Otitis Research Articles

Our Experience with Labyrinthine Fistula: Prospective Hearing Outcomes.

Chronic otitis media with cholesteatoma is a locally destructive middle ear infection with bone erosive properties which can lead to fistula if erodes labyrinth. A prospective observational study was conducted at tertiary health care centre with a total of 12 patients who presented with complaints of otorrhoea, hearing loss and vertigo. Such patients were evaluated clinic audiologically and radiologically as a pre op assessment. Post-surgery audiological assessment was done. Hearing preservation was seen in 91.7% patients and none of the patients had iatrogenic sensorineural hearing loss. Complete removal of the cholesteatoma is beneficial and does not lead to any iatrogenic SNHL when performed meticulously. A newer way of diagnosing membranous labyrinthine breach utilizing Magnetic Resonance Imaging T2 Diffusion Weighted (MRI- T2 DW) sequence can be implemented.

Identification of algD and oprL genes in Pseudomonas aeruginosa isolated from multiple environments and different local sources in Iraq

The aim of this study was to investigate the spread of the genes algD and oprL in P. aeruginosa within the genetic structure of environmental sources of isolates and various clinical studies, and to evaluate a successful alternative for diagnosing Pseudomonas aeruginosa (P. aeruginosa) among various sources. In this study, 100 samples were collected from various clinical and environmental sources. Twenty-eight isolates of P. aeruginosa bacteria were isolated. Nine pathological samples were taken from wounds, burns, blood, and ear infections in three governorates: Salah al-Din, Baghdad, and Kirkuk. Five isolates of P. aeruginosa bacteria were collected from contaminated water from the Salah Al-Din and Baghdad governorates. The isolates were diagnosed phenotypically through the colony's shape, colour, odour and interaction with Gram stain. Additionally, the VITEK 2 system was used to confirm the diagnosis of the isolates. The results show that all the isolates belonged to the bacteria P. aeruginosa. The results of the molecular diagnosis using a polymerase chain reaction (PCR) technique for three genes with specialised primers (16SrRNA, algD, and oprL) show that most of the bacterial isolates from different sources belong to the type P. aeruginosa because they contain the specific gene 16SrRNA except for five isolates (M5, M7, M8, M9 and W1). Four of these belong to isolates with a pathogenic source and one was isolated from water. The results of the PCR for the algD gene show that all isolates contain the gene except for four diseased samples. Samples M5, M7, M8, and M9 were without the gene, while all isolates had the oprL gene. A sequencing analysis of the DNA was then performed for the isolates that were not associated with the specialised primers of the above genes to ensure their genera (M5, M7, M8, and M9), in addition to a sample of 15 isolated from soil (S6) that was associated with all special primers for the same genes for the purpose of comparison. The results show that isolates M5, M7, M8 and M9 were diseased isolates belonging to Escherichia coli, while the 15 isolated from soil (S6) were diagnosed as P. aeruginosa.

Improving detached tiller culture for doubled haploid production in wheat (T. aestivum L.) by post‐pollination fungicides application and UV radiation treatment

AbstractThis work aims at improving the proven protocol for doubled haploid production in wheat. This procedure has some deficits, for example, microbial infection of ears as well as of the nutrient culture medium. In the present study, the potential effect of sterilization by detached tiller culture fungicides of ears as well as of nutrient medium to control microbial infection, and its effect on the formation of caryopses and embryos (CFF, EFF) was studied. In a further experiment, the UV‐light was used as physical sterilant for the nutrient medium. All of the fungicides and their concentrations studied were found to be effective to control infection on ears except the concentration 0.05% tilt. 0.1% tilt gave the highest CFF (79.5%) followed by 0.1% Bayleton (78.0%). The lowest CFF was recorded in control treatment (48.8%). Among Bavistin treatments, the 0.2% Bavistin gave maximum CFF (68.5%) as well as EFF (29.1%) followed by 0.1% Bavistin (64.9%, 23.7%). The higher concentration of tilt (0.2%) showed detrimental effects on EFF (17.5%). Bavistin in tiller culture nutrient medium reduced infection in medium and was shown to improve CFF and EFF (67.4%, 29.8%).

Bezold’s abscess, an uncommon complication of otitis media and cholesteatoma: a case report

BackgroundMastoiditis frequently occurs in children as they are more susceptible to middle ear infections, but infrequently occurs in adults. A rare complication that results from mastoiditis and an obstructing cholesteatoma is a Bezold’s abscess, of which there are less than 100 reported cases in literature to date.Case presentationHere, we present a case of a 72-year-old Caucasian man who has had no history of prior ear infections and was found to have a cholesteatoma and advanced acute coalescent mastoiditis complicated by a Bezold’s abscess.ConclusionsBezold’s abscess is a rare entity infrequently encountered in the modern era, likely owing to more prompt treatment of otitis media. Cholesteatoma poses a great risk for both the development of otitis media and further progression to mastoiditis and its associated complications, such as Bezold’s abscess. Knowledge of said abscess is crucial; without prompt recognition, further spread of infection can occur with vascular or mediastinal involvement.

Seeing an apocalyptic post-antibiotic future lowers antibiotics expectations and requests

BackgroundAntibiotic resistance is an ongoing pandemic which represents a global public health threat. To encourage the judicious use of antibiotics, public health discourse and campaigns often engage in threat-based messaging depicting an apocalyptic post-antibiotic future. We studied the effectiveness of the strategy because of mixed evidence for its success, and because it is unclear how experiencing the COVID-19 pandemic might have influenced it.MethodsWe conducted a randomised controlled trial with 378 participants in three waves (before and during the pandemic in 2021 and 2022). Participants were randomly allocated to either the baseline arm, featuring a control film, or the intervention arm featuring a short film, Catch, depicting a post-antibiotic future. Participants expressed expectations and intended requests for antibiotics for a hypothetical ear infection and their adherence to a prescribed antibiotic for a hypothetical kidney infection. In waves 2 and 3, they also reported any COVID-19-related changes to their antibiotic desires.ResultsShowing participants a film about a post-antibiotic future substantially lowers clinically inappropriate expectations for antibiotics and their intended requests. Participants report that the experience of the COVID-19 pandemic decreased their desire for antibiotics but only when they watched the intervention film. The intervention slightly decreases participants’ adherence intentions towards a prescribed antibiotic treatment.ConclusionsPresenting a film about an apocalyptic post-antibiotic future lowers expectations and intended requests for antibiotics and therefore has the potential to encourage judicious use of them. However, the adverse effects of such messaging on adherence to a course of antibiotics should be proactively managed.

Microbiological Profile of Ear Infection in Patients with Chronic Suppurative Otitis Media

Ear infections occur in all age groups. Chronic Suppurative Otitis Media (CSOM) is the most common illness in ear, nose and throat (ENT) practice. It may even cause hearing impairment especially sensory – neural deafness if not treated properly and with caution. The aim from the present study is to assess the frequency of microbial agents in chronic suppurative otitis media and the antibiotic susceptibility patterns of isolates among patients. A total of 65 patients clinically diagnosed with chronic suppurative otitis media, the samples were collected using sterile swabs. All bacterial and fungal isolate were identified by conventional microbiological methods. Antibiotic susceptibility patterns of the bacterial isolate were determined by Kirby–Bauer disc diffusion method. Out of total 65 samples 45 (69.2%) positive culture was Pseudomonas aeruginosa (28.8%) were the most prevalent bacteria isolated, followed by Staphylococcus aureus (22.2%) Proteus mirabilis (11.1%) Klebsiella (6.6%), E. coli (4.4%), Staphylococcus epidermidis (4.4%) and Streptococcus pyogenic (4.4%). Candida albicans (13.3%) was the most common fungus causing CSOM. The most effective antibiotic for treatment of bacterial chronic suppurative otitis media was ceftriaxone, meropenem and amikacin. It is important to know the major microbial etiologies of CSOM and their antibiotic susceptibility patterns, both for selection of the most appropriate treatment regimen and prevention of the emergence of resistant strains.

Severely complicated ear infection in a patient treated with ixekizumab: a case report.

We report a case of a severe ear infection in a 35-year-old man treated with ixekizumab for psoriasis. Ixekizumab is a humanized monoclonal antibody that selectively prevents the interaction between interleukin 17A and its receptor. Biologicals like ixekizumab are used to achieve symptom relief in autoimmune diseases including psoriasis. Unlike the mild upper respiratory tract infections usually described as side-effects of this treatment, we report a case of a patient who presented with a severe otitis media, complicated with a facial paresis and nasopharyngeal abscess. To the best of our knowledge, this is the first case presenting a severe, complicated ear infection as a possible side effect of ixekizumab. We conclude that when using ixekizumab, vigilance for upper airway infections is needed and if necessary, interruption of therapy should be considered. However, further research is needed to confirm this hypothesis.

Measuring the Direct Medical Costs of Hospital-Onset Infections Using an Analogy Costing Framework.

The majority of recent estimates on the direct medical cost attributable to hospital-onset infections (HOIs) has focused on device- or procedure-associated HOIs. The attributable costs of HOIs that are not associated with device use or procedures have not been extensively studied. We developed simulation models of attributable cost for 16 HOIs and estimated the total direct medical cost, including nondevice-related HOIs in the USA for 2011 and 2015. We used total discharge costs associated with HOI-related hospitalization from the National Inpatient Sample and applied an analogy costing methodology to develop simulation models of the costs attributable to HOIs. The mean attributable cost estimate from the simulation analysis was then multiplied by previously published estimates of the number of HOIs for 2011 and 2015 to generate national estimates of direct medical costs. After adjusting all estimates to 2017 US dollars, attributable cost estimates for select nondevice-related infections attributable cost estimates ranged from $7661 for ear, eye, nose, throat, and mouth (EENTM) infections to $27,709 for cardiovascular system infections in 2011; and from $8394 for EENTM to $26,445 for central nervous system infections in 2016 (based on 2015 incidence data). The national direct medical costs for all HOIs were $14.6 billion in 2011 and $12.1 billion in 2016. Nondevice- and nonprocedure-associated HOIs comprise approximately 26-28% of total HOI costs. Results suggest that nondevice- and nonprocedure-related HOIs result in considerable costs to the healthcare system.

"Does My Kid Have an Ear Infection?" An Analysis of Pediatric Acute Otitis Media Videos on TikTok.

With the rise of social media, online platforms have become a common way to access healthcare information. This study examines the quality of pediatric acute otitis media (AOM) videos on TikTok, a popular short-form video social media platform. A TikTok search was conducted between 8/18 and 8/19/2023 using pediatric AOM hashtags: #pediatric acute otitis media management, #kid ear infections remedy, #child ear infections treatment, and #kid ear infection. Data collected include number of views/shares per day, uploader type (nonmedical influencer, lay individual, and medical professional), and content categories. The Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-AV) and DISCERN questionnaire measured understandability, actionability, and quality of videos. Multivariable linear regression models were used (significance set at ≤0.05). Of 166 videos, 38.6% (64) of uploaders were medical professionals, and 32.5% (54) were nonmedical influencers. Nonmedical influencer videos were viewed and shared significantly more than those by medical professionals (p < 0.05). Controlling for covariates, physicians were more likely to produce more beneficial and higher quality videos as compared with nonmedical influencers (β = 2.4 and 1.3, p < 0.01, respectively). However, physicians did not have significantly different ratings for understandability compared with nonmedical influencers (β = 0.45, p > 0.05). AOM content on TikTok is often geared toward caretakers of symptomatic children. Although physician-created AOM content was significantly higher quality, these videos reached a statistically smaller audience than those from nonmedical influencers. Addressing misinformation on social media platforms requires physicians to reach larger audiences by producing more actionable and understandable content. NA Laryngoscope, 2024.

Clinical analysis of cases of otogenic sigmoid sinus thrombosis in children

Objective:To analyze the clinical characteristics of middle ear mastoiditis combined with sigmoid sinus thrombophlebitis in children. Methods:Author retrospectively analyzed the clinical data of 6 children with middle ear mastoiditis combined with sigmoid sinus thrombophlebitis who were hospitalized in the Department of Infectious Diseases and Department of Neurology with first diagnosis of fever/headache, and subsequently underwent middle ear mastoidectomy in our department. All patients underwent comprehensive otoscopic, audiologic, imaging, and pathogenetic examinations. Clinical manifestations, pathogenetic features, treatment methods and prognosis were summarized, and the follow-up period was 3-6 months. Results:All 6 cases were first diagnosed with intracranial complications such as fever and headache in the internal medicine department. Within one month, all patients developed ear symptoms including pain, discharge, and hearing loss. Audiologic examination revealed conductive hearing loss in five cases and total deafness in one case. MRI, MRV and MRA examinations suggested that there were 6 cases of middle ear infection combined with thrombophlebitis of the ethmoid sinus, of which 3 cases had thrombus in the ethmoid sinus. 6 cases received surgical treatments: 2 cases of radical mastoidectomy+grommet Insertion, and 4 cases of radical mastoidectomy. Pathogenetic examination identified Streptococcus pneumoniae in three cases, Pseudomonas aeruginosa in one case, Enterobacter cloacae complex in one case, and no pathogens were detected in one case. Postoperative pathology was inflammatory granulation in all 6 cases. Follow-up was 3-6 months with no recurrence of intracranial and middle ear lesions on regular review. Conclusion:Children with recurrent fever, headache, and a recent history of acute and chronic otitis media should be evaluated for the possibility of sigmoid sinus thrombophlebitis, and imaging tests should be performed in a timely manner to clarify the diagnosis. Once diagnosed, surgery to remove the lesions around the ethmoid sinus, smooth drainage combined with antibiotic therapy is the most direct and effective treatment, and anticoagulation therapy is given when necessary. Timely diagnosis, multidisciplinary collaboration, and accurate timing of the management of primary foci and comorbidities are crucial to the treatment of the disease.

COMPARATIVE STUDY OF SURGICAL OUT COME OF INTERLAY TYMPANOPLASTY AND UNDERLAY TYMPANOPLASTY IN TERMS OF HEARING IMPROVEMENT AND GRAFT UPTAKE

Introduction: Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. Up to 80% of these perforations heal spontaneously; for the remaining, surgical repair, known as myringoplasty, is usually proposed. The principal indications are recurrent otorrhea, the desire to swim without having to waterproof the ear and to improve conductive hearing loss. Several factors may affect surgical outcome such as the surgical approach (endaural, postaural) and technique (underlay vs. overlay), site of perforation and type of graft utilized. Material &amp;Methods: This study was carried out from January 2018 to October 2019. Detailed history and examination were carried out the patient of Chronic Otitis Media with Inactive mucosal disease in large central perforation. Out of 50 patients, 25 patients were operated by underlay technique and rest 25 patients were operated by interlay tympanoplasty. In both the techniques of myringoplasty post auricular approach and temporalis fascia was used as a graft material and operated under general or local anesthesia. Conclusion: Thus in present study as far as resolution of air bone gap is concerned, Interlay technique showed a statistically better outcome as compared to the underlay group. The findings in present study showed a better graft up take in Interlay method which coupled with a better postoperative air bone gap provided a better overall outcome. Key words: Tympanoplasty , Interlay Tympanoplasty, Underlay Tympanoplasty, CSOM,

Association of Hearing Loss Onset and Etiology with Psychosocial Outcomes Among US Older Adults.

Understand the differential association of onset and etiology of hearing loss with psychosocial outcomes among older adults. This is a cross-sectional cohort study based on 2017-2020 National Health and Nutrition Examination Survey. Adults aged ≥70 years who completed audiometric testing and questionnaires on onset and etiologies of hearing loss were included (n = 612). Outcomes included report of social avoidance and major depressive disorder (MDD, PHQ-9). Multivariable regression was utilized to examine differential associations of onset and etiology of hearing loss on psychosocial outcomes while adjusting for relevant factors. In this nationally representative sample of US older adults with hearing loss, 20.8% [95%CI: 14.5-29.0%] reported social avoidance due to hearing loss and 7.2% [95%CI: 4.3-11.8] reported symptoms suggestive of MDD. Multivariable regression demonstrated self-reported onset of hearing loss between ages 6-19 years (OR:2.49 [95%CI: 1.52-4.10]) and 20-59 years (OR:1.95 [95%CI: 1.07-3.55]) was associated with higher avoidance of social interaction than reported onset at ≥70 years. Those with onset between 20-59 years (OR:4.28 [95%CI: 1.17-15.6]) and 60-69 years (OR:5.68 [95%CI: 1.85-17.5]) were more likely to report symptoms consistent with MDD than those with onset at ≥70. Multivariable regression did not demonstrate increased risk of avoiding social interactions or MDD due to hearing loss from noise exposure, ear infection, or ear disease versus aging alone. There was an association between earlier hearing loss onset with social avoidance and MDD. This suggests a need for research to investigate the impact of earlier diagnosis and intervention for hearing loss on psychosocial outcomes. 2b Laryngoscope, 2024.

Pneumatization of the temporal bones and otitis media in ancient and modern Greenlanders

Otitis media occurs frequently among modern Greenlanders. However, knowledge of the epidemiology of this disease before the twentieth century is scanty. Information on diseases in the past may give us a better understanding of the health of historical populations. This study presents a new unbiased method for estimating the incidence of infectious middle ear disease (IMED) in childhood. The method is based on the relationship between IMED in childhood and morphological evidence present in the human temporal bones - i.e. small or asymmetrical pneumatized cell areas. In a standardized X-ray projection, we examined 434 pneumatized cell areas in temporal bones from 34 living adult modern Greenlanders, 56 historical adult Greenland Eskimo crania from the period after the European colonization of Greenland in 1721 AD, and 127 prehistoric adult Greenland Eskimo crania from the period before the colonization. The resulting X-rays of the crania were of high quality and the relationship between IMED in childhood and small or asymmetrical pneumatized cell areas was confirmed in the modern Greenlanders. On this basis a polychotomous logistic regression model was applied to the pneumatized cell areas of the three groups of material. The model allowed for the interdependence of the ears and specified probabilities of having IMED in the right ear, left ear, both ears or of being healthy in both ears. The frequency of IMED as indicated by the model was 8/34 (23 .5%) in modern Greenlanders, 10/56 (17.9%) in historical Eskimo crania and 6/127 (4.7%) in prehistoric Eskimo crania (p &lt; 0.002). The mean area also differed significantly, as it was smallest in modern Greenlanders. The results thus indicated a change in the frequency of IMED and a decrease in area from historical to present-day Greenland in subjects who survived to adulthood. The change seemed closely related to the European colonization of Greenland. As IMED is closely related to upper respiratory tract infections and to poverty, the method seems well suited for evaluating general health in past societies.

Regional anesthesia in a patient with primary ciliary dyskinesia: A case report

BACKGROUND Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases, otolaryngological diseases, central nervous system abnormalities, reproductive system abnormalities, and cardiac function abnormalities. General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease. CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture. Three years prior, he had been diagnosed with PCD. At that time, he had experienced several episodes of pneumonia, sinusitis, and chronic middle ear infections, for which he underwent surgical interventions. At the current admission, he presented with cough and sputum but no other respiratory symptoms. A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe. For the surgical procedure and postoperative pain management, combined spinal-epidural anesthesia was employed. The patient’s postoperative pain score was measured by the numerical rating scale (NRS). On the day of surgery, his NRS was 5 points. By the second postoperative day, the NRS score had decreased to 2–3 points. The epidural catheter was removed on the fourth day following the operation. The patient was subsequently discharged no respiratory complications. CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD. The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.

Parental Knowledge, Attitudes, and Practices Towards Pediatric Ear Infections in the Makkah Region of Saudi Arabia: A Cross-Sectional Study.

Pediatric ear infections constitute a significant public health concern worldwide, adversely impacting children's health and well-being. Parents play a crucial role in prevention, ensuring timely healthcare access, and therefore minimizing potential complications. This study aims to assess parental knowledge, attitudes, and practices towards pediatric ear infections in Makkah region. A descriptive cross-sectional study was conducted among Saudi parents who were ≥18 years old and lived in Makkah region. Convenience sampling was used to recruit 319 participants through social media platforms; data were collected from June to September 2023 via an online self-administered questionnaire. The questionnaire assessed sociodemographic characteristics, along with knowledge, attitudes, and practices related to pediatric ear infections. A total of 319 parents were included in the study. The majority of the participants were female 228 (71.5%), and 208 (65.2%) had a university education level. The most common age groups were 18-30 years and 31-40 years. More than half of the participants (167, 52.4%) demonstrated adequate knowledge regarding pediatric ear infections. Positive attitudes and practices were reported by 183 (57.4%) and 285 (89.3%) of participants, respectively. Adequate knowledge was significantly higher among participants with younger ages (p<0.05). It was found that having a younger age (18-30 years) was an independent predictor of good knowledge (OR: 1.26 (1.96-3.65), p=0.009) and positive practice (OR: 1.53 (1.01-2.33), p=0.045). We found that the majority of parents in Makkah region had a good level of knowledge regarding childhood ear infections, with an overall positive attitude and practice. The study revealed that younger parents had superior knowledge and younger age was an independent predictor for good knowledge and positive attitude.

Chemical compositions of Eucalyptus sp. Essential oils and the evaluation of their combinations as a promising treatment against ear bacterial infections

BackgroundThe chemical composition and biological activities of Eucalyptus essential oils (EOs) have been documented in numerous studies against multiple infectious diseases. The antibacterial activity of individual Eucalyptus EOs against strains that cause ear infections was investigated in our previous study. The study's antibacterial activity was promising, which prompted us to explore this activity further with EO blends.MethodsWe tested 15 combinations (9 binary combinations and 6 combinations of binary combinations) of Eucalyptus EOs extracted by hydrodistillation from eight Tunisian Eucalyptus species dried leaves against six bacterial strains responsible for ear infections: three bacterial isolates (Haemophilus influenzae, Haemophilus parainfluenzae, and Klebsiella pneumoniae) and three reference bacteria strains (Pseudomonas aeruginosa, ATTC 9027; Staphylococcus aureus, ATCC 6538; and Escherichia coli, ATCC 8739). The EOs were analyzed using GC/FID and GC/MS. The major compounds, as well as all values obtained from the bacterial growth inhibition assay, were utilized for statistical analysis.ResultsThe antibacterial activity of the EO blends exhibited significant variation within Eucalyptus species, bacterial strains, and the applied methods. Principal component analysis (PCA) and hierarchical cluster analysis (HCA), based on the diameters of the inhibition zone, facilitated the identification of two major groups and ten subgroups based on the level of antibacterial activity. The highest antibacterial activity was observed for the mixture of EOs extracted from E. panctata, E. accedens, and E. cladoclayx (paac) as well as E. panctata, E. wandoo, E. accedens, and E. cladoclayx (pwac) using the disc diffusion method. Additionally, significant activity was noted with EOs extracted from E. panctata, E. wandoo (pw) and E. panctata, E. accedens (pa) using the broth microdilution method.ConclusionOur findings suggest that certain EO combinations (paac, pwac, pw, and pa) could be considered as potential alternative treatment for ear infections due to their demonstrated highly promising antibacterial activities.

Gut microbiota composition in recurrent acute otitis media: a cross-sectional observational study.

Recurrent acute otitis media (rAOM) poses a significant challenge in children aged 1 to 6 years, characterized by frequent and treatment-resistant ear infections. While existing studies predominantly focus on alterations in the nasopharyngeal microbiome associated with rAOM, our research explores the understudied association with the gut microbiome.In this cross-sectional observational prospective study, we enrolled 35 children aged 1 to 6 years during the 2021/2022 cold season. The test group comprised children with rAOM (n = 16), and the control group consisted of generally healthy children (n = 19). Samples (stool and nasopharyngeal swabs) were collected in late spring to ensure an antibiotic-free period. Detailed metadata was gathered through a questionnaire examining factors potentially influencing microbiota. Microbiota composition was assessed through amplicon sequencing of the V3-V4 region of the 16S rRNA gene. Our findings revealed limited alterations in gut microbiota composition among children with rAOM compared to healthy controls. Six bacterial taxa (Veillonella, Lachnospiraceae, Ruminococcaceae, Lachnospiraceae, Bacteroides and Blautia) were differentially represented with weak statistical significance. However, several bacterial taxa displayed correlations with multiple consecutive infections, with Turicibacter showing the most significant association. Additionally, day care centre attendance emerged as a potent gut microbiota modifier, independent of rAOM. Although our study identified limited differences in gut microbiota composition between children with rAOM and healthy controls, the observed correlations between the number of infections and specific bacterial taxa suggest a potential link between rAOM and the gut microbiota, warranting further investigation.

SITE AND RATE OF OSSICULAR CHAIN EROSION IN PATIENTS UNDERWENT TYMPANOMASTOID SURGERY

Background: Chronic suppurative otitis media (CSOM) is a common problem affecting middle ear and it’s commonly presented with chronic ear discharge and decreased hearing. Hearing problem in CSOM is primarily caused perforated tympanic membrane and in some cases by the presence of erosion of the ossicular chain. The study aimed to show the rate and site of ossicular chain erosion in patients with chronic suppurative otitis media underwent tympanomastoid surgery. Patient and methods: a cross sectional study conducted on 87 patients performed tympanomastoid surgery for chronic middle ear infection where their ossicular status has been assessed intraoperatively. Results: our study shows that 40% of the operated ears has at least a single bone erosion and the Incus bone was the most affected ossicle while the Malleus was the least one 54% and 14% respectively. No statistically significant difference was seen between bone erosion and gender as well as the side of operation. Conclusion: ossicular erosion is a common problem affecting patient with chronic suppurative otitis media and the surgeons should be aware about this pathology and they should have the proper skill to correct such problem.

Common Childhood Illnesses: Diagnosis and Treatment of Asthma, Allergies, and Ear Infections

Common Childhood Illnesses: Diagnosis and Treatment of Asthma, Allergies, and Ear Infections

Phenotypic and genotypic characterization of Staphylococcus aureus strains isolated from otitis externa: Emergence of CC30-spa t019-SCCmec IV carrying PVL as major genotype

The increasing emergence of Staphylococcus aureus as the primary causative agent of otitis externa has been noted; however, detailed information regarding the molecular characteristics of these strains in Iran remains scarce. The current study aims to investigate both genotypic and phenotypic attributes of S. aureus strains implicated in ear infections. In the present work, we analyzed 60 S. aureus strains isolated from cases of otitis externa over a period of 45 months. The resistance patterns were determined using disk diffusion and microbroth dilution methods. All S. aureus isolates were confirmed by the nucA polymerase chain reaction assay, and their biofilm production was assessed by a microtiter plate assay. Molecular characterization of the isolates was performed using the staphylococcal cassette chromosome mec, multilocus sequence typing, and staphylococcus protein A typing methods. Overall, the results indicated that 44 out of 60 S. aureus isolates (73.3 %) were methicillin-resistant Staphylococcus aureus. Resistance to mupirocin and vancomycin was observed in 13.3 % and 1.7 % of the tested isolates, respectively. Furthermore, out of the 60 S. aureus isolates, 56 strains (93.4 %) were classified as positive biofilm strains at different levels. Twelve distinct clonal lineages were identified. The vast majority of S. aureus isolates belonged to CC30/ST30-MRSA IV/t019 (41.7 %). Among the 31 strong biofilm producers, the majority (64.5 %) belonged to CC30/ST30-MRSA IV/t019 clone. Biofilm negative isolates belonged to CC22/ST22 (2 isolates), CC8/ST585 (one isolate), and CC8/ST8 (one isolate). Our result revealed that about three-quarters of PVL-positive strains belonged to CC30/ST30. Our data confirmed the presence of MSSA strains among CC30/ST30 and CC22/ST22 isolates. The mupirocin resistant isolates (n = 8) belonged to CC8/ST585-MRSA III/t713 (37.5 %), CC8/ST239-MRSA III/t030 (25 %), CC8/ST8-MRSA IV/t008 (12.5 %), CC8/ST239-MRSA III/t037 (12.5 %), and CC22/ST22-MRSA IV/t790 (12.5 %) lineages. The VRSA strain belonged to the CC8/ST8-MRSA IV/t008 lineage, carrying the vanA determinant. iMLSB phenotypes (n = 14) were distributed across different lineages, including CC30/ST30-MRSA IV/t019 (21.5 %), CC30/ST30-MSSA/t021 (21.5 %), CC22/ST22-MSSA/t005 (14.3 %), CC8/ST239-MRSA III/t030 (14.3 %), CC22/ST22-MSSA/t1869 (7.1 %), CC22/ST22-MRSA IV/t790 (7.1 %), CC8/ST239-MRSA III/t037 (7.1 %), and CC1/ST772-MRSA IV/t10795 (7.1 %). These findings highlight significant genotypic diversity and high biofilm formation among our isolates. The frequent occurrence of the CC/ST30 clone in S. aureus strains isolated from otitis externa reflects the emergence of these lineages as a predominant clone in Iran, posing a significant public health concern.