your mouth when you cough. I know it sounds trivial, but it makes a huge difference." Health authorities agree: Hand-washing is the easiest way to protect yourself from getting sick. For more on the best way to scrub your mitts, have a look at the 2006 Explainer Question of the Year, reprinted below.

How clean is bar soap in a public bathroom? Is it "self-cleaning," since it's soap? It seems like a health hazard to me.

It's dirty, but that doesn't make it a health hazard. Soap can indeed become contaminated with microorganisms, whether it's in liquid or bar form. According to a series of tests conducted in the early 1980s, bars of soap are often covered with bacteria and carry a higher load than you'd find inside a liquid dispenser. But no one knows for sure whether this dirty soap will actually transfer its germs to your hands during a wash.

In fact, what little clinical evidence there is suggests that dirty soap isn't so bad. A study from 1965 and another from 1988 used similar methodologies: Researchers coated bars of soap in the lab with E. coli and other nasty bacteria, and then gave them to test subjects for a vigorous hand-wash. Both teams found no transfer of contamination from the dirty soap. However, both studies were tainted by potential conflicts of interest: The first was conducted by Procter & Gamble, and the second came from the Dial Corp.

Still, there's no good evidence to contradict these studies, and it's likely that the bacteria on a dirty bar would just wash off when you rinsed your hands. In other words, you'd be cleaning the soap as you cleaned your hands. (Your hands would probably have been a lot dirtier than the soap to begin with.)

It's not even clear that you need clean water to get the benefits of a hand-washing. Recent hand-hygiene studies in the developing world have found that washing with soap and water reduces infections even when the water supply might be contaminated. Dirty water, like dirty soap, might not make washing less effective.

Even under the best conditions, washing your hands can actually increase the number of microorganisms present on your hands, thanks to contaminated surfaces near the sink, splashes of contaminated water, or improperly dried hands. (In general, it's safer to leave your hands unwashed than to leave them wet.) The hand-washing paradox might also result from soap-induced skin damage: Dry skin tends to crack and flake and may become more permeable to infectious agents. (You're more susceptible to this if you wash many times per day.)

Still, washing with soap and water has been repeatedly shown to prevent the spread of illness, and may be helpful even when it increases your bacteria counts. That may be because two kinds of microbes live on the hands: residents and transients. (In fact, they can even protect your skin from more malicious microbes.) The transient variety are the ones that tend to cause colds or other infections—the ones you want to get rid of when you wash your hands. It's possible that the increase in bacteria that can result from a hand-washing is composed of harmless residents, not dangerous transients.

According to the guidelines from the Centers for Disease Control and Prevention, hand-washing remains a very important method of staving off infectious disease, and either bar soap or liquid soap should be used after a trip to the bathroom or before a meal. Local health agencies and inspectors are sometimes more wary of bar soap. They either ban it outright or suggest that the bar be placed on a draining rack to dry out between washings. (The gooey bars are more likely to harbor germs.)

Swine flu will be global endemik

Mexican states can begin to control the spread of swine flu. Sombrero country even revised the number of victims who died before dilansir. Meanwhile, the United States stressed that the swine flu disaster at this time not separah outbreaks of flu in 1918. However, the World Health Organization (WHO) holds different. Yesterday (3 / 5), cited as The Independent, the organization in Geneva that bermarkas plans-even in the next few days-increase the level of swine flu into the six-level official can have aliases called global pandemic. That is the highest level, marked with beruntun spread to the three people on two continents. This is already happening in Mexico, the United States, and the UK. In the UK, the case that overrides the Greatorez Barry contagious H1N1 virus after meeting for 30 minutes in Leicestershire.

WHO considered, although not wild flu virus in 1918, up to now there are no signs of the spread of swine flu will stop. Dr Nikki Shindo said that WHO's main concern is the possibility of virus resistant bermutasi and drugs such as Tamiflu.

''Instead, best scenario lead to symptoms of illness only a weak and still be able to respond to Tamiflu,''said as quoted Shindo English daily The Sunday Times.

To date, 17 countries have reported 653 cases of H1N1 infection. Mexico also confirm that the 19 new citizens who actually died because of flu-positive pigs. Mexico had a lower number of deaths due to suspected bird flu from 176 pigs to be 101. This is due to lab test results indicate that many victims that died because of the other.

Meanwhile, from Hong Kong, local governments still continue the quarantine for 350 guests and staff Metropark Hotel which starts Saturday (2 / 5) and will last seven days. As made, steps are taken after one of the hotel guests who came from Mexico as evidenced positive contagious flu. Thomas Tsang, officers from the Center for Health Protection of Hong Kong, said, all people in the hotel health.

However, one of the hotel guests, James Parer from Brisbane, Australia, said that the two-day quarantine, hotel guests complained about the Chinese breakfast menu, the cake containing raisins pork roast. Therefore, the government provides different dietary choices. ''We will prefer the halal meat and vegetarian,''said Stephen Fisher, one of the social workers.