Middle Ear and Nasopharyngeal Bacterial Flora and Their Sensitivity in Active Stage of Mucosal Disease Otitis Media: A Comparison

Abstract

Objective: Identifying the role of nasopharyngeal bacteria in recurrent middle ear (ME) infection helps in developing an effective treatment strategy. We aimed to compare bacterial flora of ME with nasopharynx (NP) and their sensitivity patterns in active stage of mucosal disease -otitis media (CSOM).Methods: Ear and nasopharyngeal swabs from patients with active ear discharge for >3 months were processed for culture and sensitivity, the organisms were identified using Gram-stain.Results: Twenty patients between 10 and 65 years and male:female ratio of 13:7 were enrolled. 9 had symptoms since childhood. 10 patients complained unilateral ear discharge; five each had discharge from the left and right ear. 11 patients had nasal symptoms; nose block due to obstruction (9), nasal discharge (8), and both symptoms were seen in eight patients. 14 patients (70.0%) had deviated nasal septum and 8 (40.0%) had discharge in the NP. Of 20 ear swabs, 19 grew bacteria; 1 was sterile (5.0%). 13 (65%) nasopharyngeal swabs grew bacteria, 7 were sterile. Culture yielded aerobic bacteria. Staphylococcus aureus was the most common bacterium (9/20, 45.0%) followed by Pseudomonas (7/20, 35.0%) isolated from the ear. The most common nasopharyngeal isolate was S. aureus (9=45%). 10 patients had common ME and nasopharyngeal flora. Organisms were sensitive to amoxicillin+clavulanic acid, fluoroquinolones. Sensitivity was observed to polymyxin, trimethoprim, and sulfamethoxazole also. Conclusion:Common ME and nasopharyngeal flora with same antibiotic sensitivity pattern suggest nasopharyngeal etiology. Nasopharyngeal flora may have a role in recurrent ME infections in mucosal disease -otitis media.