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LETTER TO EDITOR
Year : 2019  |  Volume : 25  |  Issue : 1  |  Page : 46-47

“Breastmilk-Induced Otitis Externa in Neonates:” An entity often misdiagnosed?


Department of Otorhinolaryngology, K S HEGDE Medical Academy, NITTE (Deemed to be University), Mangalore, Karnataka, India

Date of Web Publication19-Jun-2019

Correspondence Address:
Dr. Satheesh Kumar Bhandary
NITTE (Deemed to be University), Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_96_18

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How to cite this article:
Bhandary SK, Bhat VS. “Breastmilk-Induced Otitis Externa in Neonates:” An entity often misdiagnosed?. Indian J Otol 2019;25:46-7

How to cite this URL:
Bhandary SK, Bhat VS. “Breastmilk-Induced Otitis Externa in Neonates:” An entity often misdiagnosed?. Indian J Otol [serial online] 2019 [cited 2019 Jul 20];25:46-7. Available from: http://www.indianjotol.org/text.asp?2019/25/1/46/260726



Sir,

I would like to draw the attention of the readers to a condition, “breastmilk-induced otitis externa,” which is often misdiagnosed and treated as otomycosis or acute otitis media (AOM). Among the ear diseases affecting neonates, AOM is common. Short  Eustachian tube More Details, feeding habit, and milk regurgitation are the predisposing factors for AOM.[1] Children usually present with excess cry due to acute pain in the ear and at times with mucopurulent discharge from the ear.[2] A small perforation on the tympanic membrane heals spontaneously with medical treatment. External auditory canal skin is usually normal in such babies, and tragal tenderness will not be seen.

Otitis externa is an inflammation of the skin of the external auditory canal which is a common disease in adults.[3] In neonates, this condition is less common and is usually secondary to discharge due to AOM or fungal infection in the external auditory canal. Otitis externa in neonates may also mimic AOM. This can be differentiated from AOM by the presence of external auditory canal edema, purulent ear discharge (absence of mucous), and positive tragal sign. Fungal otitis externa can be differentiated by the presence of creamy (Candida albicans) or black (Aspergillus niger) discharge in the external auditory canal.[4],[5]

We have often encountered few neonates presenting with ear discharge, which is whitish in color, and having mild tenderness in the ear [Figure 1]. Careful examination revealed that the debris in the external auditory canal is milk precipitate regurgitated from the mouth, getting collected in the concha and the external auditory canal. Examination of several neonates with similar condition made us to think of a condition, which can be called “milk-induced otitis externa in neonates.” Tympanic membrane will be normal in these babies. Culture of the discharge will be negative in these cases, and examination of the discharge will not show the presence of fungus. We concluded that this entity is caused by the regurgitated milk and this condition is often misdiagnosed and treated as otomycosis. Furthermore, in few of such cases, which were diagnosed as otomycosis, application of antifungal ointment caused irritation and more pain.
Figure 1: Ear canal of a neonate filled with whitish debris

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As regurgitation of milk is common in neonates, this can enter the external auditory canal due to the dependent position of the head while sleeping [Figure 2]. This condition can be treated by removal of the milky debris from the ear canal and application of a topical antiseptic ointment. Observation and awareness about this new entity is important to prevent misdiagnosis and overtreatment. The condition can be easily prevented by educating the mother about the feeding techniques and prevention of regurgitation of milk. In case of recurrent episodes, the ear canal can be plugged while the baby is sleeping after a feed.
Figure 2: A neonate with regurgitated milk on the cheek, flowing toward the ear canal

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the baby's mother has given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bluestone CD, Klein JO, editors. Otitis Media in Infants and Children. 3rd ed. Philadelphia: WB Saunders; 2001.  Back to cited text no. 1
    
2.
Burton DM, Seid AB, Kearns DB, Pransky SM. Neonatal otitis media. An update. Arch Otolaryngol Head Neck Surg 1993;119:672-5.  Back to cited text no. 2
    
3.
Coll JR. Otitis externa in children. Gen Pract 1976;26:610-25.  Back to cited text no. 3
    
4.
Agarwal P, Devi LS. Otomycosis in a rural community attending a tertiary care hospital: Assessment of risk factors and identification of fungal and bacterial agents. J Clin Diagn Res 2017;11:DC14-8.  Back to cited text no. 4
    
5.
Pontes ZB, Silva AD, Lima Ede O, Guerra Mde H, Oliveira NM, Carvalho Mde F, et al. Otomycosis: A retrospective study. Braz J Otorhinolaryngol 2009;75:367-70.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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