Acute Gram-Negative Bacillary Infections of Middle Ear and Mastoid

Abstract

Thirty-three patients with acute purulent otitis media and mastoiditis caused by Gram-negative bacilli are presented. The main features of the disease include: predilection for young male infants, a high rate of complications that include sepsis, mastoiditis and osteomyelitis of the base of the skull. Patients that are diagnosed early respond well to drainage and ventilation of the infected middle ear combined with in vitro effective antibacterial therapy. Patients that receive prior inappropriate antibacterial therapy tend to have prolonged courses and require mastoid surgery. It is suggested that early myringotomy and bacterial cultures be performed in all patients with acute middle ear infections.

Clinical, laboratory, and microbiological differences between children with simple or complicated mastoiditis

“…The pathogen with the second highest rate of isolation was P. aeruginosa (total, 20.7%). Although the literature contains many reports of isolation of this gram-negative bacilli from patients with acute mastoiditis [14,15], whether it is a true causative organism remains controversial. In our study, P. aeruginosa was isolated almost exclusively in the group with simple mastoiditis, in whom specimens were obtained more frequently from ear discharge.…”

Acute Mastoiditis in Children: Epidemiologic, Clinical, Microbiologic, and Therapeutic Aspects over Past Years

“…6,13,[15][16][17] Some studies have implicated the common practice of administering broad-spectrum antibiotics in increasing the prevalence of resistant bacteria that can spread the infection into the mastoid bone. [18][19][20][21][22] Additionally, antibiotic treatment before hospital admission may mask the classic signs of acute mastoiditis requiring a higher degree of awareness by clinicians. 13,18,23,24 There is also evidence that unusual pathogens that do not respond to empiric antibiotic therapy for AOM can cause acute mastoiditis.…”

Superior vena cava syndrome: presenting symptom of silent otitis media

“…Accordingly, this condition may be considered as a predisposing factor for silent otitis media and for the development of the extensive lateral sinus thrombosis. Since Gram-negative bacillary infections of the ear present a clear-cut symptomatology (Ostfeld and Rubinstein, 1980), the initially asymptomatic course of the disease in the present case cannot be related to Pseudomonas aeruginosa. This pathogen appears to be superimposed on the already developed silent middle ear cleft infection.…”