Relationship between Acute Suppurative Otitis Media and Chronic Secretory Otitis Media: Role of Antibiotics

A total of 204 chronic middle ear effusions from 122 children have been studied. Bacteria were isolated from 30 effusions. The commonest species found were Strep. pneumoniae and H. influenzae. These are also the commonest organisms causing acute otitis media (AOM). A similar pattern of serotypes was also demonstrated. In vitro sensitivity testing showed that most of the organisms isolated were sensitive to most commonly-used antibiotics. The main exception was resistance to penicillin amongst strains of H. influenzae and Staph. aureus. It is suggested that some cases of chronic secretory otitis media (SOM) may arise as a result of incomplete resolution of AOM and that the use of penicillin to treat AOM may be one factor in this process.

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Acute Suppurative Otitis Media

PEDIATRICS ◽

10.1542/peds.56.2.285 ◽

1975 ◽

Vol 56 (2) ◽

pp. 285-294

Author(s):

D. Stewart Rowe

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Pathogenic Bacteria ◽

Acute Otitis Media ◽

Polymorphonuclear Cells ◽

Secretory Otitis Media ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Middle Ear Fluid ◽

Purulent Fluid

Most pediatricians recognize and treat acute otitis media several times each day. Yet there is wide disagreement about certain aspects of its diagnosis and treatment, despite a large and growing literature on the subject. This review attempts to summarize what is known about acute otitis media in children. DEFINITION Acute suppurative otitis media is distinguished from secretory (serous) otitis media by the presence of purulent fluid in the middle ear. Pathogenic bacteria may be cultured from the majority of needle aspirates of this purulent fluid. In secretory otitis media, relatively few polymorphonuclear cells are present in the middle ear fluid, which is either thin and straw-colored (serous) or thick and translucent grey (mucoid). The fluid has the chemical characteristics either of a transudate of plasma or of a mucoid secretion, presumably produced by goblet cells and mucous glands which are greatly increased in the middle ear mucosa of patients with secretory otitis media. Cultures of this middle ear fluid are usually negative for pathogenic bacteria and viruses. Suppurative otitis media can be diagnosed positively only by aspiration of purulent fluid from the middle ear, but this procedure is rarely necessary for initial diagnosis and management. Clinical findings helpful in distinguishing suppurative from secretory otitis media are discussed below. INCIDENCE In a study of 847 British children during the first five years of life, 19% had at least one episode of otitis media; one third of these had more than one episode. This was considered to be a minimal estimate in these children, since otorrhea was the chief criterion for diagnosis.

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Adenoidectomy for middle ear disease in cleft palate children: a systematic review

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-07035-6 ◽

2021 ◽

Author(s):

Cecilia Rosso ◽

Antonio Mario Bulfamante ◽

Carlotta Pipolo ◽

Emanuela Fuccillo ◽

Alberto Maccari ◽

...

Keyword(s):

Systematic Review ◽

Cleft Palate ◽

Otitis Media ◽

Middle Ear ◽

Acute Otitis Media ◽

Case Series ◽

Velopharyngeal Insufficiency ◽

Middle Ear Disease ◽

Conductive Hearing

Abstract Purpose Cleft palate children have a higher incidence of otitis media with effusion, more frequent recurrent acute otitis media episodes, and worse conductive hearing losses than non-cleft children. Nevertheless, data on adenoidectomy for middle ear disease in this patient group are scarce, since many feared worsening of velopharyngeal insufficiency after the procedure. This review aims at collecting the available evidence on this subject, to frame possible further areas of research and interventions. Methods A PRISMA-compliant systematic review was performed. Multiple databases were searched with criteria designed to include all studies focusing on the role of adenoidectomy in treating middle ear disease in cleft palate children. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for clinical indications and outcomes. Results Among 321 unique citations, 3 studies published between 1964 and 1972 (2 case series and a retrospective cohort study) were deemed eligible, with 136 treated patients. The outcomes were positive in all three articles in terms of conductive hearing loss improvement, recurrent otitis media episodes reduction, and effusive otitis media resolution. Conclusion Despite promising results, research on adenoidectomy in treating middle ear disease in the cleft population has stopped in the mid-Seventies. No data are, therefore, available on the role of modern conservative adenoidectomy techniques (endoscopic and/or partial) in this context. Prospective studies are required to define the role of adenoidectomy in cleft children, most interestingly in specific subgroups such as patients requiring re-tympanostomy, given their known risk of otologic sequelae.

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The management of acute otitis media

Drug and Therapeutics Bulletin ◽

10.1136/dtb.22.14.53 ◽

1984 ◽

Vol 22 (14) ◽

pp. 53-54

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Clinical Examination ◽

Middle Ear ◽

Acute Otitis Media ◽

Infectious Complications ◽

Middle Ear Effusion ◽

Suppurative Otitis Media ◽

Painful Condition ◽

Ear Effusion

Acute suppurative otitis media (AOM) is a common, painful condition affecting 20% of children under 4 years at least once a year,1 and perhaps more in infancy when clinical examination is most difficult. Infectious complications such as mastoiditis, meningitis and cerebral abscess are now rare, but chronic middle ear effusion and hearing loss remain common. Hearing loss may persist long after the infective episode,2 and may impair learning.

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Impedance Audiometry Suggested

PEDIATRICS ◽

10.1542/peds.54.3.384a ◽

1974 ◽

Vol 54 (3) ◽

pp. 384-384

Author(s):

John A. McCurdy

Keyword(s):

Hearing Loss ◽

Hearing Impairment ◽

Otitis Media ◽

Middle Ear ◽

Verbal Ability ◽

Secretory Otitis Media ◽

Suppurative Otitis Media ◽

Significant Percentage ◽

Children With Hearing Loss ◽

Verbal Development

The findings of Kaplan et al.1 with respect to impairment of verbal ability in Alaskan children with hearing loss greater than 25 dB ISO secondary to chronic suppurative otitis media warrant renewed attention to a similar otologic problem which constitutes a threat to the verbal development of a significant percentage of all children—hearing impairment secondary to chronic secretory otitis media. Although the hearing loss in chronic secretory otitis media may fluctuate, a significant conductive impairment will persist as long as fluid remains in the middle ear.

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Pseudomonas Otitis Media after Eustachian Tube Obstruction

Otolaryngology ◽

10.1177/019459989210700402 ◽

1992 ◽

Vol 107 (4) ◽

pp. 511-515 ◽

Cited By ~ 9

Author(s):

Patrick J. Antonelli ◽

Steven K. Juhn ◽

Marcos V. Goycoolea ◽

G. Scott Giebink

Keyword(s):

Otitis Media ◽

Eustachian Tube ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Suppurative Otitis Media ◽

Tube Obstruction ◽

Colony Forming Units ◽

Tube Function ◽

Pseudomonas Infection

Previous experiments have shown that Pseudomonas aeruginosa may infect the middle ears of chinchillas by way of the eustachian tube and that chinchillas with acute otitis media (AOM) are more susceptible to pseudomonas infection than animals without AOM. The purpose of this experiment was to examine the effects of otitis media with effusion (OME), induced by means of eustachian tube obstruction, on middle ear susceptibility to nasal inoculation of P. aeruginosa. Chinchilla eustachian tubes were obstructed with silicone rubber sponge bilaterally; OME developed in eight animals (11 ears)—three bilaterally and five unilaterally—and persisted for 6 months. Ten chinchillas with normal eustachian tube function served as controls. All animals were nasally inoculated with 5 times 104 colony-forming units of P. aeruginosa. Pseudomonas otitis media developed in eight of 11 OME ears with effusion, none of five ears without OME, and four of 20 control ears (X2 = 11.782, p = 0.003). Therefore, P. aeruginosa can infect the middle ear by way of the eustachian tube. Tubal dysfunction may lead to the development of chronic suppurative otitis media by increasing tubotympanic susceptibility to opportunistic pathogens.

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Moraxella catarrhalis Might Be More Common than Expected in Acute Otitis Media in Young Finnish Children

Journal of Clinical Microbiology ◽

10.1128/jcm.01146-16 ◽

2016 ◽

Vol 54 (9) ◽

pp. 2373-2379 ◽

Cited By ~ 14

Author(s):

Saara Sillanpää ◽

Sami Oikarinen ◽

Markku Sipilä ◽

Lenka Kramna ◽

Markus Rautiainen ◽

...

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Moraxella Catarrhalis ◽

Acute Otitis Media ◽

Pcr Analysis ◽

Considerable Proportion ◽

Bacterial Dna ◽

Content Type ◽

Conventional Culture

According to studies based on bacterial cultures of middle ear fluids,Streptococcus pneumoniae,Haemophilus influenzae, andMoraxella catarrhalishave been the most common pathogens in acute otitis media. However, bacterial culture can be affected by reduced viability or suboptimal growth of bacteria. PCR detects bacterial DNA from samples with greater sensitivity than culture. In the present study, we analyzed the middle ear pathogens with both conventional culture and semiquantitative real-time PCR in 90 middle ear fluid samples obtained from children aged 5 to 42 months during acute otitis media episodes. Samples were tested for the presence ofS. pneumoniae,H. influenzae,M. catarrhalis,Alloiococcusotitidis,Staphylococcus aureus, andPseudomonas aeruginosa. One or more bacterial pathogens were detected in 42 (47%) samples with culture and in 69 (77%) samples with PCR. According to PCR analysis,M. catarrhalisresults were positive in 42 (47%) samples,H. influenzaein 30 (33%),S. pneumoniaein 27 (30%),A. otitidisin 6 (6.7%),S. aureusin 5 (5.6%), andP. aeruginosain 1 (1.1%). Multibacterial etiology was seen in 34 (38%) samples, andM. catarrhaliswas detected in most (85%) of those cases. Fifteen signals forM. catarrhaliswere strong, suggesting a highly probable etiological role of the pathogen. In conclusion, even thoughM. catarrhalisis often a part of mixed flora in acute otitis media, a considerable proportion of cases may be primarily attributable to this pathogen.

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Characterization of bacteria causing acute otitis media using Raman microspectroscopy

Analytical Methods ◽

10.1039/c7ay00128b ◽

2017 ◽

Vol 9 (12) ◽

pp. 1864-1871 ◽

Cited By ~ 4

Author(s):

O. D. Ayala ◽

C. A. Wakeman ◽

I. J. Pence ◽

C. M. O'Brien ◽

J. A. Werkhaven ◽

...

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Acute Otitis Media ◽

Raman Microspectroscopy ◽

Bacterial Identification ◽

Middle Ear Effusion ◽

Ear Effusion

Raman microspectroscopy was used to characterize and identify the three main pathogens that cause acute otitis media (AOM)in vitro. Cultured middle ear effusion from patients was studied and results suggest the potential of using this technique to aid in accurately diagnosing AOM and providing physicians with bacterial identification to guide treatment.

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The Role of Bacterial Enzymes in Inducing Inflammation in the Middle Ear Cavity

Otolaryngology ◽

10.1177/019459987908700621 ◽

1979 ◽

Vol 87 (6) ◽

pp. 859-870 ◽

Cited By ~ 11

Author(s):

Seth H. Lowell ◽

S. K. Juhn

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Bacterial Infections ◽

Current Knowledge ◽

Acute Otitis Media ◽

Bacterial Enzymes ◽

Infectious Process ◽

The Third ◽

Host Tissues

Current knowledge of the pathophysiology of bacterial infections is elementary. The initial events leading to the invasion of host tissues are a matter of conjecture for many bacterial organisms. This is particularly true for pneumococci, the most frequent causative organisms of acute otitis media. Bacterial enzymes may account for the initial disruption of host tissues, and this study explored their role in the infectious process. As a first step, pneumococcal cultures were analyzed, and significant levels of the enzymes lipase and hyaluronidase were demonstrated. Secondly, the presence of these enzymes in middle ear effusions was explored in an animal model of acute otitis media. The enzymes reached peak levels at seven days. The third and most important portion of the study examined the significance of these enzymes in producing inflammation and alterations in the middle ear cavity of normal experimental animals. This portion was a histologic comparison of temporal bone specimens and demonstrated that marked acute and chronic changes can be induced by placing solutions of these enzymes in the middle ear cavity. This study concludes that bacterial enzymes play an important role in the induction of acute otitis media.

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POLA BAKTERI AEROB PADA PASIEN DENGAN DIAGNOSIS OTITIS MEDIA SUPURATIF AKUT DI POLIKLINIK THT-KL RSUP. PROF. DR. R. D. KANDOU MANADO

Jurnal e-Biomedik ◽

10.35790/ebm.3.1.2015.6844 ◽

2015 ◽

Vol 3 (1) ◽

Author(s):

Nur Dinih Mamonto ◽

John Porotu’o ◽

Olivia Waworuntu

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Bacterial Species ◽

Acute Otitis Media ◽

Enterobacter Cloacae ◽

Proteus Vulgaris ◽

Biochemical Tests ◽

Suppurative Otitis Media ◽

Purposive Sampling ◽

Tract Infections

Abstract: Otitis media is an inflammation of part or all of the middle ear mucosa. Eustachi tube obstruction is a basic causative factor in acute otitis media. The tract infections can cause swelling around the channel, crunch, and as a result formed pus in the middle ear. The purpose of research is to determine the pattern of aerobic bekteri in patients diagnosis of Acute suppurative otitis media in Polyclinic Hospital THT-KL. PROF. dr. R. D. Kandou Manado. This study is a descriptive study population of all patients in the diagnosis of acute suppurative otitis media by making a purposive sampling technique obtained 20 samples of patients with acute suppurative otitis media. Then, 20 samples were collected for microbiological examination by culture techniques and biochemical tests. The results of this study were 20 patient samples obtained Acute suppurative otitis media age 0-5 years (8 samples; 42%), 6-10 years (6 samples; 27%), 11-20 years (1 sample; 5%), ≥ 20 years (5 samples; 26%); male gender - male (9 samples; 55%), women (9 samples; 45%). Twenty samples examined, all showed growth of bacteria and obtained seven bacterial species and one species of candida. 3 obtained from the gram-positive bacteria, namely Streptococcus sp culture (7 samples; 35%), Staphylococcus sp (4 samples; 20%), Bacilus subtilis (2 samples; 10%) 4 gram-negative bacteria Enterobacter Aglomerans (2 samples; 10% ), Enterobacter cloacae (1 sample; 5%), Seretia Rubidaea (1 sample; 5%), Proteus vulgaris (2 samples; 10%), Candida (1 sample; 5%). Conclusion The research found most bacteria causing acute suppurative otitis media, namely Streptococcus, the largest age group experienced acute suppurative otitis media, namely children’s (0-5 years).Keywords: acute suppurative otitis media, aerobic bacteriaAbstrak: Otitis media adalah peradangan sebagian atau seluruh mukosa telinga tengah. Obstruksi tuba eustachi merupakan suatu faktor penyebab dasar pada otitis media akut. Infeksi di saluran tersebut dapat menyebabkan pembengkakan di sekitar saluran, tersumbatnya saluran, dan sebagai hasilnya terbentuklah nanah dalam telinga tengah. Tujuan penelitian adalah untuk mengetahui pola bekteri aerob pada pasien diagnosis Otitis Media Supuratif Akut di Poliklinik THT–KL RSUP. PROF. dr. R. D. Kandou Manado. Penelitian ini merupakan penelitian deskriptif dengan populasi seluruh pasien yang di diagnosis Otitis Media Supuratif Akut dengan teknik pengambilan purposive sampling didapatkan 20 sampel penderita Otitis Media Supuratif Akut. Kemudian, 20 sampel dikumpulkan untuk dilakukan pemeriksaan mikrobiologi dengan teknik kultur dan uji biokimia. Hasil dari penelitian ini adalah 20 sampel pasien Otitis Media Supuratif Akut didapatkan umur 0 – 5 tahun (8 sampel; 42%), 6 - 10 tahun (5 sampel; 27%), 11 – 20 tahun (1 sampel; 5%), ≥ 20 tahun (5 sampel; 26%); jenis kelamin laki – laki (9 sampel; 55%), perempuan (9 sampel; 45%). Duapuluh sampel yang diperiksa, seluruhnya menunjukkan pertumbuhan bakteri dan didapatkan 7 spesies bakteri dan 1 spesies candida. Didapatkan 3 bakteri gram positif dari hasil kultur yaitu Streptococcus sp (7 sampel; 35%), Staphylococcus sp (4 sampel; 20%), Bacilus subtilis (2 sampel; 10%) 4 bakteri gram negatif Enterobacter Aglomerans (2 sampel; 10%), Enterobacter cloacae (1 sampel; 5%), Seretia Rubidaea (1 sampel; 5%), Proteus Vulgaris (2 sampel; 10%), Candida (1 sampel; 5%). Kesimpulan penelitian didapatkan bakteri terbanyak penyebab Otitis Media Supuratif Akut yaitu Streptococcus,dan kelompok umur terbanyak yaitu anak – anak (0 – 5 Tahun).Kata kunci: otitis media supuratif akut, bakteri aerob

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In Vitro Activities of Cethromycin (ABT-773), a New Ketolide, against Streptococcus pneumoniae Strains That Are Not Susceptible to Penicillin or Macrolides

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.47.1.166-169.2003 ◽

2003 ◽

Vol 47 (1) ◽

pp. 166-169 ◽

Cited By ~ 10

Author(s):

Edward O. Mason ◽

Linda B. Lamberth ◽

Ellen R. Wald ◽

John S. Bradley ◽

William J. Barson ◽

...

Keyword(s):

United States ◽

Streptococcus Pneumoniae ◽

Otitis Media ◽

Middle Ear ◽

Acute Otitis Media ◽

The United States ◽

Macrolide Resistance ◽

Broth Microdilution ◽

Time Period

ABSTRACT Pneumococcal resistance to antimicrobials presents problems to physicians for empirical treatment of acute otitis media (AOM). Three hundred thirty-three isolates of Streptococcus pneumoniae selected for nonsusceptibility to penicillin (MIC >0.1 μg/ml) from the middle ear (n = 325) or mastoid (n = 8) of children seen between 1994 and 2000 at four children's hospitals in the United States were tested by broth microdilution for susceptibility to nine antibiotics. Using NCCLS 2002 breakpoints, resistance to the following drugs was as indicated: amoxicillin, 1%; azithromycin, 71%; cefprozil, 71%; ceftriaxone, 2%; cefdinir, 98%; erythromycin, 70%; levofloxacin, 0%; and trimethoprim-sulfamethoxazole, 93%. Of the penicillin- and erythromycin-nonsusceptible isolates, 97% were inhibited by cethromycin (ABT-773) and 83% were inhibited by telithromycin at a concentration of ≤0.125 μg/ml. Macrolide resistance among penicillin-nonsusceptible pneumococci increased from 44 to 80% in the 6 years of the study from which the isolates were selected; however, the proportion of isolates with M or MLSB phenotypes remained constant over the time period (53 and 18%, respectively). Prior treatment with a macrolide or clindamycin alone or in combination with a β-lactam resulted in 94 or 85% of isolates causing infections being macrolide and or clindamycin resistant. No prior individual macrolide (azithromycin, erythromycin, or clarithromycin) resulted in more macrolide resistance or in a more prevalent resistance phenotype. The ketolides appear to be active antimicrobials against penicillin- and macrolide-resistant pneumococci.

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