Infection of the middle ear related to postoperative surgery

Abstract

The possibility of infection must always be considered in the postoperative evaluation of patients following middle ear surgery for otitis media-related conditions, since the etiology of otitis media is usually infection. Organisms gain access into the middle ear cavity from the nasopharynx by aspiration, insufflation, or reflux through the Eustachian tube. However, when the tympanic membrane is not intact, contamination of the middle ear cleft from organisms in the external ear canal is also possible. Acute otitis media is usually caused byStreptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, and to a lesser extent, Streptococcus pyogenes and Staphylococcus aureus. The same organisms have been isolated from up to 50% of middle ear aspirates from chronic otitis media with effusion (“secretory” otitis media). Beta-lactamase-producing strains of H. influenzae (20%), B. catarrhilis (75%), and S. aureus(50–75%) have recently been identified from acute and chronic middle ear effusions. Pseudomonas aeruginosaor S. aureus or both, are usually cultured from ears with chronic suppurative otitis media and from infected cholesteatoma. Anaerobic bacteria have been also isolated. Recently, Candida albicans has been the offending organism in chronic suppurative otitis media (without cholesteatoma). Antimicrobial treatment is still indicated for children with acute otitis media to eliminate infection/effusion and to prevent suppurative complications. Also, antimicrobial therapy is indicated in selected patients who have otitis media with effusion. Amoxicillin is preferred since it is effective against the common pathogens, but cefaclor is a reasonable alternative, especially when a Beta-lactamase-producing organism is identified or suspected, as are erythromycin with sulfisoxazole and trimethoprim-sulfamethoxazole. For children with frequently recurrent acute infection, antimicrobial prophylaxis is an attractive alternative to surgical intervention. When chronic suppurative otitis media (without cholesteatoma) is caused by P. aeruginosa, parenteral antimicrobial therapy (e.g. carbenicillin) may be successful in eliminating the infection. Myringotomy with or without tympanostomy tube, repair of tympanic membrane defects (myringoplasty/tympanoplasty), tympa- nomastoidectomy, and reconstructive middle ear surgery are per formed to treat and prevent otitis media or its complications or sequelae, and to restore function. Appropriate and adequate antimicrobial therapy may prevent the need for such surgical procedures but, if medical treatment fails, surgery is indicated. Antimicrobial agents for preoperative treatment and perioperative prophylaxis may prevent postoperative complications following surgery for chronic suppurative otitis media and infected cholesteatoma. The success of surgical procedures for otitis media-related conditions should include, among other important outcomes, the rate of postoperative infection. This evaluation cannot be just for the immediate postoperative period but over many years, especially after surgery is performed in children.