This study aimed to assess the prevalence and profile of ear diseases in children from Delhi, India.

A population-based cross-sectional door-to-door survey was carried out in two districts of Delhi, and involved children of all demographic sections of the region. A total of 4626 children aged between 18 days and 15 years underwent examinations including otoscopy, impedance audiometry and hearing screening.

In all, 14.8 per cent of the study sample was diagnosed with one or more ear morbidities, the most common being cerumen impaction (7.5 per cent) and chronic suppurative otitis media (3.6 per cent). There was clinical evidence of otitis media with effusion in 2 per cent of children, and 0.96 per cent had otitis externa (bacterial and fungal). The point prevalence of acute suppurative otitis media was 0.39 per cent. In all, 0.45 per cent of children were found to have an undiagnosed foreign body within the ear canal.

The high prevalence of ear disease poses a significant public health problem in Delhi.

Cerumen impaction is a common problem, and aural microsuction is a technique frequently employed for its management. This study aimed to quantify the patient perception, safety and efficacy of this procedure.

Patients were asked to complete a questionnaire following cerumen clearance by microsuction. The perceived severity of pain, noise-related discomfort and vertigo was scored on a scale of 1 to 10. Patients with mastoid cavities and those who had used a cerumenolytic agent in the preceding week were analysed separately.

A total of 159 questionnaires were returned. Mean scores (95 per cent confidence intervals) were: pain, 2.34 (2.06–2.62); noise discomfort, 3.03 (2.71–3.35); and vertigo, 1.95 (1.66–2.25). There was successful clearance (i.e. sufficient to view the tympanic membrane) in 91 per cent of cases. Patients who had used cerumenolytics reported significantly less pain and vertigo (p = 0.008 and p < 0.001, respectively) compared with those who had not, whilst patients with mastoid cavities reported greater levels of vertigo (p < 0.001) than those without.

Aural microsuction is well tolerated. Side effects are mild, and the prior use of cerumenolytics appears to further reduce their severity.

To conduct an in-vitro study to determine the most effective topical cerumenolytic.

Cerumen was collected from patients who attended the ENT out-patient clinic. The collected cerumen was formed into a homogeneous ball. Discs of wax were punched out and weighed to create samples of uniform shape and size. Each cerumen sample was placed in a tube which contained one of six test solutions. The tubes were observed at specific time points. Digital photographs were taken to record the degree of cerumen disintegration. The cerumen discs were then removed from the solutions, dried and re-weighed.

Distilled water caused the greatest reduction in the mass of the cerumen disc. Cerumen placed in distilled water and in sodium bicarbonate solution showed substantial disintegration at 12 hours. Cerumen placed in solutions containing oil-based agents showed no visible sign of disintegration and no reduction in dried weight.

Distilled water resulted in the greatest degree of cerumenolysis. Oil-based cerumenolytics were ineffective.

To investigate hepatitis B virus DNA in the cerumen of hepatitis B virus infected patients.

This study comprised 30 confirmed cases of chronic hepatitis B. Patients' serum samples were examined for hepatitis B surface antigen and antibodies using enzyme immunoassay systems. The presence of hepatitis B virus DNA in cerumen was investigated using a polymerase chain reaction test.

All of the samples were positive for hepatitis B surface antigen and negative for hepatitis B surface antibodies. Hepatitis virus DNA was detected in two cerumen samples (6.6 per cent of patients).

Cerumen can be a potential source of transmission of hepatitis B virus.

Ceruminous mucoepidermoid carcinoma of the external auditory canal is extremely rare. This paper highlights the impact of concurrent chemoradiotherapy on the outcomes of this disease.

A 47-year-old female presented with a 2-month history of otalgia and a mass in her right ear. Biopsy revealed high grade ceruminous mucoepidermoid carcinoma. She underwent surgical excision of the right external auditory canal and right upper neck dissection. Pathological analysis of tumour–node–metastasis staging revealed a T2 N0 (stage II) tumour. One year later, computed tomography scanning of the temporal bone showed tumour recurrence. Biopsy revealed recurrent ceruminous mucoepidermoid carcinoma. The patient underwent salvage resection. Pathology revealed that the tumour was diffusely invading nearby structures, with perineural invasion, lymphatic spread and extracapsular extension. Pathological analysis of tumour–node–metastasis staging revealed a T3 N1 M0 (recurrent stage IV) tumour.

The patient subsequently received concurrent chemoradiotherapy. There was no evidence of disease at 37 months' follow up.

The trimodality approach, using surgery plus concurrent chemoradiotherapy, provided reasonable loco-regional control with tolerable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.

Syringing of the ear is one of the most common procedures performed for cleaning cerumen from the external auditory canal. Common complications following syringing are pain, external auditory canal trauma and otitis externa. Hearing and vestibular loss have also been reported as complications. However, we are unaware of any report of facial nerve palsy as a complication of ear syringing. Such a case is reported.

We describe a case of facial nerve palsy as a complication of syringing, which demonstrates the dramatic presentation of this condition and emphasises the need for great care while syringing the ears.

It is important to be aware of this unusual complication with its distinctive presentation. Surgical intervention should be undertaken at the earliest opportunity, for favourable results. A risk-minimising strategy for ear syringing is recommended.

The direct activity of antimicrobial peptides against microbes is thought to be an essential first line of defence in the skin; however, little is known about antimicrobial peptide secretion in the skin of the external auditory canal. Evidence suggests that mast cells contribute to the secretion of antimicrobial peptides. This study aimed to examine the distribution of mast cells and antimicrobial peptides, including human β-defensin-1 and -2 and LL-37, in the external auditory canal skin.

External auditory canal skin samples from 12 patients undergoing middle-ear surgery with canaloplasty were immunohistochemically stained to detect expression of mast cell markers (tryptase and chymase) and antimicrobial peptides (human β-defensin-1 and -2 and LL-37).

Mast cells and human β-defensin-1 were present in the ceruminous glands but not in the sebaceous glands. The increased presence of mast cells, human β-defensin-1 and LL-37 in ceruminous glands suggests that mast cells may participate in the secretion of antimicrobial peptides from ceruminous glands.

These findings suggest that mast cells contribute to the secretion of antimicrobial peptides in the ceruminous glands of the external auditory canal skin.

To assess the antibacterial and antifungal properties of human cerumen by studying its effect on the growth of Staphylococcus aureus, Esherichia coli, Pseudomonas aeruginosa and Candida albicans.

Cerumen samples were collected from 75 normal, healthy subjects aged from seven to 80 years, without ear pathology, who attended the ear, nose and throat out-patient clinic of the University Malaya Medical Center from May 2006 to October 2006. Of these 75 samples, 31 had no growth when cultured on nutrient agar. Inhibition studies on these 31 samples were performed for Staphylococcus aureus (American Type Culture Collection (ATCC) 25923), Esherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853) and Candida albicans. Nutrient agar was used to conserve all three bacterial strains and Sabouraud dextrose agar was used for Candida albicans.

A decrease in Staphylococcus aureus growth was observed for 27 of the 31 samples. All 31 samples induced decreased growth of Pseudomonas aeruginosa, while 29 induced decreased growth of Candida albicans. However, only four samples induced decreased growth of Escherichia coli.

Cerumen was demonstrated to have potential antimicrobial effects on strains of Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans.

The objective of the study was to correlate quantitative changes in the lipid composition of human cerumen with changes in age, sex and menstrual cycle stage.

Cerumen samples were collected from the external ear canal and analysed using sequential, one dimensional, high performance thin layer chromatography.

The following age groups of both sexes were investigated: one to 10 years; 11–18 years; 19–40 years; and 40 years and over. Additionally, cerumen samples from subjects in three stages of the menstrual cycle were compared.

In the cerumen samples, the peak values for wax ester and cholesterol occured between the ages of one and 10 years for both sexes. However, squalene and triglyceride content reached maximum levels at puberty. Men aged 19–40 years had a significantly greater percentage of cerumen lipid squalene content than women from the same age group; however, their cholesterol content was found to be lower. Regarding the various menstrual cycle stages, cerumen samples taken at the follicular stage from women aged 19–40 years had a significantly lower free fatty acids content, and higher cholesterol and squalene levels, compared with samples taken in the luteal or menstrual stages.

The proportions of the lipid constituents of cerumen varied with age, sex and menstrual stage. In cerumen, the main lipid constituent stimulated at puberty appears to be squalene, not wax esters as reported for sebum. The relevance of lipid constituents to cerumen's protective role is discussed.