Management Of Chronic Suppurative Otitis Media Research Articles

Management of a Case of Chronic Suppurative Otitis Media with Homoeopathic Medicine Mercurius Solubilis - A Case Report

Introduction: Chronic suppurative otitis media (CSOM) is a long-standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation. In homoeopathy, there are various medicines having a sphere of action on suppurative diseases. This is a show case of Mercurius solubilise Homoeopathic remedy for the case of CSOM: Mercurius solubilise is a black oxide of mercury. It affects the whole system, penetrating every organ and tissue and also has a wonderful effect on suppuration. Mercury, in both acute and subacute forms, is the only drug that effectively prevents suppuration. Case summary: This is the case of 24 yr old man who presented with CSOM and was successfully managed with individualized Homoeopathic medicine, Mercurius Solubilis 200c. The case was followed up with documentation of clinical symptoms and investigation findings. In this article, the ultimate aim is to provide the clinician with a homoeopathic tool in the management of CSOM after having satisfactory results in the case.

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.

BACTERIOLOGICAL PROFILE OF CHRONIC SUPPURATIVE OTITIS MEDIA IN PATIENTS AT A TERTIARY LEVEL HOSPITAL

Background: Chronic suppurative otitis media (CSOM) is a disease of multiple etiologies and is well known for its persistence and recurrence in spite of antimicrobial treatment often leading to complications. Hence, knowledge of the current bacterial pathogens along with susceptibility pattern is important in management of cases with CSOM. Objectives: The aim of present study was to observe the bacteriological profile of CSOM and their antimicrobial susceptibility pattern. Methods: The 142 samples of ear discharge from 100 patients of CSOM, reported to the out-patient department of Otolaryngology, S.S. Hospital, Banaras Hindu University, Varanasi between July 2012 and June 2013 were collected processed for Gram stain and culture isolation. Results: On culture isolation, Staphylococcus aureus was the commonest pathogen, followed by Pseudomonas spp., Proteus spp., and Escherichia coli . Staphylococcus aureus showed maximum susceptibility towards Clindamycin whereas leading gram negative isolate Pseudomonas aeruginosa showed maximum susceptibility towards levofloxacin. Conclusion: The study proved to be useful for clinicians in management of CSOM. Further, there is a definite need to ponder over those 14% cases which were negative on aerobic culture. Keywords : Chronic suppurative otitis media (CSOM) , MRSA, Pseudomonas aeruginosa , S taphylococcus aureus

Prevalence and associated factors of chronic suppurative otitis media: Data from the Korea National Health and Nutrition Examination Survey, 2009-2012.

Chronic suppurative otitis media (CSOM) is a common infectious condition that can cause hearing loss and persistent otorrhea. The prevalence rates of CSOM in developed countries is typically <1%, whereas developing countries and some racial groups have shown higher prevalence rates exceeding 4%. The aim of this study was to investigate the prevalence of CSOM in South Korea and associated factors using data from the Korea National Health and Nutrition Examination Survey during 2009-2012. Cross-sectional analysis of a nationwide health survey. Physical examination, interview, and laboratory testing were performed by the field survey team including an otolaryngologist. Among the population >4 years of age (n = 25,147), the prevalence of CSOM was 3.13% (95% confidence interval [CI] = 3.07-3.92). Specifically, the prevalence of tympanic membrane perforation, retraction pocket, and obvious cholesteatoma was 1.78% (95% CI = 1.51-2.00), 1.21% (95% CI = 1.02-1.40), and 0.34% (95% CI = 0.24-0.44), respectively. The prevalence of CSOM increased with age (P < .001) and had a female predominance (P = .014). In a multivariate analysis of associated factors in 14,396 participants >19 years of age, hearing threshold, the presence of tinnitus, diabetes, drinking alcohol, residence in a row house, and education level of the mother were significantly associated with CSOM (P < .05). The prevalence of CSOM in the Korean population >4 years of age was 3.13%. Understanding of epidemiologic data and associated factors might contribute to the better management of CSOM and reducing the social burden. 4. Laryngoscope, 126:2351-2357, 2016.

Microbiology of Chronic Suppurative Otitis Media,Study of the Role of Bacterial Biofilm and Fungal Infection

Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of middle ear cleft. The disease is common in all age groups but more prevalent in low socioeconomic group. It is most commonly seen in developing and undeveloped countries affecting 0.5-30% of any community. Local application of antibiotics remains important and first step to get a dry ear. Changes in bacterial flora in last decade and abuse of antibiotics lead to the emergence of multi-drug resistant organisms. Recently, bacterial biofilm are thought to have a major role in much otolaryngologic infection. The formation of biofilm facilitates chronic bacterial infections and reduce efficacy of anti-microbial therapy. It is estimated that biofilm account of approximately 60% of microbial infection in the body. In addition to bacterial biofilm, the role of fungal infections in CSOM needs more attention. Fungal infections of middle ear are common as fungi thrive well in moist pus. There is very little known about mycological aespect of these ears, the importance of which has increasing in the recent years because of the excessive use of broad sepectrum antidiotics, corticosteroids and cytotoxic chemotherapy. Aim: Microbiological examination of chronic suppurative otitis media by detecting bacterial and fungal isolates involved in the infection. Additionally, the detection of the capacity of bacterial biofilm formation. Patients and methods: Forty Patients suffering from chronic suppurative otitis media attending outpatient clinic in Menoufia university hospital and Karmoz insurance hospital were included in this study. Pus discharge was collected using sterile cotton swabs. These samples were cultured for detection of bacterial and fungal infections and Detection of bacterial capability of forming biofilm was done using crystal violet method and by Overnight culture in tryptic Soya Broth (TSB). Results: Most common isolated bacteria were pseudomonas aeurgiosa (37.5%), followed by Klebseilla.spp (10%) and Staph.aeureus (7.5%) and fungal culture gave results to Candida (10%) and Asperigillus (7.5%). Mixed bacterial and fungal infection occurred in (11.7%) of our patients.14 out of 15 cases of pseudomonas infection gave results to biofilm formation(93.3%)and Staph.aeureus infection,3 cases out of 3 cases(100%) were biofilm forming. Conclusion: Routine culture and sensitivity remains the most important step in management of CSOM because of its multi-etiology that makes the empirical therapy impossible. Fungal infection can occur without clinical evidence, therefore, empirical local antifungal therapy is strongly recommended in such cases. Biofilm formation may be responsible for irresponsiveness to antibiotic chemotherapy. Physical removal or inhibition of biofilm may enhance the response to antimicrobial therapy and infection eradication.

Impact of Educational Program on the Management of Chronic Suppurative Otitis Media among Children.

Background. Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups in both developing and industrialized countries. Aim of the Study. This study aimed to assess the impact of educational program on the management of children with CSOM. Subjects and Methods. An experimental study design was used. This study included 100 children of both sexes of 2 years and less of age with CSOM. Those children were divided into 3 groups: group I: it involved 50 children with CSOM (naive) who received the designed educational program; control group: it involved 50 children who were under the traditional treatment and failed to respond; group II: those children in the control group were given the educational program and followed up in the same way as group I and considered as group II. Tools of the Study. Tool I is a structured questionnaire interview sheet for mothers. It consists of four parts: (1) personal and sociodemographic characteristics of child and (2) data about risk factors of otitis media (3) assessment of maternal practice about care of children with suppurative otitis medi (4) diagnostic criteria for suppurative otitis media. Tool II is the educational program: an educational program was developed by the researchers based on the knowledge and practices needs. This study was carried out through a period of 9 months starting from September 2013 to May 2014. The educational program was implemented for mothers of children with CSOM in the form of 5 scheduled sessions at the time of diagnosis, after one week, 1, 3, and 6 months. Results. There were significant differences between children who received the educational program and control group regarding the response to treatment after one and 3 months. The percentages of complete cure increased progressively 32%, 60%, and 84% after 1, 3, and 6 months in group I while they were 24%, 44%, and 64% in group II, respectively. Cure (dry perforation) was 64%, 36%, and 12% among children of group I after 1, 3, and 6 months while it was 64%, 44%, and 24% in group II, respectively. The percentages of compliance to the educational program improved with time in both groups: 44%, 64%, and 80% in group I and 32%, 48%, and 56% in group II after 1, 3, and 6 months, respectively. The percentages of cure were statistically significantly higher among children with complete compliance with the educational program in both groups in comparison to those with incomplete compliance (P = 0.000 for both). Conclusions. From this study we can conclude that the majority of children with CSOM had one or more risk factors for occurrence of the disease; the educational program is effective for management of CSOM (whether cure or complete cure); the higher the compliance of mothers with the program the higher the response rate; regular followup and explanation of the importance of the program played an important role in the compliance with the program.

A survey of the burden of management of chronic suppurative otitis media in a developing Country

Background:Although the prevalence of chronic suppurative otitis media (CSOM) is much higher in developing counties, most surgical treatment techniques are not easily accessible in many poor resource countries.Aim:The survey aims to examine the extent to which health care facilities in Nigeria are equipped to address the management challenges of CSOM.Subjects and Methods:Online questionnaires were sent and received from otolaryngologists practicing in across Nigerian public health institutions to evaluate the institutional practice concerning management of CSOM. Information enquired include: Proportion of CSOM among the ear, nose and throat (ENT) patient load, routinely applied treatments and challenges facing availability of standard treatment options. Data were analyzed with Statistical Package for the Social Sciences version 15 (Chicago Illinois, USA), and presented descriptively.Results:Responses were returned from 17 otolaryngologists (68% [17/25]) practicing in institutions across the six geopolitical zones with a mean duration of otolaryngology services of 22.4 (14.8) years. The CSOM patients constitute an average of 25.3% (13.1) of ENT patient load, with an average of 31 (15.3) % having significant hearing loss. Surgery have never been tried in 41% (7/17) of the institutions due to lack of facilities and/or expertise. Among institutions that offer surgery, 40% (4/10) offer only cortical mastoidectomy and only 30% (3/10) offer type 1 tympanoplasty. Achievements of permanent dry ears were reported more in institutions that offer surgery. Unaffordable cost of hearing aid and lack of expertise for tympanoplasty are the major challenging factors for rehabilitation of CSOM induced hearing loss.Conclusion:Considering the enormity of CSOM in Nigeria, and the fact that > 40% (7/17) of the public health institutions still lack facilities and/or expertise for surgical treatments for CSOM, public otolaryngological centers should not only be adequately equipped for tympanomastoid surgeries, attention should be focused on further training of experts in the operative techniques from within and outside the country.

Socio-economic status and hearing loss in chronic suppurative otitis media in Nigeria

Hearing loss is reported in about 50% of cases of chronic suppurative otitis media (CSOM). To report the prevalence, type and severity of hearing loss in CSOM and identify risk factors. A prospective study of hearing loss in CSOM was undertaken in University College Hospital, Ibadan, two general hospitals and two primary health care centres, all in densely populated, semi-urban areas in south-west Nigeria. Controls were selected from school children, hospital workers' children and children whose parents were visiting the hospitals, all of whom claimed that there had been no episode of otitis media in the past. An oral questionnaire was administered to all, followed by audiometry and examination of the ear, nose and throat in study children. There were 189 CSOM subjects and 100 controls aged between 4 and 150 months [mean (SD) 59.25 (44.55), 173 girls and 116 boys, M:F 1.5:1]. The prevalence of hearing loss in CSOM was 89/189 (47%) and was conductive in 73/89 (82%) and sensorineural (SHL) in 16/89 (18%). Of the subjects with hearing loss, 72% had had otitis media during the 1st year of life. Of the 89, 61 (69%) were of low social class, 13/37 (35%) were middle class and 15/63 (24%) upper class. The duration of CSOM ranged from 4 weeks to 12 years [mean (SD) 4 yrs (2.04)] and from 5 to 12 years in those with SHL [mean (SD) 9 yrs (6.21)]. There was significant correlation between socio-economic status and hearing loss (r=0.138, p=0.02) while no correlation was found with upper respiratory infection (r=0.054, p=0.36), age of onset (r=0.037, p=0.62) or frequency of attacks (r=-0.068, p=0.35). About one fifth of patients with CSOM have SHL. Early diagnosis and management of CSOM is imperative to improve outcome. CSOM is strongly associated with low socio-economic status.

Chronic suppurative otitis media following paediatric cochlear implantation

The objective of this study was to report and discuss the management of chronic suppurative otitis media (CSOM) following cochlear implantation in children. The study was a retrospective review of 650 patients receiving an implant at two paediatric tertiary referral centres for cochlear implantation. Nine patients were identified who developed CSOM following cochlear implantation (incidence 1.38%). The mean time interval between implantation and symptom development was 3.66 years (range 2–8 years) and the mean time interval between implantation and CSOM surgery was 5.02 years (range 2.2–8 years). All patients presented with otorrhoea and/or abscess formation over the implant site. Two patients underwent a modified radical mastoidectomy and seven underwent a combined approach tympanoplasty, three of whom required posterior canal wall reconstruction with cortical bone and one with cartilage. In four cases it was possible to remove the cholesteatoma without removing the implant. All but two patients were fitted with a contralateral implant. In the explanted ears the cochlear implant electrode was cut at the cochleostomy site, which was then covered with muscle. Chronic suppurative otitis media following cochlear implantation may occur either as a result of a posterior canal wall defect related to surgery or possibly de novo. Attempts should be made to save the implant, but explantation with reimplantation of the contralateral ear may be the only option. In these cases the intracochlear part of the electrode array should be left in situ to facilitate possible future reimplantation. Surgical options for management of CSOM should be individualized and may include both canal-wall up and canal-wall down techniques. To reduce the incidence of CSOM following implantation the authors recommend: (1) prompt treatment and careful follow-up of patients with a history of otitis media with effusion, (2) avoidance of excessive thinning of the posterior canal wall during mastoidectomy and (3) reconstruction of any accidental trauma to the annulus or posterior canal wall during posterior tympanotomy. Copyright © 2006 John Wiley & Sons, Ltd.