Microbiology of Active Mucosal Chronic Otitis Media and Shifting Trends in Etiology in Idukki, Kerala: A Prospective Observational Study.

Abstract

Active mucosal Chronic Otitis Media (COM) is an important cause of preventable hearing loss particularly in the developing world and may have long term effects on early communication, language development, school performance and social interaction. This study aimed to isolate the bacterial flora in the middle ear of patients suffering from active mucosal COM in Idukki district of Kerala and also to study the antibiotic sensitivity pattern of these organisms to commonly used antimicrobial agents. This was a clinical prospective observational study conducted over a period of 3 years involving 137 patients of all age groups, who were clinically diagnosed with active mucosal COM. The inclusion criteria were patients presenting with a central tympanic membrane perforation and ear discharge (either unilateral or bilateral) of more than 3 months duration. Microbial growth was seen in 128 (94.1%) patients with aerobic bacteria (83.5%), anaerobic bacteria (6.25%) and fungi (7%), of which Pseudomonas aeruginosa (39.8%) and Staphylococcus aureus (31.2%) were the most predominant etiological agents for active mucosal COM. Pseudomonas aeruginosa showed highest susceptibility to Piperacillin-Tazobactam combination and highest resistance to Ampicillin, while Staphylococcus aureus showed highest susceptibility to Gentamicin and highest resistance to Ampicillin and Ceftriaxone. The increasing trends in the antibiotic resistance pattern in Staphylococcus aureus over the years poses a threat to Idukki district, Kerala. Due to the irrational use of antimicrobials, multi-drug resistant bacterial strains are frequent, and so, there is need for continuous surveillance of the local microbiological profile of active mucosal COM.