Clinico-Microbiological Aspect of Chronic Suppurative Otitis Media

Abstract

BACKGROUND Chronic suppurative otitis media (CSOM) is a disease of multiple aetiology and its importance lies in its chronicity and dreaded complications. Both Gram-positive and negative organisms are responsible for infection of the middle ear. Due to advent of newer and sophisticated antibiotics, the microbiological flora is changing constantly. This requires a reappraisal of the flora in CSOM and their in vitro antibiotic sensitivity pattern in cases of CSOM, which do not respond to local antibiotics. The frequent presence of CSOM in general practice and its poor response to the routine treatment are the factors responsible for undertaking this study. MATERIALS AND METHODSOne hundred and fifty patients with tubotympanic type of CSOM were prospectively studied. They had chronic ear discharge and had not received antibiotics for the previous five days. Swabs were taken and cultured for bacteria. The standard method of isolation and identification was followed. Antimicrobial susceptibility of the bacterial isolates was performed by Kirby-Bauer's disc diffusion method. RESULTSAnalysis of bacterial flora of the present study showed predominance of Gram-negative bacilli (41.4%). The highest incidence (36.5%) was that of Pseudomonas aeruginosa followed by Staphylococcus aureus (29.5%). Overall most sensitive antibiotic groups were Fluoroquinolones and Cephalosporins and least effective were Penicillin and Macrolides. CONCLUSIONThe outcome of our study enabled us to set an empirical medical treatment for an early resolution of ear discharge and inflammation in our patients with CSOM as we could understand the aetiological pathogens and their susceptibility pattern. Effective medical treatment in obtaining a discharge free ear prior to surgical treatment led us to improve the surgical outcome in our patients with CSOM.

Chronic Suppurative Otitis Media (CSOM): Evaluation of fungal and aerobic bacterial agents and antibiotic sensitivity pattern of the bacterial isolates

“…Unilateral infections were found to be higher than bilateral ear infections which is similar to previous study by Sengodan Rajesh et al 13 Mono bacterial etiology was most common in present study which was in accordance with other studies. 10,12,14 Most common bacterial isolates were Gram negative (Pseudomonas aeruginosa followed by Proteus mirabilis) followed by Gram positive (Staphylococcus aureus). This finding is in accordance with some researchers 11,14,15 but in contrast with other researchers.…”

“…10,12,14 Most common bacterial isolates were Gram negative (Pseudomonas aeruginosa followed by Proteus mirabilis) followed by Gram positive (Staphylococcus aureus). This finding is in accordance with some researchers 11,14,15 but in contrast with other researchers. 6,10,16 The most sensitive antibiotic for all Gram negative bacteria is Amikacin followed by ciprofloxacin.…”

“…This finding is consistent with studies by previous investigators. 11,14,16 Since Amikacin is cheaper and has less ototoxic effect compared to other antibiotics it is preferred choice for treatment. Among Gram positive isolates, Staphylococcus aureus was most common and showed high percentage of methicillin resistance.…”

“…14,17 More frequent isolation of environmental bacteria like Pseudomonas, Proteus and Staphylococcus and there declining sensitivity to antibiotics can be attributed to poor hygiene, unorthodox practices, recurrent upper respiratory tract and nasal diseases, indiscriminate use of antibiotics and steroids, poor patient compliance, occupation and changing life style like increased use of mobile phones & sharing of ear phones. When the results of various workers were compared, one fact became obvious that the bacteriology and antibiotic sensitivity pattern of CSOM has been changing from time to time.…”