MSOHNS  Annual  Scientific  Meeting  &  9THMalaysia-­‐Singapore  Joint  ENT  Meeting  

2014    

 

 

 

Date       20th  APRIL  2014  (SUNDAY)  

Venue     AWANA  HOTEL,  GENTING  HIGHLAND  

 

 

 

 

 

 

 

 

SPONSORED  BY:  

 

 

 

 

 

PROGRAMME  

 

0800  –  0830   Registration  

0830  –  0845   Welcome  Address  and  Exchange  of  Gifts  Professor  DrPrepagaren  Narayanan,  President  2013/2014,  MSOHNS  DrHeng-­‐Wai  Yuen,  President  2013/2014,  SOHNSS    

0845  -­‐  0915   Eustachian  Tube  Dilatation  Dr  Yuen  HengWai  Consultant,  Changi  General  Hospital  Singapore      

9th  Malaysia-­‐Singapore  Joint  ENT  Meeting  Free  Paper  Presentations      0915  -­‐  0930   Outcomes   following   total   laryngectomy   for  

squamous  cell  carcinoma  at  a  Singapore  Tertiary  Referral  Centre  E  Fu,  MY  Lim,  J  Kanagalingam,  CGL  Hobbs    

0930  –  0945   Reliability  and  Accuracy  of  Chirp  Based  Multiple  Auditory   Steady   State   Response   (MSSR)   and  Auditory  Brainstem  Response  (ABR)  in  Children  Teoh  Jian  Woei,  Asma  Abdullah,  RafidahMazlan,  Azmi  Mohd  Tamil,  Faridah  Hassan,  Nur  Syuhada  Mohd  Rosli    

0945  –  1000   Cystic  Nodal  Metastasis  as  a  Prognostic  Factor  in  Nasopharyngeal  Carcinoma  Yohanes  Ting,  Jeremy  Chee,  Charn  TZ,  Thomas  Loh,  Chong  CC,  Eric  Ting,  Lim  CM    

1000  –  1030   GUEST  LECTURE    Trans-­‐  Oral   Brush  Biopsies   and  Quantitative  PCR  for  EBV  DNA  Detection  and  Screening  of  Nasopharyngeal  Carcinoma  Associate  Prof  Dr  Siow  Jin  Keat  Associate  Prof  and  Senior  Consultant,  TTSH  Medical  Centre,  Singapore    

1030  –  1100   Tea  Break  

1100  –  1115   A   Study   on   the   Association   Between   Glycemic  Control   and   Sensorineural   Hearing   Loss   Among  Type  2  Diabetes  Mellitus  Patients    Nik  Azrizie  Muhamed,  Mohd  Khairi  Md  Daud,  Rosdan  Salim,  Nani  Draman    

1115  –  1130   Pre-­‐operative   High   Resolution   Computed  Tomography   Scans   for   Cholesteatoma   –   has  anything  changed?    Ng  CHL,  Ng  JH,  Soon  SR,  TY  Tan,  KH  Mok,  HW  Yuen    

1130  –  1145   3D   Model   of   Abnormal   Cochlear   –   Mondini   for  Training  of  Cochlear  Implant  Surgery    Chitrabanu  G,  Vickneswaran,  N  Prepageran    

1145  –  1200   9thMalaysia-­‐  Singapore  Joint  Meeting  Free  Paper  Awards  Ceremony      

1200  –  1230   GUEST  LECTURE    Microdebrider  in  ESS  Prof  Dato’  Dr  Balwant  Singh  Gendeh  Professor  and  Senior  Consultant,  UKM  Medical  Centre,  Kuala  Lumpur    

1230  –  1330   Lunch  

MSOHNS  Annual  Scientific  Meeting  Free  Paper  Presentations          1330  –  1345   Identification   of   Nasal   Irrigation   Bottle  

Contamination  in  Post  Sinonasal  Surgery    A  Najihah,  BS  Gendeh,  Salasawati  H    

1345  –  1400   The   Effect   of   Mometasone   Furoate   Nasal   Spray  on   Nasal   Obstruction   Symptoms   and   Blood  Oxygenation  in  Allergic  Rhinitis  Patients    Mohamad    Azizul  Fitri  Khalid,    Ramiza  Ramza  Idris,  Rosdan  Salim,  Amirozi  Ahmad    

1400–  1430   GUEST  LECTURE    Basic  Sialendoscopy  Dr  Pua  Kin  Cho  Head  and  Senior  Consultant,  Hospital  Pulau  Pinang    

1430  –  1445   A   Retrospective   Study   of   Juvenile  Nasopharyngeal  Angiofibroma  in  UKMMC    Syed  Zaifullah,  Mohd  Razif  Mohamad  Yunus,  Balwant  Singh  Gendeh    

1445–  1500   Obstructive   Sleep   Apnea   Among   Malaysian  Children:  Treatment  Modalities  and  Outcomes    CC  Gan,  A  M  Manuel    

1500  –  1515   The  Prevalence  and  Characteristics  of  Microtia:  A  cross   Sectional   Study   in   Universiti   Kebangsaan  Malaysia  Medical  Centre  Eyzawiah  H,  Goh  B.S    Specialist  Category    

1515  –  1535   House  Dust  Mites   in   External  Auditory   Canal:   A  Cause  of  Itching  or  Normal  Commensals?  Elizabeth  Lim      

1535  –  1550   MSOHNS  Annual  Scientific  MeetingFree  Paper  Awards  Ceremony    

1550  –  1630   Tea  break  and  END      

                                 

MSOHNS  Annual  Scientific  Meeting  &  9THMalaysia-­‐Singapore  Joint  ENT  Meeting  2014  

INSTRUCTION TO FREE PAPER PRESENTORS 1. The topics of presentation should be ORIGINAL with new findings. Repeat

presentation of earlier scientific meetings would not be deemed fit for this years presentation.

2. Presentation: 10 minutes presentation and 2 minutes Q & A bythe judges. 3. All presenters must provide the presentation material on CD ROM orthumb drive

before the commencement of the scientific meeting. 4. Qualified ENT Specialists & ENT MO/Masters Students are eligible topresent their

work for this award. There will be two categories, onefor specialists and the other for Master’s students. Each will bejudged separately. Winners of each category will receive a prize.

 

• Decision  made  by  judges  are  final  • Speakers  for  selected  abstracts  are  required  to  present  their  work  

                                       

                               

ABSTRACTS

RELIABILITY AND ACCURACY OF CHIRP BASED MULTIPLE AUDITORY

STEADY STATE RESPONSE (MSSR) AND AUDITORY BRAINSTEM

RESPONSE (ABR) IN CHILDREN

Teoh Jian Woeia, AsmaAbdullaha, RafidahMazlanb, AzmiMohdTamilc, , FaridahHassand , NurSyuhadaMohdRoslie

aDepartment of ORL HNS, UKM Medical Center (UKMMC)

bDepartment of Audiology, School of Rehabilitation Sciences, Faculty of Health Sciences, UniversitiKebangsaan Malaysia cDepartment of Community Health, Faculty of Medicine, UniversitiKebangsaan Malaysia dDepartment of ORL HNS, Selayang Hospital, Malaysia eDepartment of Audiology, Selayang Hospital, Malaysia

ABSTRACT Objective: The purpose of this study was to compare the reliability and accuracy of Chirp Based Auditory Brainstem Response (ABR) and Multiple Auditory Steady State Response (MSSR) in children. Methods: It was a prospective clinical study in Selayang Hospital and UniversitiKebangsaan Malaysia Medical Centre from 1st December 2011 to 30th November 2012 with 38 children ranging from 3 to 18 years old. The subjects underwent hearing evaluation using ABR tests and MSSR under sedation.The duration of both tests were then compared. Results: The estimated hearing threshold of frequency specific chirp MSSR showed good correlation with ABR especially in higher frequencies such as 2000Hz and 4000Hz with the value of cronbach alpha of 0.890, 0.933, 0.970 and 0.969 on 500Hz, 1000Hz, 2000Hz and 4000Hz. The sensitivity of MSSR are 0.786, 0.75, 0.957 and 0.889 and specificity are 0.85, 0.882, 0.979 and 0.966 over 500Hz, 1000Hz, 2000Hz and 4000Hz. The duration of MSSR tests were shorter than ABR tests in normal hearing children with an average of 35.3 minutes for MSSR tests and 46.4minutes for ABR tests. This can also be seen in children with hearing loss where the average duration for MSSR tests is 40.0 minutes and 52.0 minutes for ABR tests. Conclusions: MSSR showed good correlation and reliability in comparison with ABR especially on higher frequencies. Hence, MSSR is a good clinical test to diagnose children with hearing loss.

A STUDY ON THE ASSOCIATION BETWEEN GLYCEMIC CONTROL AND SENSORINEURAL HEARING LOSS AMONG TYPE 2 DIABETES MELLITUS PATIENTS

NikAzrizieMuhamed#, MohdKhairiMdDaud#, Rosdan Salim#, NaniDraman# # Department of Otorhinolaryngology – Head & Neck Surgery, UniversitiSains Malaysia

ABSTRACTS

Introduction:Diabetes related hearing loss had been debating for many years with no clear conclusion. It was postulated that microvascular complication of diabetes will also affect the organ of hearing particularly cochlea leading to hearing loss. The aim of this study is to determine prevalence of SNHL in type 2 diabetic patients and to determine the association between glycemic control and SNHL, whether the good glycemic control can reduce the incidence of hearing loss.

Methodology: A cross-sectional case study was conducted in Otorhinolaryngology clinic, USM from Disember 2012 to June 2013 on 138 type 2 diabetes Mellitus patientsattendingfor routine checkup. Detailed information regardingtheage, sex and duration of diabetes andtreatment history, was obtained from patient’s medical record. They were divided into two groups based on HbA1C level. HbA1C ≤7 were grouped as controlled DM while HbA1C >7 were grouped as uncontrolled DM. Pure Tone Audiometry was done to determine hearing function, degree, type and configuration of hearing loss.

Results: The prevalence of SNHL among type 2 DM was 29% (95%CI,21%,37%).The prevalence of SNHL in controlled diabetic patients was 17% (95% CI: 7%,27%) while the prevalence of SNHL in uncontrolled diabetic patients was 36% (95% CI: 26%,47%). Uncontrolled DM showed a significant association with sensorineural hearing loss in type 2 Diabetes Mellitus patients (p value= 0.014). The degree of hearing loss in uncontrolled DM was also found to be higher as compared to controlled diabetic group. However the duration of Diabetes Mellitus had no significant correlation with hearing loss. The presence of diabetic nephropathy was significantly increase the risk of getting hearing loss (p value = 0.002).

Conclusion:Type 2 Diabetes Mellitus was associated with progressive bilateral mild to moderate high frequency hearing loss. The prevalence of sensorineural hearing loss in diabetic patients was 29% which was consistent with other studies. Poor glycemic control was significantly associated with high prevalence of sensorineural hearing loss among type 2 diabetic patients. Thus hearing screening was justified especially for uncontrolled diabetic patients.

 

 

3D MODEL OF ABNORMAL COCHLEAR - MONDINI FOR TRAINING OF COCHLEAR IMPLANT SURGERY

Chitrabanu, Vickneswaran, N Prepageran

Department of Otorhinolaryngology – Head & Neck Surgery, Universiti Malaya

ABSTRACT

Introduction: The skills of ear surgery are best developed by practising dissection of human temporal bones. Due to the scarcity of cadaveric bones and issues of training on live patients, rapid prototype (RP) 3D temporal bone models have been made available since last decade for the purpose of surgical training and education. The aim of this study is to produce abnormal cochlear ( Mondini ) model for the purpose of training in cochlear implant.

Materials and Methods: A High-resolution (1 mm slice) axial Computed Tomographic(HRCT) scans of patient with Mondiniwere obtained in Digital imaging and communications in medicine (DICOM) format. The structures within the temporal bone (sigmoid sinus, facial nerve, ossicles, semicircular canals, cochlea) were then manually drawn (outlined) on each HRCT image.Prototype model were produced using stereolithography. Temporal bone dissection was done using conventional surgical instruments. Anatomical landmarks were confirmed and cochlear implant insertion was done via microscope and otoendoscopy. Respondents were given questionnaire after procedure for evaluation.

Results: Temporal bone dissection was performed by 3 practisingOtorhinolaryngologists using conventional instruments and questionnaires on anatomical, haptic and acoustic realism was answered by each of them. In summary, the average score was 3.67 for anatomical realism, 3.33 for haptic realism and 3.0 for acoustic realism. Cochlear implant was successfully inserted via cochleostomy.

Conclusion: Prototype model using stereolithography can be used in surgical planning and training with regards to cochlear implant. This provides a platform to produce prototype models for other congenital ear anomalies such as common cavity for cochlear implant.

IDENTIFICATION OF NASAL IRRIGATION BOTTLE CONTAMINATION IN POST SINONASAL SURGERY

A Najihah1, BS Gendeh1, Salasawati H 2

1Department of Otorhinolaryngology-Head and Neck Surgery, UKMMC 2Department of Microbiology, UKMMC

ABSTRACT

Nasal irrigation is an effective and cheap method in managing post sinonasal surgery patients. It works by improving ciliary clearance and performing mechanical debridement of the thick crust, decreasing mucosal edema and reducing the inflammatory mediators. Presence of nasal irrigation bottle contamination and its effect on patients have been studied. The aim of this study is to prospectively identify the risk of contamination in the nasal irrigation bottle, nasal cavity and to correlate with endoscopic findings from the patients who had underwent sinonasal surgery. Swabs were taken from the nasal irrigation bottle and patient’s middle meatus before the surgery and at each post surgery visits (2 and 4 weeks). Patients were advised to irrigate their nose three times per day post sinonasal surgery. During endoscopic examination of the patient’s nasal cavity at 2 and 4 weeks, any evidence of infection will be noted and documented. The specimens were sent to the Microbiology laboratory for standard culture and sensitivity test. A total of 27 patients completed the study and were divided into case (n=15) and control (n=12) groups. The majority of the swabs from the nasal cavity of the patients and the nasal irrigation bottles were positively cultured for Pseudomonas sp group. Other groups of bacteria that were cultured were Enterobactersp, Coagulase Negative Staphylococcus (CONS) and Klebsiella sp. The CFU (colony-forming unit) value of the bacteria cultured from the nasal cavity and the nasal irrigation bottle was statistically significantly (p=0.00) increased from the baseline to the second week follow-up in both groups but not from the second week to the fourth week follow-up. Endoscopically, there was no clinical evidence of infection found in the nasal cavity of the patients. The nasal irrigation bottle that was used in the post sinonasal surgery treatment and for alleviation of symptoms of sinonasal diseases was found to have bacterial contamination from the swabs taken from the bottle. However, despite this finding there was not clinical evidence of infection noted from the nasal endoscopic examination. A simple and effective method of cleaning the bottle would be helpful to reduce the bacterial contamination for this useful treatment method.

 

 

 

 

THE EFFECT OF MOMETASONE FUROATE NASAL SPRAY ON NASAL OBSTRUCTION SYMPTOM AND BLOOD OXYGENATION IN ALLERGIC RHINITIS PATIENTS

Mohamad AzizulFitri Khalid #, RamizaRamzaIdris#, Rosdan Salim #, Amirozi Ahmad#

Department of Otorhinolaryngology – Head & Neck Surgery, UniversitiSains Malaysia

ABSTRACTS

Background: Allergic Rhinitis (AR) is a disease which is widely spread on the world and causing symptoms like nasal discharge, itchiness and also nasal blockage which impaired the quality of life of most patients depending on severity. However, the symptoms are treatable with the use of intranasal steroid. Many studies have shown that AR patients are having persistent nasal blockage which can be considered part of the upper airway tract. In theory, any obstruction to the upper airway may affect the blood oxygenation to the lung.

Objective: In this study, the objective is to elicit the influence of nasal obstruction to blood oxygenation and its reversibility using intranasal steroid to improve the blood oxygenation and also symptoms of nasal obstruction.

Methodology: This study was conducted from November 2012 until October 2013 involving 33 AR patients ageing from 18 to 35 year-old. All subjects had moderate to severe nasal obstruction based on Visual Analogue Scale (VAS) and had arterial blood gases (ABG) taken from their radial artery. They were started with Mometasonefuroate nasal spray (MFNS) two puff twice a day for two weeks. A repeated assessment of nasal obstruction symptom and ABG was done after two weeks. Four parameters were compared pre and post medication including VAS of nasal obstruction, partial oxygen arterial pressure (PaO2), partial arterial carbon dioxide pressure (PaCO2) and oxygen saturation (O2 Saturation).

Results: All parameters showed significant difference between pre and post medication. VAS difference was significant (p <0.01), PaO2difference was significant (p < 0.01), PaCO2 was significant (p = 0.029) and O2 Saturation was also significant pre and post medication (p<0.01).

Conclusion: Therefore we found that a comprehensive treatment of nasal obstruction using MFNS will help to improve nasal obstruction symptom and also blood oxygenation.

A RETROSPECTIVE STUDY OF JUVENILE NASOPHARYNGEAL ANGIOFIBROMA IN UKMMC Syed Zaifullah#, MohdRazif Mohamad Yunus#, Balwant Singh Gendeh#

# Department of Otorhinolaryngology - Head and Neck Surgery, UKMMC

ABSTRACT

Objective: The objective of this study is to document the presenting symptoms of JNA, evaluate the stages of JNA based on radiological study, determine the effects of embolization prior to surgery, describe the surgical techniques/approaches of JNA and determine the outcome of JNA after treated surgically. Method: This is a retrospective study of 14 patients who were diagnosed with Juvenile Nasopharyngeal Angiofibroma (JNA), of which only 11 patients had data available between January 1998 to December 2010 at the Otorhinolaryngology, Head and Neck Surgery, UnversitiKebangsaan Malaysia Medical Center. Results: Eleven cases of JNA were seen, in which all patients were male. The average age of presentation was 17.1 years with a range of 13-32 years. Ten out of 11 patients were Malay, and patient was Chinese. Most of them presented with epistaxis (90.9%), nasal blockage (90.9%) and nasal discharge (45.5%). Average duration of symptoms was 8 months, ranging from 1 week to 3 years. All 11 patients underwent CT scan imaging to diagnose JNA, and 4 patients subsequently underwent MRI. All patients were stage according to Fisch Grading system. All patients undergone angiography but only 9 patients were embolized due to procedure abandonment as patients were experiencing severe pain during the procedure. There were 4 (36.4%) patients in stage I, 3 (27.3%) in stage II, 3 (27.3%) in stage III and 1 (9.1%) patient in stage IV. All patients underwent primary surgical intervention for tumour removal. Four (36.4%) patients underwent open-technique approach while another 7 (63.6%) patients through close-technique (endonasal endoscopic) approach. We noted overall result were better and supporting close-technique approach in terms of operation time, estimated blood loss, total blood transfusion, total duration of hospital stay and recurrence rate. Conclusion: In conclusion, we noted that endonasal endoscopic approach is better surgical approach in treating small and medium size JNA tumour, and may be as an adjunct procedure in combination with open surgery in treating advanced JNA tumour.

 

OBSTRUCTIVE SLEEP APNEA AMONG MALAYSIAN CHILDREN: TREATMENT MODALITIES AND OUTCOMES CC Gan1,AM Manuel1

1 Department of Otorhinolaryngology – Head & Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia

ABSTRACTS

Introduction: Sleep disordered breathing (SDB) is a disease spectrum ranging from simple snoring to upper airway resistance syndrome (UARS), to the more severe obstructive sleep apnea (OSA). There are evidences showing children with OSA carry significant adverse consequences on their development, growth and health.

Study Objective: To assess the effect of treatment based on pediatric sleep questionnaire by Chervin and its outcome and the predictors of persistent disease after treatment

Material & Methods: A prospective cohort study in children aged 18 years old and below who underwent polysomnogram (PSG) and diagnosed obstructive sleep apnea (OSA) at University Malaya Medical Center from 1st June 2012 to 31st December 2013. Parents were consented for the study. After OSA was confirmed by the results of technician-attended nocturnal PSG, patients are treated with medical therapy or surgical intervention depending on the severity and cause of the OSA. Variables taken into account include body mass index (BMI), neck circumference, grading of adenotonsillar hypertrophy, Friedman tongue position (FTP) and syndromes. They will then be followed up to assess the progress response to treatment taking into account the variables mentioned above. Chervinpaediatric sleep questionnaire (Chervin PSQ) was completed by patients’ parents or guardians before and after treatment.

Result: 92 patients recruited into the study. 91 patients had snoring as their primary symptom, 81 of them confirmed OSA by PSG, 11 are habitual snorers. Majority are male patients, 68.5%, only 29 are females. 46 children who underwent tonsillectomy (42), adenoidectomy (39) and tracheostomy (2). Another 46 received only medical therapy, weight reduction (44), intranasal steroid (44), monteleukast (6) and CPAP (10). Patient who received surgical intervention show significant improvement in PSQ score, p-value <0.001. Syndromic children who received surgical treatment noted post-PSQ score back to normal (p-value<0.05). Those who are overweight and obese have improved PSQ score (p-value <0.05) after receiving treatment. Children who snore more frequently and those with witnessed apnea have more severe OSA (p value <0.05). Those who have daytime mouth breathing, bigger tonsils, exposure to cigarette smoke and PSQ of more than 7 associated with higher risk (p-value <0.05) of undergoing surgical treatment. In this study, FTP neither associated with severity of OSA nor related to treatment outcome. 11 patients have persistent disease(postPSQ>7) after treatment.

Conclusion: children who snore should be screen for OSA. Adenotonsillectomy(T&A) is recommended as the first-line treatment of patients with adenotonsillar hypertrophy. Weight loss is recommended in addition to other therapy in patients who are overweight or obese. Patients should be re-evaluated postoperatively to determine whether further treatment is required. The data collected support the clinical practice guideline provided by the American Academy of Pediatrics which should be followed before we establish our own in future.

THE PREVALENCE AND CHARACTERISTICS OF MICROTIA: A CROSS

SECTIONAL STUDY IN UNIVERSITI KEBANGSAAN MALAYSIA MEDICAL

CENTRE

Eyzawiah H#, Goh B.S# # Department of Otorhinolaryngology - Head & Neck Surgery, Faculty of Medicine, UniversitiKebangsaan Malaysia, Kuala Lumpur, Malaysia ABSTRACT

Microtia is a malformation of the auricle, ranging from minimal abnormalities to major structural alterations or even total absence of the external ear. Unilateral microtia is more common and the right ear affected more than the left. There is also ahigher prevalence in male. Most of the studies on microtia have been conducted among the Caucasians. The studies that were conducted in the Asian population were from China. There is no study carried out among the South East Asian population. Therefore we investigated the prevalence and characteristics of microtia as well as to evaluate the option of hearing amplification and associated risk factors in our populations. Forty eight patients were recruited from Otorhinolaryngology (ORL), Head and Neck’s clinic or ward of UKMMC from the period of March 2012 to March 2013. An interview, clinical examination and hearing assessment and high resolution computed tomography (HRCT) of temporal bone were used in this study. This study showed the prevalence of microtia was 0.27% with predominance in Malay populations. Majority of our study populations had unilateral microtia (62.5%) with the right ear as the affected side (39.6%) corresponding to other studies reported. The patients were classified according to Marx’s classification into 3 groups (grade 1-3), and grade 3 was the commonest type (50%). The HRCT of temporal bone showed various associated ear anomalies such as canal stenosis 20.8%, canal atresia 79.2% and other anomalies of middle and inner ear. In this study, the comparison between the severity of hearing loss with the different grades of microtia had been analysed, which showed significant worsening of hearing loss as the grade of microtia increased (p value = 0.032). Majority of patients with bilateral microtia (77.8%) received appropriate hearing amplifications, with 50% were preferred Bone Anchored Hearing Aids (BAHA). The median age of starting to use hearing amplification is at 8 years old. However we would like to advocate that all bilateral and unilateral microtia patients with hearing loss should perform hearing assessment and received hearing rehabilitation as early as possible for better speech and language development. Several risk factors have been identified, including parental academic and economic background, potential genetic factors, maternal obstetric history and environmental exposure which may predispose to microtia formation. However this study did not yield any significant risk factors and further case control study is needed.

House Dust Mites in External Auditory Canal: A Cause of Itching or

Normal Commensals?

Elizabeth Lim Yenn Lynn#

#Department of Otorhinolaryngology – Head & Neck Surgery, University of Malaya, Kuala

Lumpur, Malaysia

ABSTRACT

Introduction: In humans, mites have been blamed for causing severe pruritus and otitis

externa.

Aim: A study was done to investigate the presence of mites in the external ear canal

resulting in itching.

Material and Methods: Sixty (60) with itchy ears and 53 asymptomatic (non-itchy)

earsas control. Ear scrapings were examined under microscope by a parasitologist.

Result : House dust mite was identified in 5 (8.3%) ears of the itchy group and 3

(5.7%) ears of the control group. There was no significant difference between the two

groups.

Conclusion: Mites may be normal commensals of external ears in tropical countries, and

not the cause of itch.