Otitis Media Patients Research Articles

Microbiological profile and their antimicrobial sensitivity pattern in patients of otitis media with ear discharge

Objective: Our aim is to study the microbiological profile and their antimicrobial sensitivity pattern in patients of otitis media with ear discharge in tertiary care teaching centre in Agra region and its application in the empirical treatment of chronic suppurative otitis media (CSOM). Place and Duration : The study was conducted from March 2012 to July 2012 on 125 patients attending the ENT OPD and Microbiology Department having ear inflammation history for more than 3 months. Materials and Methods: Samples were taken from 125 patients (both male and female) in all age groups suffering from CSOM and having ear discharge. Their gram staining, direct microscopy with KOH, culture sensitivity, and biochemical tests were carried out to identify the organisms and to know their sensitivity pattern. Results: It showed the predominance by Staphylococcus species (37.6%), followed by Pseudomonas aeruginosa (32.8%), Klebsiella pneumoniae (4%), and Escherichia coli (3.2%). The susceptibility of Staphylococcus species was high (80-85%) with moxifloxacin, levofloxacin, and doxycycline among the commonly used antibiotics. Sensitivity of Staphylococcus species was low (<50%) with beta-lactam drugs. Pseudomonas aeruginosa was 100% sensitive with colistin, polymyxin B, and carbapenems. It is highly sensitive (80%-90%) to aminoglycosides and piperacillin/tazobactam. Its sensitivity was about 60-70% with the commonly used antibiotics, viz. cephalosporins and fluoroquinolones . Conclusion : The study of microbial pattern and their antibiotic sensitivity determines the prevalent bacterial organisms causing CSOM in local area and to start empirical treatment of otitis media and its complications for successful outcome, thus to prevent the emergence of resistant strains.

Pre and post operative evaluation of hearing in chronic suppurative otitis media

Aim: To evaluate pre- and postoperative hearing status in patients of chronic suppurative otitis media (CSOM) undergoing mastoidectomy with tympanoplasty. Study type- Prospective. Materials and Methods: Eighty cases of CSOM were included. All patients underwent a pre-operative pure-tone audiometry (PTA) to find out the hearing status and to obtain documentary evidence for the same, and X-ray mastoid (bilateral Schullre's view) to assess the pathology and surgical anatomy of the mastoid. All patients included in the study were categorized into three groups according to the surgery planned: Group-A: Tympanoplasty, Group-B: Canal wall up (CWU) mastoidectomy with tympanoplasty, and Group-C: Canal wall down CWD mastoidectomy with reconstruction. Post-operatively, after 10 weeks and 6 months, audiological examination (PTA) was carried out to compare pre- and post-operative hearing status. Results: In this study we found that postoperative hearing results were better in the case of safe CSOM as compared with unsafe CSOM and of tympanoplasty as compared with tympanoplasty with mastoidectomy.

Audiological and Clinical Finding of Eosinophilic Otitis Media in Korea

Received July 3, 2013 Revised September 12, 2013 Accepted September 13, 2013 Address for correspondence Seung-Ha Oh, MD, PhD Department of Otorhinolaryngology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel +82-2-2072-3649 Fax +82-2-745-2387 E-mail shaoh@snu.ac.kr Background and ObjectivesZZEosinophilic otitis media (EOM) is characterized by the presence of a highly viscous effusion containing eosinophils. It mainly occurs in patients with bronchial asthma, nasal polyps and is resistant to conventional treatments for otitis media. In these patients, steroid is very effective in controlling the disease. However, the major complication is sensorineural hearing loss, especially at high frequencies, which may occur despite steroid therapy. Subjects and MethodZZHere we report 10 cases of EOM at Seoul National University Hospital. Clinical courses and characteristics of the patients were analyzed. We compared the hearing deterioration and other clinical variables between EOM patients and age-matched non-EOM chronic otitis media patients. ResultsZZAll cases had viscous effusion and 9 cases were associated with asthma and nasal polyps. All patients had a decreased hearing in high frequency range compared to the age matched controls. The average bone conduction threshold difference at 2 kHz, 4 kHz was 22.4 dB HL and 42.5 dB HL, respectively. Among the patients, one showed profound sensorineural hearing loss bilaterally after the onset of EOM and received cochlear implantation. The open set sentence score was 82% 6 months after cochlear implantation. Most of the cases were resistant to conventional treatments for otitis media, such as administration of antibiotic agents, ventilation tube insertion or mastoidectomy. However, cases that were given steroid treatment had improvement in ear symptoms. ConclusionZZSince EOM patients show deterioration of hearing, it is important to properly diagnose EOM, start adequate treatment and explain to patients that the disease may last for a long period and progressive hearing loss may occur. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:692-9

Artificial neural network modelling of the results of tympanoplasty in chronic suppurative otitis media patients

The application of computer modelling for medical purposes, although challenging, is a promising pathway for further development in the medical sciences. We present predictive neural and k-nearest neighbour (k-NN) models for hearing improvements after middle ear surgery for chronic otitis media. The studied data set comprised 150 patients characterised by the set of input variables: age, gender, preoperative audiometric results, ear pathology and details of the surgical procedure. The predicted (output) variable was the postoperative hearing threshold. The best neural models developed in this study achieved 84% correct predictions for the test data set while the k-NN model produced only 75.8% correct predictions.

Allergic rhinitis common in otitis media patients

Allergic rhinitis common in otitis media patients

Association between adult otitis media and nasopharyngeal cancer: A nationwide population-based cohort study

PurposeTo determine whether the diagnosis of otitis media (OM) in adults is associated with an increased risk for the subsequent development of nasopharyngeal cancer (NPC) using a nationwide population-based retrospective study. Methods and materialsWe selected 13,513 adult patients that had been previously diagnosed with OM between 2000 and 2005 from the Taiwan Longitudinal Health Insurance Database 2000 as the study cohort, and randomly extracted the data of 135,130 participants matched by sex, age, and baseline year for the comparison cohort. The follow-up period was terminated upon developing NPC, withdrawal from the national health insurance system, or the end of 2009. Cumulative incidences and hazard ratios (HRs) of NPC development were determined. ResultsThe subsequent NPC incidence rates in the OM and comparison cohorts were 6.41 and 0.58 per 10000 person-years, respectively (adjusted HR, 11.04; 95% CI, 7.68–5.87; P<0.0001). The NPC risk for males was significantly higher than that for females (adjusted HR=3.24; 95% CI, 2.16–4.85). In both female and male patients, the diagnosis of OM was associated with a significantly increased risk for NPC (adjusted HR, 11.91 vs. 10.78, respectively). Among the OM cohort, 62 participants were subsequently diagnosed with NPC, with 71% of them occurring within 1year following the diagnosis of OM. However, even after 5-year follow-up, the OM cohort still displayed a higher risk for NPC (adjusted HR=2.50). Stratified by the frequency of OM episodes, more than one episode per year had a significantly greater risk of developing NPC, compared with the comparison cohort (HR=29.22; 95% CI, 20.19–42.27). ConclusionWe found that adult OM is a warning sign for the development of NPC in Taiwan, with approximately an 11-fold higher risk for adult OM patients. We recommend that OM patients undergo follow-up examinations for at least 5years. To extrapolate our findings, further studies are warranted in other areas in which NPC is endemic.

Clinical Treatment and Analysis of 58 Cases of Chronic Suppurative Otitis Media

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Analyzing cause of disease and clinical performance of clinical patients with chronic suppuratie otitis media, as well as discuss the effective surgical treatment methods and post-operative nursing prevention. &lt;strong&gt;Methods: &lt;/strong&gt;58 cases of chronic suppurative otitis media patients, clinical data and follow-up results were retrospectively analyzed during March 2008 to July 2011 in our hospital, in order to investigate the treatment effect of the operation. &lt;strong&gt;Results: &lt;/strong&gt;58 cases (60 ears) patients were indicated the procedure, including 33 ears open vesssed dash forward line, and 17 ears did close type papilloma wildly improved, and 10 ears did for drum sinus and attic area open treatment. After 2 years of follow-up observation, fifty-six ears was survived, with the survival rate of 93.3%, and second perforated eardrums happened in 4 ears, accounted for 6.7%. After eight months, There were 31 ears with hearing improvement of 10‒15 dB (accounting for 51.7%), 22 ears with hearing improvement of 15‒30 dB (accounting for 36.7%), 3 ears with no hearing improvement (accounting for 5.0%), 4 ears with mild hearing loss (accounting for 6.7%); total effective rate of hearing improvement was 88.3%, and hearing ability has improved significantly statistical significance. &lt;strong&gt;Conclusion: &lt;/strong&gt;According to the different patients with the disease choosing appropriate surgical method, it has a great significance to enhance the curative rate, reduce post-operative complications and recrudescent possibility.&lt;/p&gt;

Modified Lipooligosaccharide Structure Protects Nontypeable Haemophilus influenzae from IgM-Mediated Complement Killing in Experimental Otitis Media

ABSTRACTNontypeable Haemophilus influenzae (NTHi) is a Gram-negative, human-restricted pathogen. Although this bacterium typically colonizes the nasopharynx in the absence of clinical symptoms, it is also one of the major pathogens causing otitis media (OM) in children. Complement represents an important aspect of the host defense against NTHi. In general, NTHi is efficiently killed by complement-mediated killing; however, various resistance mechanisms have also evolved. We measured the complement resistance of NTHi isolates isolated from the nasopharynx and the middle ear fluids of OM patients. Furthermore, we determined the molecular mechanism of NTHi complement resistance. Complement resistance was strongly increased in isolates from the middle ear, which correlated with decreased binding of IgM. We identified a crucial role for the R2866_0112 gene in complement resistance. Deletion of this gene altered the lipooligosaccharide (LOS) composition of the bacterium, which increased IgM binding and complement-mediated lysis. In a novel mouse model of coinfection with influenza virus, we demonstrate decreased virulence for the R2866_0112 deletion mutant. These findings identify a mechanism by which NTHi modifies its LOS structure to prevent recognition by IgM and activation of complement. Importantly, this mechanism plays a crucial role in the ability of NTHi to cause OM.

Oxidative stress in chronic otitis media

Chronic otitis media usually presents with a benign tumor-like lesion of the temporal bone known as a cholesteatoma. The role of oxidative stress in the pathogenesis of chronic otitis media and cholesteatoma has not yet been fully explored. Therefore, the aim of this study was to investigate the oxidative stress markers and antioxidant enzymes in patients with cholesteatomatous and noncholesteatomatous chronic otitis media and in healthy subjects. A prospective controlled trial was performed on cholesteatomatous and noncholesteatomatous chronic otitis media patients in a tertiary referral center in a university hospital. A total of 75 subjects, including 25 cholesteatomatous and 25 noncholesteatomatous chronic otitis media patients and 25 healthy subjects participated in this study. Serum total oxidant status (TOS) and oxidative stress index (OSI) levels were significantly increased in the patient groups with or without cholesteatoma compared with the control group. Serum total antioxidant status (TAS) levels and Paraoxonase and arylesterase activity were significantly lower in the patient groups with or without cholesteatoma compared with the control group. Serum TOS and OSI levels were lower in the noncholesteatomatous group, whereas serum TAS levels were higher compared with the cholesteatomatous group. Serum arylesterase activity was significantly lower in the noncholesteatomatous group compared with the control group. The results of this study reveal that in cholesteatoma cases, the oxidative stress and antioxidant enzyme imbalance were more significant than in cases of chronic otitis media without cholesteatoma.

Complete Genome Sequence of Streptococcus pneumoniae Strain ST556, a Multidrug-Resistant Isolate from an Otitis Media Patient

Streptococcus pneumoniae is a major pathogen causing bacterial infection in the middle ear of humans. We previously used S. pneumoniae strain ST556, a low-passage 19F isolate from an otitis media patient, to perform a whole-genome screen for ear infection-associated genes in a chinchilla model. This report presents the complete genome sequence of ST556. The genome sequence will provide information complementary to the experimental data from our genetic study of this strain.

Detection of recurrent and primary acquired cholesteatoma with echo-planar diffusion-weighted magnetic resonance imaging

To evaluate the diagnostic value of echo-planar diffusion-weighted magnetic resonance imaging in pre-operative detection of suspected primary acquired, residual and/or recurrent cholesteatoma. Fifty-eight chronic otitis media patients with suspected cholesteatoma were thus evaluated two weeks pre-operatively, and divided into group one (41 patients, no previous surgery, suspected primary acquired cholesteatoma) and group two (17 patients, previous surgery, scheduled 'second-look' or revision surgery for suspected residual or recurrent cholesteatoma). Patients' operative, histopathology and radiological findings were compared. Cholesteatoma was found in 63 per cent of group one patients and 58 per cent of group two patients at surgery. Histopathological examination of surgical specimens indicated that imaging accurately predicted the presence or absence of cholesteatoma in 90 per cent of group one (37/41; 23 true positives, 14 true negatives) and 76 per cent of group two (13/17; seven true positives, six true negatives). Three patients in both groups were false negative diagnoses and one patient in both groups was a false positive. The sensitivity, specificity, and positive and negative predictive values of echo-planar diffusion-weighted magnetic resonance imaging of cholesteatoma were respectively 88, 93, 95 and 82 per cent in group one and 70, 85, 87 and 66 per cent in group two. Echo-planar diffusion-weighted magnetic resonance imaging is a valuable technique with high sensitivity and specificity for cholesteatoma imaging.

Mental health and quality of life in patients with chronic otitis media

The present study focused on the comparison of mental health and quality of life (QoL) between chronic otitis media (COM) patients and the hearing population. The patients with chronic otitis media and healthy control group were enrolled in the study. The duration and severity of the auditory impairment were recorded. In addition to hearing loss (HL), the findings of each patient's other ear disorders (ear discharge and tinnitus) were also recorded. In both the groups, psychological symptom profile and health-related QoL were evaluated and compared using a sociodemographic questionnaire, the Symptom Check List 90-Revised Form (SCL-90-R), and the Short Form-36 (SF-36). According to SCL-90-R, somatization (p < 0.001), interpersonal sensitivity (p < 0.001), depression (p < 0.001), phobic anxiety (p < 0.001), and other subscores, and also global severity index score (p < 0.001) were significantly high in patient group when compared to the control group. The patients with COM reported significantly lower levels of QoL in terms of physical role difficulty (p < 0.001), general health perception (p < 0.004), social functioning (p < 0.001), and mental health (p < 0.017) than those of control subjects. Our results indicated that COM patients with mild or moderate HL have poorer life quality and higher psychological problems. Psychological well being should be also considered in assessment of COM patients in addition to the clinical evaluation and audiological tests.

Bacterial Biofilm Formation in the Middle-Ear Mucosa of Chronic Otitis Media Patients

Biofilm formation is present in the middle-ear mucosa of chronic otitis media (COM) patients and COM is a biofilm-related disease. Biofilms are organized and complex communities in which bacteria communicate to each other and gain tremendous advantages. In this unique structure, bacteria can diffuse nutrients, gain resistance to antimicrobials agents and host defense mechanisms. Recently bacterial biofilms have been proven to be important in infectious diseases of head and neck region. A prospective case-control study was conducted. The study group comprised of patients with chronic otitis media and patients undergoing surgery for cochlear implantation was involved in the control group. Study group also divided to subgroups SSA and SSB according to history of ear discharge within last six months. Direct microscopy (DM) and transmission electron microscopy (TEM) were used to assess presence of biofilms. Totally 19 patients, 10 with ear discharge history within last 6months and 9 without discharge comprised the study group. Control group comprised of 9 patients undergone cochlear implantation. In all of the patients with ear discharge history and in two of the patients without ear discharge history, biofilm formation was detected by both DM and TEM. All control group members were free of biofilm formation. The differences were statistically significant between study and control groups (p=0.002) and between study subgroups (p<0.001); but not significant between study subgroup without ear discharge history and control group (p=0.470). In the middle ear mucosa of patients with chronic otitis media, biofilm formation is common, especially when ear discharge history is present.

Management and Outcomes of Chronic Otitis Media in Patients Who Received Solid Organ Transplantation

Control of perioperative infection can increase the success rate of organ transplant. The incidence, clinical features, and optimal management of chronic otitis media (COM) in solid organ transplant recipients have not been adequately evaluated. We therefore assessed the incidence and clinical course of COM in solid-organ transplant recipients. Case series with chart review. Tertiary referral center. We reviewed the medical records of 3278 patients who underwent solid organ transplantations between February 1995 and December 2007 to identify those diagnosed with COM before and after transplant. We analyzed the long-term clinical course and management of COM in these patients. Of 3278 solid organ transplant recipients, 65 (2.0%) were diagnosed with pretransplant COM with a perforated ear drum, including 31 liver, 28 renal, and 6 heart transplant recipients. The primary symptom was otorrhea, followed by hearing disturbance, otalgia, and tinnitus. Middle ear swab culture showed bacterial growth in 17 of the 40 patients (42.5%) with suppurative COM. Of these 40 patients, 14 underwent tympanomastoid surgery (operation group) and 26 were prescribed antibiotics (medication group). The remaining 25 patients, with dry perforated ear drums and well-pneumatized mastoids, were observed without treatment (observation group). After transplantation, the incidence of otorrhea was significantly lower in the operation group (11.1%) than in either the medication (26.9%) or observation (26.7%) group (P = .040, .048, respectively). Precise diagnosis and proper surgical intervention for COM may reduce the rate of otorrhea and exacerbation of COM in solid organ transplant recipients.

Eustachian Tube Function and Mastoid Pneumatization as Prognostic Factors of Type 1 Tympanoplasty

Received September 29, 2011 Revised April 5, 2012 Accepted April 5, 2012 Address for correspondence Hyung-Jong Kim, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, Korea Tel +82-31-380-3840 Fax +82-31-386-3860 E-mail hjk1000@hallym.ac.kr Background and ObjectivesZZPre-operative eustachian tube function (ETF) and mastoid aeration are important in maintaining a post-operative aerated middle ear. In this study, we evaluated the prognostic value of pre-operative ETF and of mastoid aeration predicting postoperative outcomes after chronic otitis media surgery. Subjects and MethodZZOne hundred eighty patients of non-cholesteatomatous chronic otitis media who underwent type 1 tympanoplasty were categorized into two groups (well-patent ETF versus obstructed ETF) according to the results of Valsalva maneuver test, and also categorized into four groups according to the results of a modified pressure inflation-deflation equilibration test. The extent of mastoid aeration was measured using high resolution computerized tomography scan of the temporal bone and image analysis software (Rapidia). The post-operative outcomes at 3 months of surgery were compared with those of the tympanoplasty only group and the mastoidectomy with tympanoplasty (MT) group as well as with the different pre-operative ETF groups. ResultsZZSuccessful post-operative outcome was 87.9% in the well-patent ETF group and 82.8% in the obstructed ETF group according to the Valsalva maneuver test (p=0.418). Successful outcome was 90.6% in the good ETF group and 74.5% in the poor ETF group according to the modified pressure equilibration inflation-deflation test, which was significantly different (p=0.047). Patients with successful outcome had greater extent of mastoid aeration than those with poor surgical outcome (p=0.026). Distributions of surgical outcome were not statistically different between the tympanoplasty only group and the MT group (p>0.05). ConclusionZZThe ETF measured by modified pressure inflation-deflation equilibration test and the extent of mastoid aeration measured using the Rapidia program were valuable information that can be used to predict post-operative outcomes after chronic otitis media surgery. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:284-9

Cartilage–Perichondrium: An Ideal Graft Material?

Temporalis fascia has long been regarded as the ideal graft material for tympanic membrane repair. However it often does not seem to withstand negative middle ear pressure in the post operative period. Tragal cartilage with perichondrium would appear to be a better graft material with good hearing outcome. It can be obtained easily with cosmetically acceptable incision. In the present study, we have compared the graft properties of temporalis fascia verses tragal cartilage perichondrium with respect to healing, hearing and rate of post operative retraction or reperforation. 132 patients of chronic otitis media with pure conductive hearing loss were posted for tympanoplasty. Temporalis fascia graft was used in 71 patients and cartilage perichondrium (composite graft) was used in 61 patients. Post operative healing, hearing and rate of retraction or reperforation was compared for both the graft materials. All the patients were followed up for 2years. Patients where temporalis fascia graft was used, 60 (84.5%) showed a good neotympanum, 7(9.85%) had reperforation and 5(7.04%) had retraction pockets. Patients where tragal cartilage perichondrium was used, 60(98.36%) showed a healed tympanic membrane and only 1(1.63%) had reperforation. None of the patients showed retraction pocket or cholestetoma. Postoperative hearing was accessed 6months after surgery. Patients with temporalis fascia graft showed an air bone gap of less than 10dB in 49 (82%) patients and more than 10dB in 11 (18%) patients. Air bone gap closure with tragal cartilage perichondrium was less than 10dB in 45 (78%) patients and more than 10dB in 13 patients (22%). Tragal cartilage perichondrium (<0.5mm) seems to be an ideal graft material for tympanic membrane in terms of postoperative healing and acoustic properties. It can easily withstand negative middle ear pressure which may have contributed to the development of otitis media and significantly affect healing outcomes in postoperative period. Tragal cartilage being composed of collagen type II is also physiologically similar to the nature of the tympanic membrane.

Prevalence of Profound Hearing Loss and Cophosis in 1015 Patients from the Chronic Otitis Media Outpatient Clinic in Brazil

Objective: An issue that has recently gained attention is, in addition to conductive hearing loss, sensorineural hearing loss (SNHL) due to chronic otitis media (COM). The objective of this study is to evaluate the prevalence of profound hearing loss and cophosis in chronic otitis media patients with or without cholesteatoma. Method: Transversal study. We studied 1015 patients from the Chronic Otitis Media Outpatient Clinic of the Hospital de Clínicas in Porto Alegre, evaluated between August 2000 and January 2011. The inclusion criterion was presence of COM, with or without cholesteatoma. The main outcome was the presence of profound hearing loss and cophosis. Results: A total of 1015 patients were evaluated. Ages varied between 2 and 87 years, with an average age of 28.36 ± 18.85 years; 50% of them were females, and 371 had cholesteatoma. Of all samples, 16 had profound hearing loss or cophosis (1.57%). Considering only our deaf samples, ages varied between 10 and 74 years, with an average age of 44.23 ± 19.20 years; 11 patients (68.8%) were females, and 7 had cholesteatoma. The prevalence of profound hearing loss or cophosis in patients with and without cholesteatoma was 1.3 and 2.2%, respectively. Cholesteatoma determined an estimated risk of 1.69 for very significant hearing loss. Conclusion: COM can affect round and oval windows and others sites of the inner ear. The prevalence of profound hearing loss and cophosis strongly associated with COM was only 1.4% in our sample. Patients with cholesteatoma have 1.7 times more chance of profound deafness/cophosis due to COM than patients without cholesteatoma.

Clinical Findings of Acute Otitis Media Patients Complicated with Transient Sensorineural Hearing Loss

Clinical Findings of Acute Otitis Media Patients Complicated with Transient Sensorineural Hearing Loss

The role of computed tomography scanning in chronic otitis media

The purpose of this study was to determine the role of high-definition computed tomography (CT) in chronic otitis media (COM) patients and to present which parameters were useful or misleading for preoperative evaluation for management. Fifty cases of COM that underwent preoperative CT scanning at a tertiary referral center were retrospectively analyzed. Their CT scan reports were compared with the operative findings. The patients had undergone tympanoplasty with or without mastoidectomy for COM between April 2008 and January 2010. Patient charts were used to obtain the necessary data. In 62% (31/50) of cases, the CT scan showed the presence of cholesteatoma. Operative findings revealed cholesteatoma in 61.8% (19/31) of these cases. However, when a bone eroding soft tissue mass involved the epitympanum on CT, the presence of cholesteatoma was observed in 83.3% (15/18) of cases intraoperatively. Cholesteatoma was present in the mastoid or middle ear intraoperatively in 77.7% (7/9) of patients with an external ear bony canal defect found on CT. Despite 89.7, 85.29, and 90% agreement ratios for dehiscence of facial canal, lateral semicircular canal, and tegmen, respectively, CT could not detect dehiscence of these anatomic structures successfully. Based on these results, CT scanning has limitations but is a useful adjunct for the surgical management of COM patients.

Nasopharynx as a Microbiologic Reservoir in Chronic Suppurative Otitis Media: Preliminary Study

ObjectivesThe present study was designed to identify the correlations of bacterial strains of the middle ear and the nasopharynx in chronic suppurative otitis media (CSOM) patients who were scheduled for operations.MethodsSixty-three patients with CSOM were enrolled in the study. Culture specimens were collected from the middle ear and nasopharynx of patients who were admitted for operation. Samples collections were performed 3 times; from the middle ear and nasophaynx at the admission day, from the middle ear during the operation, and from the external auditory canal post-operatively. Bacteria were identified by gram staining and biochemical tests. The correspondence rate of organisms which simultaneously exist in the middle ear and the nasopharynx was measured.ResultsSixty-eight organisms were isolated from the middle ear and 57 organisms from the nasopharynx among 63 patients. Of 68 bacteria identified in middle ear, 26.52% (18 bacteria) corresponded with those of nasopharynx. MRSA had the high correspondence rate, and of 18 methicillin-resistant Staphylococcus aureus (MRSA) isolated from middle ear, 33.3% (6 bacteria) corresponded with nasophaynx. Meanwhile, 3 organisms of MRSA were detected from the external auditory canal post-operatively, although they were only found in nasopharynx pre-operatively.ConclusionThe current trend of middle ear swab alone for bacterial detection would be insufficient to identify the potent MRSA and impede early antibiotic intervention for the effective middle ear surgery. Therefore, it is necessary to perform nasopharynx cultures together with conventional middle ear culture to control potent risk for infection pre-operatively.