Introduction: Many studies have been done on prevalence and complications of ear bud across the globe but very few talk about the characteristics physical findings associated with ear cleaning. We aim to find the prevalence and characteristic physical findings of cotton bud usage in patients visiting a tertiary care center in Bhutan. Methods: A cross sectional study in a tertiary care center in Bhutan over a period of one month. Results: The prevalence of ear cleaning was 92.15%. The most common physical finding was shiny external auditory canal (66%), excoriations in the external auditory canal (longitudinal furrowing along the floor or Circular scratch marks)(52%), erythema and edema of ear canal (46.6%), wax in the bony canal near tympanic membrane(9.3%), stenosed external auditory canal (3.8%), cotton wool remnants in ear canal(2.8%). Conclusions: It is important to recognize these characteristic clinical findings of cleaning the ear so that proper counseling can be given against its usage and prevent undue complications associated with it.
Eagle’s syndrome is a collection of symptoms due to abnormal and/or elongated styloid process. This can irritate the various neurovascular structures that lie in its close proximity, mainly the glossopharyngeal nerve, leading to odynophagia, dysphagia, foreign body sensation, cervicofacial pain, and headache. It is a diagnosis of exclusion and needs high degree of clinical suspicion. It is a rare condition with no reported incidence in the Bhutanese population so far. In this article, we present a case of elongated styloid process that was causing persistent and troublesome orofacial pain in a patient, which was not relieved by medication. The patient underwent trans-oral styloidectomy, which helped cure his symptoms.
Background Hearing impairment due to ototoxicity is one common cause adding to global burden of disability. Amikacin and kanamycin are two common Aminoglycosides used to treat multidrug resistant tuberculosis which results in ototoxicity. The mean prevalence rate of multidrug resistant tuberculosis in Bhutan stood at 16%. Objective The study is aimed to establish prevalence rate of hearing impairment due to ototoxicity and secondary side effects which may ascertain specific early intervention. Method A total of 42 Patients undergoing multidrug resistant tuberculosis treatment participated in the study conducted at Jigme Dorji Wangchuk National Referral Hospital and Gidakom Hospital over a period of one year. Audiological tests were conducted once every month. The severity of ototoxicity was being graded using Brock's hearing loss grades. Result The study found 45.23% participants with some degree of hearing loss consequent to multidrug resistant tuberculosis treatment. Around 9.5% of the total participants developed potential disabling hearing loss. Around 30.09% of participants had experienced subjective tinnitus during the course of treatment. Study found no significant association (p-value 0.88, 95%CI 0.93–1.00) between referred test result of DPOAE (distortion product Otoacoustic emission) screener and the ototoxicity. Conclusion Study showed with significant prevalence of ototoxicity. Since hearing impairment have negative impact on psychosocial wellbeing and communication abilities, it is paramount importance to put in place the various preventative measures. With current guidelines by World Health Organisation on replacement of second-line injectable by oral regimens while treating patients with MDR-TB, it is expected to address ototoxicity and related issues.
We present a 38 year old male with a rare case of plasma cell granuloma arising from facial nerve which posed a diagnostic and therapeutic challenge. He has no other comorbidities except for a history of left ear modified radical mastoidectomy performed in 2002 for cholesteatoma after which he recovered uneventfully. This time he presented with mass in the ear canal with ear block and otorrhea for 1 month duration. Initial biopsy revealed granulation tissue. CT scan revealed bony destruction with soft tissue mass. Diagnosis of recurrence of cholesteatoma was made for which he underwent MRM under general anesthesia. Intraoperatively, there was soft tissue mass filling the mastoid and the middle ear and destruction of all ossicles. The mass was arising from facial nerve and there was bony dehiscence of facial nerve. The mass sent for histopathology revealed plasma cell granuloma. He recovered uneventfully with intact facial nerve and hearing level of 40 dB .Ear canal polyp should not be avulsed as it may arise from facial nerve and any mass should be subjected to histopathological examination and should not be left as granulation tissue. This case posed both diagnostic and therapeutic challenge and supported the hypothesis of that plasma cell granuloma are psudotumour and with proper excision and post-operative steroids, there will be complete remission.
The outer third of external auditory canal is cartilaginous and contains pilosebaceous glands and hair follicles. The medial two third is bony, and the skin is devoid of these skin appendages and its secretions. It also has outward migratory property which makes the ear self-cleansing. Here we present an exceeding rare case of hair in the tympanic membrane causing distressing symptom of scratchy sensation, tinnitus, and otalgia. We hypothesize, it is the distortion of migratory pattern medially due to repeated otitis externa caused by abuse of cotton bud that led to presence of hair in the tympanic membrane.
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