Otorrhea In Children Research Articles

Association of Diet Patterns and Post-Operative Tympanostomy Tube Otorrhea: A Pilot Study.

The objective of this study was to explore diet patterns in children with tympanostomy tube placement (TTP) complicated by postoperative tympanostomy tube otorrhea. Cross-sectional survey and retrospective cohort study. Caregivers of children (0-12 years old), at a tertiary-care pediatric hospital who underwent TTP within 6 months to 2 years prior to enrollment were included. Children with a history of Down syndrome, cleft palate, craniofacial syndromes, known immunodeficiency, or a non-English-speaking family were excluded. Our primary outcome variable was the number of otorrhea episodes. The primary predictor was diet patterns, particularly dessert intake, which was captured through a short food questionnaire. A total of 286 participants were included in this study. The median age was 1.8 years (IQR, 1.3, 2.9). A total of 174 (61%) participants reported at least one episode of otorrhea. Children who consumed dessert at least two times per week had a higher risk of otorrhea compared to children who consumed one time per week or less (odds ratio [OR], 3.22, 95% Confidence Interval [CI]: 1.69, 6.12). The odds ratio increase continued when considering more stringent criteria for otorrhea (multiple episodes or one episode occurring 4 weeks after surgery), with a 2.33 (95% CI: 1.24, 4.39) higher odds of otorrhea in children with dessert intake at least 2 times per week. Our pilot data suggest that episodes of otorrhea among children with TTP were associated with more frequent dessert intake. Future studies using prospectively administered diet questionnaires are necessary to confirm these findings. 4 Laryngoscope, 133:3575-3581, 2023.

Tetanus; a dreadful complication of ear piercing, ear instrumentation and chronic otorrhea in children of Southern Punjab Pakistan.

Objective: Tetanus remains a major public health problem in the developing countries despite the availability of active immunization and passive immunization since long. Non-sterile ear piercing and instrumentation pose a constant threat of developing tetanus associated with morbidity and mortality. Study Design: Retrospective Cross-sectional study. Setting: Department of Pediatric, Bahawal Victoria Hospital Bahawalpur. Period: June 2019 to June 2022. Material & Methods: The data of children admitted with tetanus following ear piercing, ear cleaning/instrumentation and chronic ear discharge was collected. The data included their age, gender, history of ear piercing, instrumentation and chronic ear discharge (otorrhea), duration between piercing/instrumentation and development of signs & symptoms of tetanus, history of tetanus vaccination (during routine childhood EPI vaccination), history of tetanus toxoid administration after the causative event, residence, socioeconomic status, education status of parents and outcome of cases. Results: Total 17 cases of otogenic tetanus (tetanus following ear piercing, ear instrumentation and with chronic otorrhea) were admitted in pediatric department of the hospital during study period. Age range was between 03 to 13 years with mean age 7.71+2.80 years. Of these cases, there were 12 females (70.6%) and 5 males (29.4%). Nine cases developed tetanus after ear piercing, five cases developed tetanus following ear instrumentation and three cases had history of chronic ear discharge. Conclusion: Tetanus is an uncommon but dreadful complication of non-sterile ear piercing, ear instrumentation and chronic discharging ears in chronic otitis media, and is still occurring in our country.

Etiology of Childhood Otorrhea in Luanda, Angola, and a Review of Otitis Media in African Children.

In resource-poor settings, otorrhea causes a significant burden of disease in children. Etiologic studies and structured data on otorrhea and chronic otitis media among African children remain scarce. Here, we reviewed 678 bacteriologically analyzed otorrhea samples from Luanda Children's Hospital from children ≤15 years of age between 2008 and 2015. We then compared these with data from other studies among African children through a literature review of 20 articles published over 2 decades. Overall, 32 different bacteria were identified among 542 isolates from 654 children in Luanda. Gram-negative bacteria constituted the majority of all isolates (85%), whereby Pseudomonas spp. was the most common (n = 158; 29%), followed by Proteus spp. (n = 134; 25%). Among Staphylococcus aureus (n = 54; 10%), 69% of tested isolates were Methicillin-resistant S. aureus, and among Enterobacteriaceae, 14% were expanded-spectrum β-lactamase isolates. Resistance to quinolones was rare. Furthermore, in a review of the literature, we found a high occurrence of otorrhea and chronic suppurative otitis media in children as well as possible gaps in existing knowledge. In Angola, Gram-negative rods emerged as common causative agents of otorrhea in children followed by S. aureus. The magnitude of chronic otorrhea in Africa represents a cause for public health concern.

Respiratory Microbiota Predicts Clinical Disease Course of Acute Otorrhea in Children With Tympanostomy Tubes.

Acute otitis media (AOM) is one of the most common childhood infections, generally thought to be caused by ascension of bacteria from the nasopharynx (NP) to the middle ear. Using 16S ribosomal RNA-based sequencing, we evaluated the relationship between the NP and middle ear fluid (MEF) microbiota in children with AOM with tympanostomy tubes (AOMT) as a proxy for AOM and explored whether microbiota profiling predicts natural disease course. Microbiota profiles of paired NP and MEF samples of 94 children below 5 years of age with uncomplicated AOMT were determined. Local diversity (P < 0.001) and overall microbiota composition (P < 0.001) of NP and MEF samples differed significantly, although paired NP and MEF samples were much more similar than unpaired samples (P < 0.001). High qualitative agreement between the presence of individual bacteria in both niches was observed. Abundances of Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pyogenes, Turicella otitidis, Klebsiella pneumoniae and Haemophilus spp. were strongly correlated between the 2 niches. Additionally, P. aeruginosa, S. aureus, T. otitidis and Streptococcus pneumoniae abundance in NP were predictive of the presence of a range of oral types of bacteria in MEF. Interestingly, there was no association between Moraxella catarrhalis in NP and MEF samples, which was highly present in NP but virtually absent in MEF. Finally, the NP microbiota composition could predict duration of AOMT, even better than MEF microbiota. We observed substantial correlations between paired NP and MEF microbiota in children with AOMT. Our data also suggest that NP microbiota profiling deserves further exploration as tool for future treatment decisions.

Tympanostomy tube otorrhea in children: prevention and treatment.

One in two children treated with tympanostomy tubes, experience episodes of otorrhea whilst their tubes are in place. In this review, we present the results of the most recent publications on prevention and treatment of tympanostomy tube otorrhea (TTO). Recent systematic reviews on water precautions for children with tympanostomy tubes support the American Academy of Otolaryngology - Head and Neck Surgery guideline recommendation against such preventive measures as there is no evidence that it protects against TTO. Studies on tympanostomy tube design and material suggest that silicone tubes have a lower TTO risk and that biofilms appear to be mainly located in the perpendicular junction of the T-tubes and the round rims of the Paparella-type tubes. Another study shows that the biofilm-component DNAB-II protein is present in otorrhea of half of children with TTO. Targeting this protein could lead to a collapse of the biofilm structure and as such a potential new treatment for chronic TTO. New systematic reviews show that antibiotic eardrops are the most effective first-line treatment of acute TTO and suggest that an antibiotic-corticosteroid combination is more effective than antibiotic only. Although in many countries, quinolone eardrops are the preferred choice because of being non-ototoxic, one study found a higher risk of persistent perforation after tube extrusion in children treated with quinolone eardrops as compared with children treated with aminoglycoside eardrops. Recent evidence confirms that water precautions for children with tympanostomy tubes are not effective in preventing TTO. Antibiotic-corticosteroid eardrops are the most effective treatment of acute TTO.

Efficacy and Safety of Ciprofloxacin and Fluocinolone Solution in the Treatment of Acute Otitis Media with Tympanostomy Tubes Otorrhea in Children: A Comparative Clinical Trial

Efficacy and Safety of Ciprofloxacin and Fluocinolone Solution in the Treatment of Acute Otitis Media with Tympanostomy Tubes Otorrhea in Children: A Comparative Clinical Trial

Prevention and Treatment of Tympanostomy Tube Otorrhea: A Meta-analysis.

Children with tympanostomy tubes often develop ear discharge. Synthesize evidence about the need for water precautions (ear plugs or swimming avoidance) and effectiveness of topical versus oral antibiotic treatment of otorrhea in children with tympanostomy tubes. Searches in Medline, the Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature. Abstracts and full-text articles independently screened by 2 investigators. 25 articles were included. One randomized controlled trial (RCT) in children assigned to use ear plugs versus no precautions reported an odds ratio (OR) of 0.68 (95% confidence interval, 0.37-1.25) for >1 episode of otorrhea. Another RCT reported an OR of 0.71 (95% confidence interval, 0.29-1.76) for nonswimmers versus swimmers. Network meta-analyses suggest that, relative to oral antibiotics, topical antibiotic-glucocorticoid drops were more effective: OR 5.3 (95% credible interval, 1.2-27). The OR for antibiotic-only drops was 3.3 (95% credible interval, 0.74-16). Overall, the topical antibiotic-glucocorticoid and antibiotic-only preparations have the highest probabilities, 0.77 and 0.22 respectively, of being the most effective therapies. Sparse randomized evidence (2 RCTs) and high risk of bias for nonrandomized comparative studies evaluating water precautions. Otorrhea treatments include non-US Food and Drug Administration approved, off-label, and potentially ototoxic antibiotics. No compelling evidence of a need for water precautions exists. Cure rates are higher for topical drops than oral antibiotics.

The Treatment of Otorrhea in Children with Cleft Palate: An Institutional Review

We conducted a retrospective observational chart review to characterize otorrhea in patients with cleft palate (CP) after tympanostomy tube placement in terms of the bacteria profile, treatment effectiveness, and overall disease burden. A total of 157 patients over 6 years were reviewed. Fifty of the 157 patients (31.8%) experienced postoperative otorrhea. Of the 50 patients with otorrhea, all received topical antibiotics, 30 received oral antibiotics, and 12 received povidone-iodine irrigations. The average duration of otorrhea was 5.2 months for patients with povidone-iodine irrigations and 8.5 months for those without povidone-iodine irrigations. Methicillin-resistant Staphylococcus aureus was the most commonly cultured microorganism. The average number of total healthcare visits over a 12-month period was 13.6 per patient. We conclude that postoperative otorrhea is a common problem after tympanostomy tube placement in children with CP and places a significant burden on these patients and the healthcare system. The bacteriologic profile may be different in this population compared with the non-CP population with otorrhea after tympanostomy, and a search for more effective treatment options is warranted, including further investigation into povidone-iodine irrigations.

Long-term outcomes of a transmastoid lateral semicircular canal approach to congenital CSF otorrhea in children associated with recurrent meningitis and severe inner ear malformation

ObjectiveTo investigate the long-term effectiveness of transmastoid lateral semicircular canal approach (TMLSCCA) to repair cerebrospinal fluid (CSF) leakage in children associated with recurrent meningitis and severe congenital inner malformation. MethodA retrospective study was conducted in a university hospital, academic medical center. Fifteen children with recurrent meningitis, secondary to severe congenital inner ear malformation, were included in the study. All of them had CSF associated otorrhea and treated using TLSCCA to repair CSF otorrhea by packing the vestibule with muscle and fascia. Observation of the status of postoperative CSF leakage, recurrence of meningitis and complication were conducted. ResultsNone of the cases had recurrent meningitis and CSF leakage after their TLSCCA procedure in the follow-up period of 1–8.5 years. One case presented with transient facial nerve paralysis and completely recovered 3 months later. ConclusionTLSCCA for CSF otorrhea in children with recurrent meningitis secondary to congenital inner ear malformation is an alternative approach that offers some advantages.

Topical versus oral antibiotics, with or without corticosteroids, in the treatment of tympanostomy tube otorrhea

ObjectiveAntibiotic treatment is the standard of care for tympanostomy tube otorrhea. This meta-analysis aims to evaluate the efficacy of topical antibiotics with or without corticosteroids versus oral antibiotics in the treatment of tube otorrhea in children. Data SourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and ProQuest. Review MethodsThe above databases were searched using a search strategy for randomized controlled trials for optimal treatment of tube otorrhea in the pediatric population. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Primary outcome was cure (i.e. clearance of otorrhea) at 2–3 weeks. Secondary outcomes were microbiological eradication and complications such as dermatitis and diarrhea. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) and number needed to benefit (NNTB) in a random-effects model. ResultsWe identified 1491 articles and selected 4 randomized controlled trials which met our inclusion criteria. Topical treatment had better cure (NNTB = 4.7, pooled RR = 1.35, p < 0.001) and microbiological eradication (NNTB = 3.5, pooled RR = 1.47, p < 0.001 among 3 of the studies) than oral antibiotics. Oral antibiotics had higher risk of diarrhea (pooled RR = 21.5, 95% CI 8.00–58.0, p < 0.001, Number needed to harm (NNTH) = 5.4) and dermatitis (pooled RR = 3.14, 95% CI 1.20–8.20, p = 0.019, NNTH = 32). The use of topical steroids in addition to topical antibiotics was associated with a higher cure rate (pooled RR = 1.59, p < 0.001 vs pooled RR = 1.57, p = 0.293). ConclusionTopical antibiotics should be the recommended treatment for management of tympanostomy tube otorrhea in view of its significantly improved clinical and microbiological efficacy with lower risk of systemic toxicity as compared to oral antibiotics. Further research is necessary to confirm the benefits of topical corticosteroids as an adjunct to topical antibiotics.

Modeled Analysis of Entrance of Colloid Suspensions into the Middle Ear Cavity.

Otic suspensions have a positive effect on the duration of otorrhea in children with a tympanostomy tube. It is still questionable how eardrops reach the middle ear. We hypothesized that otic suspensions do not pass the tympanostomy tube if the middle ear is dry but pass by diffusion when wet. The median concentration of Evans blue (colorant) in the middle ear was <15.6 mg/mL (lower limit of quantification) when diffusion was impossible but 45.3 µg/mL when diffusion was possible (P = .01). When the outward flow was increased to 0.1 mL/h, the concentration of Evans blue in the middle ear increased significantly (P = .03). With further-increasing outward flows, the concentration of Evans blue decreased linearly (β = -144, P < .001, R (2) = 0.44). We conclude that diffusion is the mechanism by which otic suspensions enter the middle ear in children with tympanostomy tubes and otorrhea.

Cost-effectiveness of treatment of acute otorrhea in children with tympanostomy tubes.

Acute otorrhea is a common problem in children with tympanostomy tubes. We recently demonstrated that treatment with antibiotic-glucocorticoid eardrops is clinically superior to oral antibiotics and initial observation. The aim of this study was to assess the cost-effectiveness of these three common treatment strategies for this condition. We performed an open-label pragmatic trial in which 230 children with acute uncomplicated tympanostomy-tube otorrhea were randomly allocated to receive 1 of 3 treatments: hydrocortisone-bacitracin-colistin eardrops, oral amoxicillin-clavulanate suspension, and initial observation (no assigned medication prescription to fill). Parents kept a daily diary capturing ear-related symptoms, health care resource use, and non-health care costs for 6 months. At 2 weeks and 6 months, the study doctor visited the children at home performing otoscopy. Using a societal perspective, treatment failure (otoscopic presence of otorrhea at 2 weeks) and number of days with otorrhea as reported in the daily diary were balanced against the costs. Antibiotic-glucocorticoid eardrops were clinically superior to oral antibiotics and initial observation both at 2 weeks and 6 months. At 2 weeks, mean total cost per patient was US$42.43 for antibiotic-glucocorticoid eardrops, US$70.60 for oral antibiotics, and US$82.03 for initial observation. At 6 months, mean total cost per patient was US$368.20, US$420.73, and US$640.44, respectively. Because of the dominance of eardrops, calculating incremental cost-effectiveness ratios was redundant. Antibiotic-glucocorticoid eardrops are clinically superior and cost less than oral antibiotics and initial observation in children with tympanostomy tubes who develop otorrhea.

Cost-Effectiveness of Treatment of Acute Otorrhea in Children With Tympanostomy Tubes

Cost-Effectiveness of Treatment of Acute Otorrhea in Children With Tympanostomy Tubes

Lateral petrosectomy with obliteration cavity for spontaneous cerebrospinal otorrhea in children

PurposeThe most common causative factors of CSF otorrhea in children are injuries and congenital abnormalities of the temporal bone. Spontaneous CSF leak as a consequence of congenital temporal bone defects may result in recurrent meningitis. Diagnosis and management of such an entity are particularly difficult in early childhood. Materials and methodsThe aim of this study was to investigate clinical features and to discuss possible methods of treatment of spontaneous CSF otorrhea in children. ResultsSevere unilateral sensorineural hearing loss or total deafness was found in children with CSF otorrhea. CT and MRI of the temporal bones revealed dehiscences in the walls of the tympanic cavity and defects of the inner ear, which were confirmed intraoperatively. Lateral petrosectomy and closure of the fistula with muscle tissue and fat obliteration cavity were performed. The children remain free of otorrhea and recurrences of meningitis. ConclusionThe diagnosis of spontaneous otorrhea in children is based on the severe unilateral sensorineural hearing loss and presence of CSF in the middlę ear cavity. It may be successfully treated by means of lateral petrosectomy with obliteration of the vestibule with muscle tissue and tympanic cavity with fat tissue.

Nano-transfersomal ciprofloxacin loaded vesicles for non-invasive trans-tympanic ototopical delivery: In-vitro optimization, ex-vivo permeation studies, and in-vivo assessment

Ciprofloxacin is a synthetic fluoroquinolone antibiotic that has been used for systemic treatment of otitis media in adults. It was approved for topical treatment of otorrhea in children with tympanostomy tubes. The aim of this work was to enhance the local non-invasive delivery of ciprofloxacin to the middle ear across an intact tympanic membrane (TM) in an attempt to treat acute otitis media (AOM) ototopically. In order to achieve this goal, ciprofloxacin nano-transfersomal vesicles were prepared by thin film hydration (TFH) technique, using several edge activators (EAs) of varying hydrophilic–lipophilic balance (HLB) values. A full factorial design was employed for the optimization of formulation variables using Design-Expert® software. The optimal formulation was subjected to stability testing, ex-vivo permeation studies (through ear skin and TM of rabbits), and in-vivo evaluation. Results revealed that the optimal formulation (composed of phospholipid and sodium cholate as an EA at a molar ratio of 5:1) exhibited enhanced ex-vivo drug flux through ear skin and TM when compared with the commercial product (Ciprocin® drops). It demonstrated a greater extent of in-vivo drug deposition in the TM of albino rabbits relative to Ciprocin®. Consequently, transfersomes could be promising for the non-invasive trans-tympanic delivery of ciprofloxacin.

A Trial of Treatment for Acute Otorrhea in Children with Tympanostomy Tubes

BackgroundRecent guidance for the management of acute otorrhea in children with tympanostomy tubes is based on limited evidence from trials comparing oral antibiotic agents with topical antibiotics.MethodsIn this open-label, pragmatic trial, we randomly assigned 230 children, 1 to 10 years of age, who had acute tympanostomy-tube otorrhea to receive hydrocortisone–bacitracin–colistin eardrops (76 children) or oral amoxicillin–clavulanate suspension (77) or to undergo initial observation (77). The primary outcome was the presence of otorrhea, as assessed otoscopically, 2 weeks after study-group assignment. Secondary outcomes were the duration of the initial otorrhea episode, the total number of days of otorrhea and the number of otorrhea recurrences during 6 months of follow-up, quality of life, complications, and treatment-related adverse events.ResultsAntibiotic–glucocorticoid eardrops were superior to oral antibiotics and initial observation for all outcomes. At 2 weeks, 5% of children treated with antibiotic–glucocorticoid eardrops had otorrhea, as compared with 44% of those treated with oral antibiotics (risk difference, −39 percentage points; 95% confidence interval [CI], −51 to −26) and 55% of those treated with initial observation (risk difference, −49 percentage points; 95% CI, −62 to −37). The median duration of the initial episode of otorrhea was 4 days for children treated with antibiotic–glucocorticoid eardrops versus 5 days for those treated with oral antibiotics (P<0.001) and 12 days for those who were assigned to initial observation (P<0.001). Treatment-related adverse events were mild, and no complications of otitis media, including local cellulitis, perichondritis, mastoiditis, and intracranial complications, were reported at 2 weeks.ConclusionsAntibiotic–glucocorticoid eardrops were more effective than oral antibiotics and initial observation in children with tympanostomy tubes who had uncomplicated acute otorrhea. (Funded by the Netherlands Organization for Health Research and Development; Netherlands Trial Register number, NTR1481.)

Extracts from The Cochrane Library: Interventions for the Prevention of Postoperative Ear Discharge after Insertion of Ventilation Tubes (Grommets) in Children

The "Cochrane Corner" is a section in the journal that highlights systematic reviews relevant to otolaryngology-head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane Review, "Interventions for the Prevention of Postoperative Ear Discharge after Insertion of Ventilation Tubes (Grommets) in Children," that concludes if a surgeon has a high rate of postoperative otorrhea in children, then saline irrigation or antibiotic ear drops at the time of surgery would significantly reduce that rate. If topical drops are chosen, a single application at the time of surgery is suggested to reduce the cost and potential for ototoxic damage (if applicable).

Parent-reported otorrhea in children with tympanostomy tubes: incidence and predictors.

PurposeAlthough common in children with tympanostomy tubes, the current incidence of tympanostomy tube otorrhea (TTO) is uncertain. TTO is generally a sign of otitis media, when middle ear fluid drains through the tube. Predictors for otitis media are therefore suggested to have predictive value for the occurrence of TTO.ObjectiveTo determine the incidence of TTO and its predictors.MethodsWe performed a cohort study, using a parental web-based questionnaire to retrospectively collect data on TTO episodes and its potential predictors from children younger than 10 years of age with tympanostomy tubes.ResultsOf the 1,184 children included in analyses (total duration of time since tube placement was 768 person years with a mean of 7.8 months per child), 616 children (52%) experienced one or more episodes of TTO. 137 children (12%) had TTO within the calendar month of tube placement. 597 (50%) children had one or more acute TTO episodes (duration <4 weeks) and 46 children (4%) one or more chronic TTO episodes (duration ≥4 weeks). 146 children (12%) experienced recurrent TTO episodes. Accounting for time since tube placement, 67% of children developed one or more TTO episodes in the year following tube placement. Young age, recurrent acute otitis media being the indication for tube placement, a recent history of recurrent upper respiratory tract infections and the presence of older siblings were independently associated with the future occurrence of TTO, and can therefore be seen as predictors for TTO.ConclusionsOur survey confirms that otorrhea is a common sequela in children with tympanostomy tubes, which occurrence can be predicted by age, medical history and presence of older siblings.

Clinical manifestations and microbiology of acute otitis media with spontaneous otorrhea in children

In Taiwan, clinical and microbiological data on acute otitis media (AOM) with spontaneous otorrhea in children are limited. We retrospectively collected data on children with AOM and spontaneous otorrhea between January 2011 and June 2012. Otorrhea samples were collected using sterile swabs and sent for cultures. Pathogens found were Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, and Staphylococcus aureus. Pneumococcal isolates collected from October 2011 to June 2012 were serotyped. A total of 92 patients were enrolled in the study for demographic and microbiological analysis. Their median age was 2.5 years. After excluding those with lobar pneumonia, 84 patients were included for analysis of clinical manifestation. The mean febrile duration was 6 days. Leukocytosis and C-reactive protein (CRP) level >50mg/L were noted in 29 (34.5%) patients and 38 (45.2%) patients, respectively. Patients with pneumococcal infection were older (p=0.007) and had more severe symptoms [fever (p=0.001), otalgia (p=0.055), respiratory symptoms (p=0.002-0.03), and higher CRP level (p=0.015)] than children with other bacterial infection. Otorrhea cultures were obtained from 69 (75%) patients, of whom 52 had definitive AOM pathogens. The most common causative pathogen was S. pneumoniae (61.5%), followed by S. aureus (36.5%). Serotype 19A accounted for two-thirds of pneumococcal isolates and had a high rate of nonsusceptibility to penicillin (66.7%) and ceftriaxone (83.3%). S. pneumoniae was found to be the most important source of AOM with spontaneous otorrhea in children and caused more severe symptoms. Serotype 19A, which was usually nonsusceptible to antimicrobial agents, was the most prevalent serotype in these patients.

A retrospective evaluation of microbiology of acute otitis media complicated by spontaneous otorrhea in children living in Milan, Italy

To evaluate the microbiology of acute otitis media (AOM) with otorrhea due to spontaneous tympanic membrane perforation (STMP) in children living in Milan, Italy. We evaluated middle ear fluid (MEF) specimens taken from children affected by AOM associated with STMP and otorrhea between January 2001 and December 2011. The fluid was collected by means of direct swab sampling, sent for culture, and processed within 4 h. A total of 705 specimens were obtained from 458 children (233 boys; mean age ± SD 28.3 ± 19.9 months), and were positive for bacteria in 487 cases (69.1 %). The most frequently cultured infectious agent in single-pathogen cultures was Haemophilus. influenzae (51.0 %), followed by Streptococcus pneumoniae (19.4 %), Streptococcus pyogenes (17.4 %), and Staphylococcus aureus (10.7 %). After adjusting for the sub-period of data collection, age, gender, and previous full heptavalent pneumococcal conjugate vaccine (PCV-7) schedule, it was found that the prevalence of H. influenzae slightly increased in 2008-2010, and the prevalence of S. pneumoniae significantly decreased over time (p = 0.02). AOM with STMP is a particular form of AOM in which S. pyogenes plays a significant causative role although, as in uncomplicated cases, H. influenzae and S. pneumoniae retain their etiological importance. The frequency of the detection of S. aureus in MEF deserves further study because this pathogen can give rise to severe clinical problems. Finally, although the use of PCV-7 was relatively efficacious, the benefit of pneumococcal vaccination would be increased by vaccines including a larger number of serotypes.