Therapeutic Management of Chronic Suppurative Otitis Media with Otic Drops

AbstractObjective:This systematic review aimed to establish that quinolones are as effective as aminoglycosides when used to treat chronic suppurative otitis media.Method:The review included good quality, randomised, controlled trials on human subjects, published in English, that compared topical aminoglycosides with topical quinolones for the treatment of chronic suppurative otitis media.Results:Nine trials met the criteria. Two studies showed a higher clinical cure rate in the quinolone group (93 per centvs71 per cent,p= 0.04, and 76 per centvs52 per cent,p= 0.009). Four studies showed no statistically significant difference in clinical outcome. A significant difference in microbiological clearance in favour of quinolones was shown in two studies (88 per centvs30 per cent,p< 0.001, and 88 per centvs30 per cent,p< 0.001).Conclusion:Topical quinolones do not carry the same risk of ototoxicity as aminoglycosides. Furthermore, they are equal or more effective in treating chronic suppurative otitis media and when used as prophylaxis post-myringotomy. Topical quinolones should be considered a first-line treatment for these patients.

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Perbedaan sensitivitas tetes telinga antibiotik terhadap Pseudomonas aeruginosa pada otitis media supuratif kronik

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v42i2.22 ◽

2012 ◽

Vol 42 (2) ◽

Author(s):

Anton Budhi Darmawan ◽

Dwi Utami Anjarwati

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Test Results ◽

Sectional Study ◽

Suppurative Otitis Media ◽

Number Of Patients ◽

Significant Difference ◽

Cochran Test ◽

Post Hoc

Background: Chronic suppurative otitis media (CSOM) is one infectious disease of the middle ear, most commonly caused by Pseudomonas aeruginosa. A high number of patients come to the ENT outpatient clinic with active benign type of CSOM. The bacteria Pseudomonas aeruginosa is capable of producing biofilm which protects itself from penetration of antibiotics, and therefore creates resistance towards antibiotics and difficult to eradicate. Objective: The aim of this study was to compare the sensitivity levels of chloramphenicol, polymyxin-neomycin, cyprofloxacin and ofloxacine against Pseudomonas aeruginosa in patients with active benign type CSOM in ENT clinic. Method: The method used was across sectional study on 25 patients, from August 2010 until December 2010. Samples were taken withear swab and then put on sensitivity test to chloramphenicol, polymyxin-neomycin, cyprofloxacin andofloxacine using the diffusion disc method. The analysis used in this study was Cochran test. Results: Results showed a significant difference in sensitivity among chloramphenicol (38,70%), polymyxinneomycin(83,87%),cyprofloxacin(90,32%)andofloxacin(58,06%)withp=0,000(p<0,05).PostHocanalysisusing the Mc Nemar indicated that there were significant differences in sensitivity betweenpolymyxin-neomycin to chloramphenicol with p=0,000 (p<0,05), ciprofloxacin to chloramphenicol andciprofloxacin to ofloxacine with p= 0,002, but there were no significant differences between cyprofloxacinto polymyxin-neomycin with p=0,687, polymyxin-neomycin to ofloxacin p=0.057 and ofloxacin tochloramphenicol p=0,109. There were significant differences in antibiotic ear dropssensitivity to Pseudomonas aeruginosa in patients with active benign type of CSOM. Cyprofloxacin andpolymyxin-neomycin were more sensitive than ofloxacin and chloramphenicol. Keywords: Pseudomonas aeruginosa, active benign type of chronic suppurative otitis media, antibioticear drops. Abstrak : Latar belakang: Otitis media supuratif kronik (OMSK) merupakan penyakit infeksi kronik telinga tengah yang sering dijumpai di klinik THT. Penyebab tersering OMSK adalah bakteri Pseudomonasaeruginosa. Pseudomonas aeruginosa mempunyai kemampuan untuk membentuk biofilm yangmelindunginya dari penetrasi antibiotik sehingga menimbulkan resistensi terhadap antibiotik dan sulituntuk eradikasinya. Tujuan: Untuk mengetahui perbandingan tingkat sensitivitas kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin terhadap isolat Pseudomonas aeruginosa padapasien OMSK benigna aktif di klinik THT RSMS. Metode: Metode yang digunakan adalah crosssectional terhadap 29 pasien OMSK di klinik THT RSMS periode bulan Agustus 2010 - Desember2010. Pengambilan sampel dilakukan dengan swab telinga. Uji sensitivitas terhadap kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin dilakukan dengan metode cakram secara difusi.Analisis yang digunakan dalam penelitian ini adalah Cochran dan analisis post hoc. Hasil: Didapatkansensitivitas kloramfenikol sebesar 38,70%, polimiksin-neomisin sebesar 83,87%, ciprofloksasin sebesar90,32% dan ofloksasin sebesar 58,06% dengan p=0,01 (P<0,05), yang menunjukkan adanya perbedaansensitivitas yang bermakna antara kloramfenikol, polimiksin-neomisin, ciprofloksasin dan ofloksasinterhadap Pseudomonas aeruginosa. Analisis post hoc menggunakan Mc Nemar menunjukkan bahwaterdapat perbedaan sensitivitas yang bermakna antara tetes telinga polimiksin-neomisin terhadapkloramfenikol, dan ciprofloksasin terhadap kloramfenikol p=0,000 (p<0,05), serta terdapat perbedaanyang bermakna antara tetes telinga ciprofloksasin terhadap ofloksasin, p=0,002, tetapi tidak terdapatperbedaan yang bermakna antara ciprofloksasin terhadap polimiksin-neomisin, p=0,687, polimiksinneomisinterhadap ofloksasin p=0,057, dan kloramfenikol terhadap ofloksasin p=0,109. Kesimpulan:Terdapat perbedaan sensitivitas yang bermakna tetes telinga antibiotik terhadap Pseudomonas aeruginosa pada pasien OMSK benigna aktif. Ciprofloksasin dan polimiksin-neomisin tetes telinga mempunyai sensitivitas yang lebih baik dibanding ofloksasin dan kloramfenikol. Kata kunci: Pseudomonas aeruginosa, otitis media supuratif kronik, tetes telinga antibiotik

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Effect of aerobic bacteriology on the clinical presentation and treatment results of chronic suppurative otitis media

The Journal of Laryngology & Otology ◽

10.1017/s0022215100133535 ◽

1996 ◽

Vol 110 (4) ◽

pp. 315-318 ◽

Cited By ~ 19

Author(s):

Eero Vartiainen ◽

Jukka Vartiainen

Keyword(s):

Surgical Treatment ◽

Otitis Media ◽

Clinical Presentation ◽

Chronic Suppurative Otitis Media ◽

Long Term Results ◽

Treatment Results ◽

Suppurative Otitis Media ◽

Hearing Results ◽

Significant Difference

AbstractThe effect of aerobic bacteriology on the clinical presentation, complications of the disease and long-term results of surgical treatment was assessed in a cohort of 368 patients with chronic suppurative otitis media. Bacteriological findings showed no significant difference between child and adult patients. Staphylococcus aureus was isolated in cholesteatoma ears more frequently than Pseudomonas aeruginosa, in chronic ears without cholesteatoma the situation was reversed. Bacteriological findings had no significant effect on the incidence of complications caused by the disease. Failures after surgical treatment were most common in Pseudomonas ears. The bacteriology had no significant effect on pre-operative hearing levels nor postoperative hearing results. It was concluded that, in order to improve results of chronic ear sugery, more attention should be paid to pre-operative conservative treatment of chronically discharging ears, especially those infected by P. aeruginosa.

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Neutrophil Elastase and its Complex with Alpha1-Antitrypsin in the Pathogenesis of Chronic Suppurative Otitis Media

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489492101s1007 ◽

1992 ◽

Vol 101 (10_suppl) ◽

pp. 26-31 ◽

Cited By ~ 6

Author(s):

Yukiyoshi Hamaguchi ◽

Yasuo Sakakura

Keyword(s):

Otitis Media ◽

Neutrophil Elastase ◽

Bacterial Infections ◽

Otitis Media With Effusion ◽

Chronic Otitis Media ◽

Mean Value ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Significant Difference ◽

The Mean

Neutrophil elastase (NE) and its complex with α1-antitrypsin were quantified in ear discharges from 15 patients with chronic suppurative otitis media (CSOM), and their levels were compared to those in middle ear effusions from 10 pediatric patients with chronic otitis media with effusion (OME). The localization of immunoreactive NE was also examined by immunocytologic study. The mean value of total NE was 161.8 ± 29.5 μg/mL in CSOM, which was significantly higher than that in OME (16.5 ± 6.7 μg/mL). The mean value of NE–α1-antitrypsin complex was 13.7 ± 8.8 μg/mL in CSOM and 7.8 ± 4.0 μg/mL in OME. There was no significant difference between culture-positive and culture-negative samples in CSOM. Immunoreactive NE could be observed in the neutrophils of ear discharges, and extracellular release of NE was also observed. Ear discharges in CSOM contain a considerable amount of uncomplexed NE, of which the level does not depend on active bacterial infections. Uncomplexed NE seems to play a role in the chronicity of CSOM.

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Sensorineural hearing loss in tubotympanic variety of chronic suppurative otitis media

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v22i1.45075 ◽

2020 ◽

Vol 22 (1) ◽

pp. 26-30

Author(s):

Dhiman Pramanik ◽

Mesbah Uddin Ahmed ◽

Abm Luthful Kabir ◽

Mohammad Harun Or Rashid ◽

Mohammad Anamul Haque ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Otitis Media ◽

Noise Exposure ◽

Bone Conduction ◽

Sensorineural Hearing ◽

Chronic Suppurative Otitis Media ◽

Threshold Elevation ◽

Suppurative Otitis Media ◽

Bone Conduction Threshold

Objectives: To determine whether chronic suppurative otitis media(CSOM) can cause Sensorineural hearing loss(SNHL) and to note its degree and its relation to duration of disease. Methods: This was a cross sectional study which was carried out in the departments of Otolaryngology and Head-Neck Surgery of Dhaka Medical College Hospital during the period of April’2012 to March’2013. A total number of 76 patients having unilateral CSOM were included in this study age ranging from 6 to 59 years after exclusion of other possible causes of SNHL such as meningitis, head injury, previous ear surgery and chronic noise exposure. The use of unilateral CSOM cases provided a contralateral ear to serve as a control. Bone conduction threshold elevation between diseased and control ear was considered as the indicator of inner ear damage. Results: In this series, CSOM was seen to be associated with sensorineural hearing loss. Significant threshold elevation was observed in relation to disease duration. Here bone conduction measurement in all frequencies (500Hz,1000Hz,2000Hz and 4000Hz) in diseased and uninvolved contralateral side showed elevation of bone conduction in diseased side and this elevation was significantly higher (p<0.001). The average bone conduction loss at 4kHz was higher than the average at the speech frequency range. Conclusion: This study suggests that CSOM can cause significant bone conduction threshold elevation and it should be considered when managing this problem. Early detection and prompt treatment may limit this potential handicap. Bangladesh J Otorhinolaryngol; April 2016; 22(1): 26-30

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Comparison of Germ Patterns and Antimicrobial Susceptibility in Chronic Suppurative Otitis Media with Cholesteatoma and without Cholesteatoma in Dr. Mohammad Hoesin Hospital.

BioScientia Medicina ◽

10.32539/bsm.v5i7.332 ◽

2021 ◽

Vol 5 (7) ◽

pp. 647-656

Author(s):

Ahmad Hifni ◽

Rian Hasni ◽

Fiona Widyasari ◽

Abla Ghanie ◽

Erial Bahar

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Media ◽

Middle Ear ◽

Bacterial Culture ◽

Chronic Suppurative Otitis Media ◽

Mastoid Cavity ◽

Design Data ◽

Cross Sectional ◽

Suppurative Otitis Media ◽

Significant Difference

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity. It is necessary to identify bacterial patterns and antibiotics susceptibility in CSOM. Appropriate administration of antibiotics is essential to treat infection and prevent widespread resistance. Objective: The aim of this study is to compare the pattern of germs and antibiotic susceptibility between CSOM with cholesteatoma and without cholesteatoma. Methods: Observational study with cross-sectional design. Data collection was carried out using medical record data on 102 subjects who underwent middle ear swab and bacterial culture from January to December 2019. Results: From 102 subjects and 122 bacterial culture results. it was found that Pseudomonas aeruginosa (36.1%) was one of the most common organisms to cause CSOM. followed by Staphylococcus haemolyticus. Staphylococcus epidermidis and Staphylococcus aureus. There was a significant difference between the germ pattern and the type of CSOM (p = 0.002). Amikacin. meropenem. gentamicin. cefepime. ciprofloxacin and ceftazidime were found to be the most effective antibiotics for Pseudomonas aeruginosa. The rate of resistance to tigecycline and cefazoline were highest. Age. sex. nutritional status and comorbidities were not factors that significantly influenced the incidence of cholesteatoma in CSOM. Conclusion: There is a significant difference between the germ pattern in both CSOM groups. Patients that show Gram negative have a significant effect on the incidence of CSOM with cholesteatoma.

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Correlation between degree of hearing loss and intraoperative findings in tubotympanic type of chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180717 ◽

2018 ◽

Vol 4 (2) ◽

pp. 537 ◽

Cited By ~ 1

Author(s):

Ravi Dudda ◽

Sowmya Tumkur Rangaiah ◽

M. Hanumantha Prasad ◽

Nagavara Kalegowda Balaji

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Significant Difference

Background: The aim of tympanoplasty done for tubotympanic type of chronic suppurative otitis media (CSOM) should not only be to achieve a dry ear, but also to give hearing improvement to the patient. Aim of this study was to determine the correlation between size and site of tympanic membrane perforation with degree of hearing loss and correlation between ossicular chain status and degree of hearing loss on pure tone audiometry.Methods: Patients with tubotympanic CSOM with hearing loss upto 60 dBHL undergoing tympanoplasty were examined to know the site and size of tympanic membrane(TM) perforation. Intraoperative findings pertaining to middle ear and ossicles were noted. Results: Out of 52 patients of tubotympanic type of CSOM, hearing loss was least (31.18±7.46 dBHL) in small perforations of the TM and highest in subtotal perforations (48.74±7.83 dBHL) which was statistically significant. Hearing loss was significantly more in posterior perforation (46.61±7.02 dBHL) than in anterior perforation of TM (32.65±8.77 dBHL). There was a statistically significant difference in pure tone average hearing loss between intact ossicle group (32.87±9.77 dBHL) and eroded ossicle group (43.39±9.60dBHL). Difference in air bone gap was also significant between intact ossicle group (24.09±9.56 dB) and eroded ossicle group (31.02±9.83 dB). Multiple ossicles were eroded in nineteen patients with incus being the most commonly eroded ossicle.Conclusions: In this study, hearing loss increased with increased size of TM perforation and also with posterior perforation. Incus was found to be the most commonly eroded ossicle. Multiple ossicles were seen eroded most commonly when hearing loss was moderate. The surgeon will be better equipped to do ossiculoplasty in view of these preoperative findings and also to counsel the patient better about their expectation of hearing improvement following surgery.

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Comparison of Germ Patterns and Antimicrobial Susceptibility in Chronic Suppurative Otitis Media with Cholesteatoma and without Cholesteatoma in Dr. Mohammad Hoesin Hospital.

BioScientia Medicina ◽

10.32539/bsm.v5i3.332 ◽

2021 ◽

Vol 5 (3) ◽

pp. 675-684

Author(s):

Ahmad Hifni ◽

Rian Hasni ◽

Fiona Widyasari ◽

Abla Ghanie ◽

Erial Bahar

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Media ◽

Middle Ear ◽

Bacterial Culture ◽

Chronic Suppurative Otitis Media ◽

Mastoid Cavity ◽

Design Data ◽

Cross Sectional ◽

Suppurative Otitis Media ◽

Significant Difference

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity. It is necessary to identify bacterial patterns and antibiotics susceptibility in CSOM. Appropriate administration of antibiotics is essential to treat infection and prevent widespread resistance. Objective: The aim of this study is to compare the pattern of germs and antibiotic susceptibility between CSOM with cholesteatoma and without cholesteatoma. Methods: Observational study with cross-sectional design. Data collection was carried out using medical record data on 102 subjects who underwent middle ear swab and bacterial culture from January to December 2019. Results: From 102 subjects and 122 bacterial culture results. it was found that Pseudomonas aeruginosa (36.1%) was one of the most common organisms to cause CSOM. followed by Staphylococcus haemolyticus. Staphylococcus epidermidis and Staphylococcus aureus. There was a significant difference between the germ pattern and the type of CSOM (p = 0.002). Amikacin. meropenem. gentamicin. cefepime. ciprofloxacin and ceftazidime were found to be the most effective antibiotics for Pseudomonas aeruginosa. The rate of resistance to tigecycline and cefazoline were highest. Age. sex. nutritional status and comorbidities were not factors that significantly influenced the incidence of cholesteatoma in CSOM. Conclusion: There is a significant difference between the germ pattern in both CSOM groups. Patients that show Gram negative have a significant effect on the incidence of CSOM with cholesteatoma.

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Treatment of Chronic Suppurative Otitis Media: A Comparison between Topical, Systemic and Combined Topical-Systemic antibiotics

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v4i1.52871 ◽

2015 ◽

Vol 4 (1) ◽

pp. 27-32

Author(s):

Syed Hasan Imam Al Masum ◽

Ali Jacob Arsalan

Keyword(s):

Hearing Impairment ◽

Otitis Media ◽

Hearing Threshold ◽

Chronic Suppurative Otitis Media ◽

Treatment Modalities ◽

Suppurative Otitis Media ◽

Duration Of Illness ◽

Significant Difference ◽

Successful Resolution ◽

Systemic Antibiotics

Background and Objectives: The present study was undertaken to determine which of the three treatment modalities (topical, systemic and topical systemic combined) is the best in treating chronic suppurative otitis media (CSOM) in children. Patients & Methods: This comparative clinical trial was conducted prospectively in Dhaka Shisu Hospital, Sher-e-Bangla Nagar, Dhaka over a period of 6 months. We enrolled 92 children with chronic CSOM, aged 5- 12 years, from patients attending at pediatric ENT OPD. The children were randomly assigned to three treatment groups. All parents were advised dry mopping of their children two times daily. The first group (n = 51) received topical ciprofloxacin 4 times daily, the second group received systemic ciprofloxacin only10 mg/kg body weight/day twice daily for 14 days and the third group received both systemic and topical ciprofloxacin. The primary outcome measures were resolution of otorrhoea by 2 - 3 weeks of intervention and healing of tympanic membranes on otoscopy by 8-12weeks of intervention. Hearing levels were assessed by audiometry. Results: Of the three groups of children enrolled in the study, the topical-systemic group was significantly older than the topical and systemic groups (p = 0.003). However, the groups were not different in terms of sex and duration of illness (p = 0.125 and p = 0.191 respectively). The cardinal presentation was otorrhoea. Over half of the children in each group had marginal perforation (p=0.062). Most of the children in each group had mild hearing impairment (p = 0.212). Poor attention and poor academic performance were rarely found. After 2 weeks of treatment, majority of patients in Topical, Systemic and Topical Systemic Combined Group had a successful resolution (92.1%, 95.4% and 94.7%) with no significant difference among the groups (p = 0.641). Time taken for resolution was almost similar among the groups with mean resolution time being 2 weeks (p = 0.313). Difference among the groups regarding hearing impairment was evident with highest impairment being in the Topical and the lowest in the combined group (p = 0.048). Among groups, topical and systemic group had higher improvement of hearing threshold than topical, systemic combined group (p=0.024). The groups were no different with respect to treatment failure (p = 0.595) Conclusions: The study concluded that there was no significant difference in outcome in three modalities of treatment - topical, systemic and topical-systemic combined. So only topical antibiotics will do suffice in the treatment of CSOM, unless there is no sign of complications (like fever and/or pain). Ibrahim Cardiac Med J 2014; 4(1): 27-32

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