Abstract
An acquired cholesteatoma generally occurs as a consequence of otitis media and eustachian tube dysfunction. Patients with acquired cholesteatoma generally present with chronic otorrhea and progressive conductive hearing loss. There are many microbes reportedly associated with acquired cholesteatoma. However, conventional culture-based techniques show a typically low detection rate for various pathogenetic bacteria and fungi. Metagenomic next-generation sequencing (mNGS), an emerging powerful platform offering higher sensitivity and higher throughput for evaluating many samples at once, remains to be studied in acquired cholesteatoma. In this study, 16 consecutive patients from January 2020 to January 2021 at the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU) were reviewed. We detected a total of 31 microbial species in patients, mNGS provided a higher detection rate compared to culture (100% vs. 31.25%, p = 0.000034). As the severity of the patient’s pathological condition worsens, the more complex types of microbes were identified. The most commonly detected microbial genus was Aspergillus (9/16, 56.25%), especially in patients suffering from severe bone erosion. In summary, mNGS improves the sensibility to identify pathogens of cholesteatoma patients, and Aspergillus infections increase bone destruction in acquired cholesteatoma.
Highlights
An acquired cholesteatoma generally occurs as a consequence of otitis media and eustachian tube dysfunction
Surgery is currently regarded as the only clinical treatment option for cholesteatoma patients, which is directed at eradication of the entrapped keratinized epithelium and keratin from the middle ear and mastoid spaces
In the remaining five patients, bacterial species were successfully cultured and identified in four cholesteatoma specimens, and fungal species were detected in only one specimen
Summary
An acquired cholesteatoma generally occurs as a consequence of otitis media and eustachian tube dysfunction. Since conventional culture-based techniques have a typically low detection rate due to the unculturability of many bacteria and fungi, more sensitive methods, such as 16S rRNA gene sequencing for bacteria identification have been developed to characterize microbiota (Liu et al, 2011; Kalcioglu et al, 2018; Weiss et al, 2019). The limitation of these studies based on 16S rRNA is obvious, the fungi, viruses and parasites were not considered. We apply this novel technique to investigate the diversity and composition of microbiota that accompany with cholesteatoma in order to provide insight into how these microbes contribute to the pathogenesis of cholesteatoma
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