Cases Of Chronic Suppurative Otitis Media Research Articles

Antibiotic sensitivity and bacteriology of chronic suppurative otitis media in department of ENT in tertiary care centre St. John’s Medical College and Hospital Bangalore

<p><strong>Background: </strong>Chronic suppurative otitis media (CSOM) is a disease of middle ear. The aim of this study is to know the antibiotic sensitivity pattern in CSOM cases attending to ENT out patient department (OPD) in a tertiary care hospital and device an appropriate antibiotic protocol to treat CSOM cases.</p><p><strong>Methods: </strong>This is a prospective observational study. Fifty-eight patients of CSOM who present to the ENT OPD with ear discharge will be studied. Ear swabs of these patients will be collected and sent to microbiology to know the causative bacteria and their drug susceptibility.</p><p><strong>Results: </strong>Of the 58 patients studied 64% were males and 36% were females. Of the organisms isolated Stap aureus (53%) was most common followed by <em>Pseudomonas</em> (36%). All the gram-positive organisms were sensitive to cotimaxozole, amikacin and gentamycin and all gram-negative organisms were sensitive to ciprofloxacin, amikacin and netlimycin. </p><p><strong>Conclusions: </strong>It is better to collect an ear swab in all CSOM cases and then start antibiotics based upon the culture and sensitivity reports in order to improve the results and reduce the emergence of resistant strains, which can happen when antibiotics are prescribed randomly.</p>

Mycobacterial profile and antibiotic susceptibility pattern in chronic suppurative otitis media: a cross- sectional study

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is a disease of mucoperiosteal lining of the middle ear cleft. The poor compliance of patients to antibiotic treatment, Incomplete treatment, misuse/improper choice of antibiotics have resulted in changes in susceptibility to antibiotics and also development of resistant strains by microbes to commonly used antibiotics. This study aimed to identify the mycobacteriological profile and determine antibiotic susceptibility pattern in CSOM patients.</p><p class="abstract"><strong>Methods:</strong> This cross sectional study was conducted on 120 clinically diagnosed cases of CSOM attending otolaryngology department. Ear discharges obtained were processed for microbial culture (aerobic, anaerobic and fungi). Antimicrobial susceptibility testing was done by Kirby–Bauer disc diffusion method. </p><p class="abstract"><strong>Results:</strong> Of total 120 cases, pathogens were isolated from 114 cases. The commonest aerobic organism isolated was <em>Pseudomonas aeruginosa</em> (34.5%) followed by <em>Staphylococcus aureus</em> (29.4%). <em>Staphylococcus aureus</em> showed maximum sensitivity to erythromycin (70%), followed by cotrimoxazole (62.5%) and ampicillin (55%). Maximum resistance was observed for ciprofloxacin (77.5%), followed by amoxiclave (55%). <em>Pseudomonas aeruginosa</em> showed maximum sensitivity to piperacillin (89.36%) followed by gentamicin (70.2%), amikacin (70.2%), moderate sensitivity to ceftazidime (51.06%); however resistance to carbpenicillin (60%). Ciprofloxacin which is the most prescribed topical antibiotic showing an increase in resistance to causative organisms of CSOM.</p><p class="abstract"><strong>Conclusions:</strong> Hence, it becomes essential to study each case of CSOM bacteriologically to formulate local antibiotic policy for appropriate use of antibiotics. This will certainly help in achieving a safe ear and to control the organisms developing resistance to prevalent antibiotics.</p>

Clinico-bacteriological and antibiotic drug resistance profile of chronic suppurative otitis media at a tertiary care hospital in Western Rajasthan.

Background:Chronic suppurative otitis media (CSOM) is a major cause of hearing disability and morbidity in poor socioeconomic developing countries with prevalence of 4%. Indiscriminate use of antibiotics and poor follow up of patients has resulted in treatment failure, emergence of resistant strains, super infection, intra-cranial and extra-cranial complications in CSOM patients. Staphylococcus aureus, P. aeruginosa, Proteus spp. and Klebsiella spp. are most common organisms causing infection. Knowledge of microbial profile and susceptibility pattern is essential for efficacious treatment of this disorder.Objective:To determine the clinico-bacteriological profile of CSOM, to analyze the susceptibility pattern of various antibiotics and to evaluate the in vitro efficacy of aminoglycosides over fluoroquinolones against the aerobic bacterial isolates from CSOM.Methods:We studied 153 clinically suspected CSOM cases from March 2018 to October 2018 in Microbiology and Otorhinolaryngology department. The ear swabs were aerobically cultured and identification of the isolate was done by standard bacteriological methods.Results:Safe type CSOM was a major cause of disease. Moderate (35.3%) and mild degree (32.7%) of hearing loss was seen in most of the CSOM cases. The culture positivity rate was 82.4% and the most common isolate was P. aeruginosa (55.8%) followed by S. aureus (27.5%). P. aeruginosa, A. baumannii and Enterobacteriaceae spp. showed high sensitivity to colistin, piperacillin-tazobactam, ceftazidime-tazobactam and good sensitivity for cefepime and amikacin; 33.3% S. aureus isolates were Methicillin-resistant which was sensitive to gentamicin, vancomycin and linezolid.Conclusion:Knowledge of the spectrum of microorganisms causing ear discharge is important for effective treatment.

Clinico-Mycological Profile of Otomycosis in Chronic Suppurative Otitis Media Patients Attending a Tertiary Care Teaching Hospital

Chronic Suppurative Otitis Media (CSOM) is commonly encountered chronic inflammation of middle ear as well as the mastoid cavity due to dysfunction of Eustachian tube followed by microbial infection. Fungal infection in CSOM is now a major otolarynological problem in India not only in children but in adults too. Excessive use of steroids, antibiotics, cytotoxic chemotherapies and immunosuppressive diseases has increased the incidence of otomycosis in recent years. To define the aetiology of clinically diagnosed otomycosis. To isolate and identify fungal agents and their association with different factors(age, sex, predisposing factors). A total of 100 clinically diagnosed patients of CSOM with suspicion of otomycosis were included in the study. Patients where passing swab is difficult as with canal stenosis were excluded. Samples were taken using sterile swabs and studied for microbial profile. Male to female ratio in study was 1.6:1. The most common fungi isolated in CSOM cases was Aspergillus fumigatus followed by Aspergillus niger. Other fungus isolated were Aspergillus flavus, Penicillium species, Mucor species and Candida species. 04 samples showed mixed growth of Aspergillus species and Candida species. In our study we concluded that Aspergillus complex was most commonly isolated fungi in CSOM cases.

English

BACKGROUND Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear and mastoid cavity. The disease usually begins in childhood. We need to study the prevalence and risk factors of chronic suppurative otitis media in a teaching hospital in Telangana. METHODS This was a cross sectional study done among patients with CSOM attending the Department of ENT for a duration of one year from January 2019 to December 2019. Detailed history, otoscopic examination and culture sensitivity tests of ear discharge were done. RESULTS The sample size was 150. The prevalence of CSOM was reported to be 7.5 %. Majority of the cases were in the 11 - 15 years age group, i.e., 56.6 %. Tubotympanic type was most commonly reported and accounted for 80 % (100 / 150) whereas atticoantral type was 20 %. Pseudomonas aeruginosa was the most commonly isolated organism from the ear discharge. Most of the CSOM cases presented with upper respiratory tract infection i.e., 20 %. CONCLUSIONS The prevalence of CSOM in our study was 7.5 % and it was more common in the younger age group. CSOM was more common in the lower socioeconomic class. Upper respiratory tract infection is a frequent mode of presentation of CSOM. KEYWORDS CSOM, Ear Discharge, Tubotympanic CSOM, Atticoantral CSOM

Profile of aerobic bacteria and their antibiotic sensitivity in chronic suppurative otitis media in Al-Ramadi Teaching Hospital, Ramadi City, Iraq.

Chronic suppurative otitis media (CSOM) is a common otological problem in daily clinical practice. It is crucial to know the bacterial pathogens and their antimicrobial susceptibilities in patients with CSOM to achieve a good clinical outcome. To identify the aerobic bacterial pathogens and their antibiotic sensitivities in subjects with CSOM in Al-Ramadi Teaching Hospital. A cross-sectional, descriptive study included 102 subjects with a clinical diagnosis of CSOM (aural discharge >2 weeks, eardrum perforation, and conductive deafness). Purulent discharge was obtained from the middle ear with sterile swabs and cultured for bacterial microorganisms. The sensitivity of the isolated agents to antimicrobials was evaluated by a culture and sensitivity method. SPSS version 22 was used for statistical analysis of the data. Differences were considered statistically significant at p<0.05. Out of 3634 outpatient subjects, 102 (2.8%) presented with active CSOM. The age range of the patients was 1-70 years (mean 28.90±19.8). There were 58 females (56.9%). Out of 117 ear swab specimens, 107 (91.5%) yielded positive cultures. The majority (101, 94.4%) of the specimens yielded a single organism. There was a high statistically significant difference (p<0.001) between gram-positive (n=77, 68.1%) and gram-negative pathogens (n=36, 31.9%). Pseudomonas aeruginosa in 65 (57.5%) cases and Staphylococcus aureus in 19 (16.8%) cases were the two most commonly isolated organisms. The drugs imipenem (93.8%), amikacin (86.1%), azteronam (83.1%), and ciprofloxacin (81.5%) were effective against P. aeruginosa (p<0.001). Amikacin (100%), imipenem (94.7%), ciprofloxacin (68.4%), and gentamicin (63.1%) were the most effective antibiotics against Staph. aureus (p<0.001). The prevalence rate of active CSOM was 2.8%. Ciprofloxacin showed high effectiveness against the two most common isolated pathogens (P. aeruginosa and Staph. aureus); therefore, it could be used as empirical therapy for active CSOM cases.

Evaluation of the role of middle ear risk index as a prognostic tool in cases of tympanoplasty in chronic suppurative otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In chronic suppurative otitis media (CSOM), the success rate of tympanoplasty, can range from 35% to 92% and is influenced by a number of factors such as age of patient, size and site of perforation, status of ear, ossicular status and surgical technique. The middle ear risk index (MERI) of a CSOM patient is an effective numerical grading system helpful in predicting the outcome of surgery. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective observational study was conducted in 50 patients over a period of 1 year including all cases of CSOM in age group of 18-55 years with conductive hearing loss that underwent tympanoplasty with or without cortical mastoidectomy and role of MERI was analysed for the outcome of the surgery. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Successful graft uptake was seen in 92% cases while in 8% cases graft was rejected. Of these 46 cases, 32 cases had mild MERI score, 10 had moderate MERI score and 4 had severe MERI score. It was observed that higher the MERI score, lower the graft uptake. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study comprised of 50 patients of CSOM which were categorized into mild, moderate and severe on the basis of MERI score preoperatively. All the patients underwent tympanoplasty with or without cortical mastoidectomy and surgical outcome in terms of graft uptake was found to be significant. Higher the MERI score, lower was the graft uptake while lower the MERI score, higher was the graft uptake. Hence, MERI is a useful tool to ascertain the prognosis of tympanoplasty.&lt;/p&gt;

Comparison of Tympanosclerosis and Chronic Suppurative Otitis Media Cases in Terms of Sigmoid Sinus Position, High Jugular Bulb and Carotid Artery Dehiscence

Comparison of Tympanosclerosis and Chronic Suppurative Otitis Media Cases in Terms of Sigmoid Sinus Position, High Jugular Bulb and Carotid Artery Dehiscence

METHICILLIN RESISTANCE STAPHYLOCOCCUS AUREUS (MRSA) FROM CSOM IN A TERTIARY CARE HOSPITAL

Introduction: Chronic Suppurative Otitis Media (CSOM) is one of the major cause of preventable hearing loss if treated promptly. Emergence of resistant strains in the world is of great concern. The aim of the present study was to determine the aetiology and antibiotic sensitivity pattern of bacterial isolates from CSOM cases with special emphasis on Methicillin Resistant Staphylococcus aureus. Materials and methods: Ear swabs were collected from 212 patients attending otorhinolaryngology department, GKMC, Chennai was processed in Microbiology lab. Direct gram staining was done and then inoculated into Blood, MacConkey and Nutrient agar. Bacterial identification was done using standard microbiological techniques. Antibiotic susceptibility was done by Kirby Bauer disc diffusion technique. Methicillin Resistant Staphylococcus aureus (MRSA) was detected by Cefoxitin disc diffusion method as per CLSI guidelines. Results: 60 Gram positive bacteria were isolated from collected ear swabs. Staphylococcus aureus 46(26.59%) was the most common bacteria among Gram positive organism followed by CONS 9(5.20%) and Enterococci 5(2.89%). Staphylococcus aureus showed 41(89.13%) was sensitive to amikacin and 40(86.95%) to ofloxacin. All the Gram Positive cocci were 100% sensitive to Vancomycin and Linezolid. 19.53% were confirmed as MRSA by cefoxitin disc diffusion method. Conclusion: Microbial pattern can vary in different location in different periods of time. Hence knowledge of appropriate aetiology and antimicrobial resistance pattern of CSOM helps in rational use of antibiotics and control of drug resistance.MRSA is emerging as an important pathogen in CSOM. Empirical antibiotics should be directed to gram positives, and especially, MRSA should be taken into consideration.

Bacterial Profile and Antimicrobial Susceptibility Pattern of Chronic Suppurative Otitis Media from a Tertiary Care Hospital in Kannauj, Uttar Pradesh, India

Introduction: Chronic Suppurative Otitis Media (CSOM) is a chronic and persistent inflammation of the mucosal lining of middle ear cleft which presents with recurrent ear discharge through a tympanic membrane perforation. CSOM is a worldwide disease and has higher prevalence in developing countries causing serious local damage and threatening complications. Aim: To determine the profile of CSOM, its causative agents and their antibiotic susceptibility pattern. Materials and Methods: The present study was a retrospective study in which data for culture and antimicrobial susceptibility profile of CSOM cases was retrieved from Microbiology department of Government Medical College, Kannauj, Uttar Pradesh, India, from January 2019 to October 2019 the analysis of data was done in February 2020. Two hundred pus swabs from discharging ears were processed during the study period for aerobic bacterial culture and antimicrobial susceptibility pattern in Microbiology department using standard microbiological techniques. The result analysis of the study was expressed as percentage and proportion for distribution of CSOM cases. Results: Out of 200 patients, 114 (57%) were males and 86 (43%) females. Among the 200 cases, 147 (73.5%) cases showed growth and 53 (26.5%) showed no growth. The most common organism isolated in this study was Pseudomonas aeruginosa, 67 (42.40%) followed by Staphylococcus aureus.48 (30.37%) and Klebsiella spp. 23 (14.55%). Gentamicin (85%) and amikacin (83%) had high level of antibacterial activity on all the isolates. Meropenem was found to be most effective drug for gram negative isolates. All Staphylococcus spp isolates were sensitive to vancomycin (100%). Conclusion:Pseudomonas aeruginosa was the most predominant organism isolated in otitis media patients. Most of the isolates were sensitive to meropenem.

Chronic Suppurative Otitis Media Contributory Factors and their Prevention

Background: Chronic suppurative otitis media has declined in the developed countries because of better health resources and better socioeconomic status of the people, but it still remains a major health problem in developing countries like Pakistan. Chronic suppurative otitis media (CSOM) is relatively common among illiterate people having poor socioeconomic status residing in the rural areas. Objective: To identify the contributory factors responsible for chronic suppurative otitis media and to devise strategies to prevent them. Study Design: Cross sectional observational study. Settings: This study was conducted in the department of ENT and Head &amp; Neck surgery allied hospital (FMU) Faisalabad Pakistan. Duration: Two years from September 2016 to August 2018. Methodology: A total of 150 patients with CSOM, both tubotympanic and atticoantral types, were included. The patients of either gender with CSOM, both tubotympanic and atticoantral types, ranging from 03 to 64 years and giving consent for any surgical intervention if required were included in the study. Patients below 03years and above 64 years, having acute suppurative otitis media with complication, and patients not willing for any surgical intervention were excluded from the study. Results: Out of 150 patients of the study 60% patients were males and 40% were females with male : female ratio of 1.5 : 1. The age range was found to be 3-64 years with mean age of 28.9 years. Socioeconomic status showed that 62.8% patients with CSOM belonged to poor class (tubotympanic-46.8% &amp; atticoantral -16%), 23.9% patients had middle class (tubotympanic-16.6% &amp; atticoantral-7.3%) and 13.3% patients belonged to upper class (tubotympanic - 11.3% &amp; atticoantral – 2%). 84 patients (56%) were under matric (tubotympanic-42% &amp; atticoantral – 14%). 57.2% patients were rural residents and 42.8% patients were urban residents in case of tubotypmpanic type of CSOM while 55.2% patients were rural and 44.8% patients were urban in case of atticoantral type of CSOM. SPSS software version 10 was used to analyse the data. Chi square test was applied for analysis. Tubotympanic type of CSOM cases were treated conservatively along with surgical treatment where indicated. All cases of atticoantral type of CSOM were treated by surgery. Conclusion: CSOM is still an important public health problem in developing countries like Pakistan due to poverty, illiteracy, malnutrition, lack of health education and people living in substandard &amp; rural areas. It is the need of the hour that health education programs should be organized to raise the awareness about the disease among the people.

Chronic Suppurative Otitis Media (CSOM): Evaluation of fungal and aerobic bacterial agents and antibiotic sensitivity pattern of the bacterial isolates

Introduction: Chronic suppurative otitis media (CSOM) is an important cause of preventable hearing loss, particularly in the developing world. Aim: To determine the microbiological profile of CSOM and determine the antibiotic susceptibility testing of aerobic bacteria which will be beneficial for appropr iate treatment there by reducing complications. Methods and Materials: A total of 109 patients with CSOM attending outpatient and admitted inpatient in ENT department were included in the study. Two pus swabs each for infected ear were collected. Specimens were subjected to Gram stain and plated on to appropriate culture media to isolate bacterial and fungal pathogens. Bacterial and Fungal species identification and Antibiotic susceptibility testing of aerobic bacteria of isolated pathogens was done. Results: Out of 109 samples cultured there were 70 bacterial and 14 fungal isolates. Most common aerobic bacterial isolate was Pseudomonas aeruginosa (34.2%) followed by Proteus mirabilis (22.8%) and Staphylococcus aureus (17%). Among fungal isolate, Aspergillus niger (64.3%) was predominant followed by Aspergillus flavus (21.4%) and Candida species (14.3%). Amikacin (91.6%) and Ciprofloxacin(87.5%) showed maximum activity to Pseudomonas aeruginosa. The antibacterial susceptibility pattern of Staphylococcus aureus revealed 58.3% Methcillin resistant Staphylococcus aureus (MRSA) strains. Conclusions: Emergence of Pseudomonas aeruginosa as most common aerobic isolate and high incidence of Methicillin Resistant Staphylococcus aureus in present study indicates the necessity of continuous evaluation of bacteriological profile and antimicrobial susceptibility testing in all CSOM cases. Keywords: Chronic suppurative otitis media (CSOM), Methcillin resistant Staphylococcus aureus (MRSA).

ROLE OF HIGH-RESOLUTION COMPUTED TOMOGRAPHY TEMPORAL BONE IN THE EVALUATION OF UNSAFE CHRONIC SUPPURATIVE OTITIS MEDIA

Background: Unsafe or atticoantral chronic suppurative otitis media (CSOM) is characterized by scanty, purulent, and foul-smelling discharge with attic or marginal tympanic membrane perforation. This can be associated with serious complications. Objective: The objective of the study was to evaluate the pre-operative high-resolution computed tomography (HRCT) temporal bone findings in unsafe CSOM and to determine its usefulness in patients undergoing surgery. Materials and Methods: In this prospective study, 50 random patients with clinically diagnosed as unsafe CSOM from the ENT Department were subjected to HRCT temporal bone in the Department of Radiodiagnosis, Sriram Chandra Bhanj Medical College, Cuttack. The radiological findings were compared with the intraoperative findings. Results: The study results show a good correlation between the pre-operative (HRCT) and intraoperative findings. Cholesteatoma was seen in 35 cases. Ossicle erosion was seen in 40 cases with incus being the most commonly eroded ossicle, followed by scutum erosion (25 cases), mastoid cortex erosion (10 cases), sinus plate erosion (8 cases), tegmen erosion (6 cases), lateral semicircular canal erosion (4 cases), and facial canal erosion (5 cases). Among the extracranial complications (32 cases), mastoiditis was the most common complication and among the intracranial complications (3 cases), epidural abscess was most commonly seen. Conclusion: HRCT temporal bone helps in depicting the site, extent of the disease, bony erosions, and complications associated with the disease proving to be very helpful in surgical planning. Hence, it is necessary to preoperatively evaluate every case of unsafe CSOM with HRCT.

Analysis of main pathogenic bacteria and drug sensitivity in patients with chronic suppurative otitis media and middle ear cholesteatoma in China.

Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) were classified as different diseases recently. Owing to the difference in pathogeneses, the pathogenic bacteria of the two diseases can be different. However, few studies have compared the two types of pathogenic bacteria. To analyze the main pathogenic bacteria and drug sensitivities in patients of Southwest China with CSOM and MEC and compare the difference of ear dryness rate between empirical and sensitive medication. According to the data of culture of ear discharge and postoperative pathological examination, the patients were divided into CSOM and MEC groups. A cohort study was carried out in 1087 hospitalized patients with CSOM and MEC in the Department of Otolaryngology head and neck surgery, West China Hospital from January 2015 to June 2019. Pathogenic bacteria were detected in 467 of 726 cases of CSOM (64.46%) and in 190 of 361 cases of MEC (52.63%). Of the positive cases, 53.96% involved gram-positive(G+) bacteria and 46.04% involved gram-negative (G-) bacteria in the CSOM group; 41.05% involved G+ bacteria and 58.95% involved G- bacteria in the MEC group (P < 0.05). In the CSOM group, the top four pathogens were Staphylococcus aureus (33.62%), Pseudomonas aeruginosa (23.98%), Proteus (16.92%), and Coagulase-negative Staphylococci (10.28%). The top four pathogens in the MEC group were Proteus (22.11%), S. aureus (21.05%), P. aeruginosa (15.26%), and coagulase-negative staphylococci (8.42%). S. aureus was more sensitive to ciprofloxacin and moxifloxacin in the MEC group than in the CSOM group (= 14.286, P < 0.001; = 8.244, P < 0.01). P. aeruginosa was more sensitive to neomycin and tobramycin in the MEC group than in the CSOM group (= 21.285, P < 0.001; = 4.060, P < 0.05). The sensitivity rate of coagulase-negative staphylococci to neomycin in the MEC group was higher than that in the CSOM group (= 5.126, P < 0.05). The sensitivity of Proteus to piperacillin tazobactam in the CSOM group was higher than that in the MEC group (= 8.881, P < 0.05). The dry ear rate of patients with sensitive drug was significantly higher than the patients with empirical drug (= 19.431, P < 0.001). The detection rate of G+ bacteria in the CSOM group was higher than that in the MEC group. The detection rate of G- bacteria in the CSOM group was lower than that in the MEC group. The main pathogens in the two groups included S. aureus, P. aeruginosa, Proteus and coagulase negative Staphylococcus. The dry ear rate of patients who used sensitive drugs was significantly higher than the patients who used empirical drugs. Reducing the rate of empirical use of antibiotics as much as possible and selecting antibiotics reasonably were beneficial to the improvement of dry ear rate after surgery.

The microbial burden in chronic suppurative otitis media patients along with their antibiogram

Introduction: Chronic suppurative otitis media (CSOM) is a common health problem in countries with low socio-economic strata because of poor nutrition, population burden, low hygienic condition, insufficient health care, and repeated upper respiratory tract infection (URTI). Untreated cases of CSOM result in complications ranging from persistent otorrhoea, mastoiditis, labyrinthitis, facial nerve palsy to intracranial abscesses or thromboses. Microbiological profile and their antibiotic sensitivity pattern are essential to enable proper treatment of this disease and preventing the development of complications. Material and Methods: The current study was designed to identify the pathogenic agents causing CSOM and to understand their antimicrobial resistance pattern who attended ENT Department of this hospital between July 2017 to June 2019. Results: Among 496 clinical samples, microbes were seen in 329 (66.3%) cases with predominant male (66.3%) distribution and age group of 11-20 years (31%). Pseudomonas spp. (50.7%) is predominantly isolated. It showed resistance to aminoglycosides and fluoroquinolones but was found sensitive to carbapenems with a resistance rate of 1.2%. ESBL (Extended-spectrum β- lactamase) detection was seen in 30.9% of GNB while MBL (Metallo β- lactamase) was detected in 2.7% of cases. S.aureus was highly resistant to first-line antibiotics with MRSA (Methicillin-resistant S.aureus) rate of 64.1%, however, all were sensitive to glycopeptides. Conclusions: There should be a minimum gap between the onset of symptoms and the treatment provided to prevent complications of CSOM and also the complicated cases should be referred to specialized centers for better management.

Cochlear Dysfunction in Chronic Otitis Media and Its Determinants.

Introduction:Long-standing chronic otitis media (COM) may lead to sensorineural hearing loss (SNHL). The present study aimed to evaluate the factors affecting the sensorineural component to counsel patients regarding the risk of SNHL at the event of untreated COM.Material and Methods:A time-bound cross-sectional study was conducted in the Department of Otorhinolaryngology at a tertiary care hospital. The study population included the study group comprising 137 patients with chronic suppurative otitis media (CSOM) and the control group which consisted of 137 individuals with the same age range and gender as the case study group. Moreover, the hearing was assessed using a pure tone audiogram and special tests of hearing.Results:Based on the findings of the present study, the SNHL was found in 71.4% of CSOM cases with an ear discharge duration of more than 5 years. The SNHL occurred in 55.2% and 44.7% of the cases with pars flaccida and of pars tensa perforations, respectively. In the case of pars tensa perforation, greater perforation size resulted in a steady increase in the odds of developing SNHL. Patients with subtotal and total perforations were at higher risk of developing SNHL. Conclusion:Patients with longer duration of disease, squamous type of disease, and larger size of pars tensa perforation had greater susceptibility to develop SNHL. Therefore, eradication of the disease from the middle ear and early reconstruction of the hearing mechanism during the course of the disease result in reducing the burden of SNHL.

Hearing Loss In Chronic Suppurative Otitis Media (CSOM)

Objectives: To evaluate the type and degree of hearing loss in CSOM and also to find out any relationship between the hearing loss and disease duration.&#x0D; Methods: This was a cross sectional study which was carried out in the departments of Otolaryngology and Head-Neck Surgery of BSMMU and Dhaka Medical College Hospital during the period of July’2011 to December’2011. A total 80 cases of CSOM were collected. Patient below the age of 5 years and patients above the age of 50 years were excluded from this study. The diagnosis of CSOM was established on the basis of clinical examination- otoscopy and tunning fork test. Pure tone audiogram (PTA) was done for hearing assessment. Thus, 80 cases of CSOM were collected with their PTA reports of 117 ears.&#x0D; Results: The study included 80 patients of CSOM, of them 60 were with tubo-tympanic type and 20 were with attico-antral disease. Highest number of patients was in 2nd decade in both type of disease. 44.79% of ears of tubo-tympanic type were associated with mild (26-40 dB) hearing loss and 42.85% attico-antral variety was with moderate (41-55 dB) hearing loss. Conductive type of hearing loss was common in both types of disease. 98% of ears in tubotympanic and 81% of ears in attico-antral disease had conductive hearing loss. Mixed type (2.08%) of hearing loss was found in tubo-tympanic disease. Attico-antral disease was also associated with mixed (14.28%) and SNHL (4.76%).&#x0D; Conclusion: The above study revealed that hearing loss in CSOM is mostly conductive in nature rarely sensorineural in type.&#x0D; Bangladesh J Otorhinolaryngol; April 2017; 23(1): 59-66

Sensorineural hearing loss in tubotympanic variety of chronic suppurative otitis media

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.&#x0D; 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.&#x0D; 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&lt;0.001). The average bone conduction loss at 4kHz was higher than the average at the speech frequency range.&#x0D; 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.&#x0D; Bangladesh J Otorhinolaryngol; April 2016; 22(1): 26-30

Isolation and Identification of Bacteria Causing Chronic Suppurative Otitis Media and Its Antibiogram

Background: Chronic Suppurative Otitis Media (CSOM) is defined as chronic inflammation of middle ear and mastoid cavity, which presents with recurrent ear discharge or otorrhoea through a tympanic perforation. According to WHO, the prevalence of CSOM in India is more than 4% and it falls among those countries where urgent attention is needed. It can be caused by various bacteria, fungus and viruses. Bacterial origin of CSOM is more common than other etiologies. Aims and Objectives: The present study is aimed to detect common organisms which are responsible for CSOM, most common organism responsible for the complications and to determine the antibiotic sensitivity pattern of the organisms isolated from CSOM. Results: Ear swabs were taken from 100 clinically diagnosed cases of CSOM attending department of ear, nose and throat, MBS hospital and NMCH and were subjected to culture and antibiotic susceptibility. 104 (88.13%) among 118 ear swabs from total 100 patients were culture positive and 14 (11.87%) were culture negative. The most frequently isolated organisms in CSOM patients were Pseudomonas aeruginosa (42 (40.38%)), followed by Staphylococcus aureus (36 (34.6%)), Klebsiella pneumoniae (12 (11.53%)), Escherichia coli (08 (7.69%)) and Proteus mirabilis (06 (5.76%)). Most effective and favorable drug in our study for Pseudomonas aeruginosa was piperacillin-tazobactum, followed by cefepime. Staphylococcus aureus were 100% sensitive to Vancomycin and Linezolid, and 61.11% were MRSA. Conclusion: This study highlights the need for active diagnosis and management of CSOM. Judicious use of antibiotics is recommended and also the patient must complete a course of treatment as prescribed, because inadequate treatment may cause the emergence of resistant microorganisms. Keywords: CSOM, bacterial, gram positive, gram negative Cite this Article Anita E. Chand, Charu Sharma. Isolation and Identification of Bacteria Causing Chronic Suppurative Otitis Media and Its Antibiogram. Research & Reviews: A Journal of Microbiology and Virology. 2019; 9(3): 1–5p.

Comparison of High Resolution Computed Tomography with Intraoperative Findings in Patient with Chronic Suppurative Otitis Media, NAMS, Bir Hospital, Kathmandu, Nepal

Introduction: Chronic suppurative otitis media (CSOM) is an important cause of middle ear disease and its complications challenge both otologist and radiologist. The major benefit of HRCT is an excellent visualization of the osseous structure by means of special algorithms. This study compares the HRCT with intraoperative findings in patients with CSOM.&#x0D; Methods: This is an observational descriptive study conducted at NAMS Bir Hospital. Total of 30 patients, referred for HRCT from the department of ENT were studied. Comparison of HRCT findings was done with intraoperative findings regarding the status of EAC, ossicular chain, bony plate, inner ear structure and facing nerve canal was done, considering intraoperative findings as the gold standard.&#x0D; Results: Out of 30 patients, 16 patients had CSOM with cholesteatoma and 14 patients had CSOM without cholesteatoma. HRCT presented sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 87.5%, 85.7%, 87.5%, 85.7% and 86.7% respectively in diagnosing CSOM with cholesteatoma. HRCT presented sensitivity and specificity of 85.7% and 87.5% in identification of malleus erosion, sensitivity and specificity of 86.7% and 80%, in the identification of incus erosion. HRCT showed the specificity of 85% with relatively low sensitivity of 70% in identification of erosion of stapes. HRCT showed a sensitivity of 100% and specificity of 85.7%. HRCT presented sensitivity and specificity of 83.3% and 95.8% in diagnosing tegmen tympanum erosion. HRCT showed the highest sensitivity (100%) and specificity (100%) in diagnosing erosion of sigmoid sinus plate and mastoid cortex. HRCT showed relatively low sensitivity of 66.7% and 75% in diagnosing erosion of LSCC and facial canal respectively. HRCT detected soft tissue mass in the middle ear/mastoid in all 30 patients of CSOM. Hence, the sensitivity, specificity, positive predictive value and negative predictive value of HRCT for soft tissue mass in the middle ear and mastoid, all were 100%.&#x0D; Conclusion: The HRCT has a valuable role in preoperative evaluation of a case of CSOM. It has high sensitivity in diagnosing CSOM with cholesteatoma. However, HRCT has relatively low sensitivity for LSCC and facial nerve canal erosion.