Aerobic Bacteriology In Chronic Otitis Media & Its .
International Journal of Research and ReviewVol.7; Issue: 4; April 2020Website: www.ijrrjournal.comE-ISSN: 2349-9788; P-ISSN: 2454-2237Original Research ArticleAerobic Bacteriology in Chronic Otitis Media & ItsClinical SignificanceN A Mohammad1, Shafeeq Mohammed2, Gangadhara Somayaji31Associate Professor, 2Former Resident, 3Professor,Department of ENT, Yenepoya Medical College, Mangalore - 575018Corresponding Author: Gangadhara SomayajiABSTRACTBackground and Objectives: Chronic otitismedia (COM) poses a major health problem indevelopingcountriescausingserioussocioeconomic consequences and occasional lifethreatening complications. Early and effectivetreatment based on the antibiotic sensitivity ofthe microbes is the key for effectivemanagement. This study was done to find outaerobic microorganisms responsible for chronicotitis media (COM), in both mucosal andsquamosal disease and to study the antibioticsensitivity pattern of the organisms isolated.Materials & Methods: 100 patients with COMwere included in the study. The patients hadchronic ear discharge and had not receivedantibiotics for the last two weeks. Swabs weretaken and cultured for microbial flora. Drugsusceptibility testing for aerobic isolates wasconducted by Kirby-Bauer’s disc diffusionmethod.Results: Out of 100 patients 88 were diagnosedwith mucosal disease and 12 squamosal disease.Analysis of this study showed predominance ofgram negative organisms (60%). The highestincidence was that of Pseudomonas aeruginosa(42%), followed by Staphylococcus aureus(21%). Antimicrobial profile revealed maximumsensitivity to gentamicin (75%), ciprofloxacin(70% and Amikacin (66%).Conclusion: Knowing the aetiological agents ofCOM and their antimicrobial susceptibility isimportant in effective treatment and preventionof complications and development of nic otitis media (COM) is thechronic inflammation of middle ear cleftpresenting with recurrent ear discharge anddeafness.1 It can be of two types; mucosaland squamosal. Mucosal type is oftenassociated with recurrent ear discharge andantibiotic therapy is the treatment of choiceto make the ear dry. Inadequate treatmentmay lead to persistence of the disease andmay promote bacterial resistance which inturn can lead to complications, increasingthe morbidity.2 In vitro antibiotic sensitivitybecomes important for the clinician to makea protocol for a patient of discharging ear.3The incidence of COM appears to dependon race and socio-economic factors. Socioeconomic factors such as overcrowding,poor hygiene and nutrition have beensuggested as a basis for the wide spreadprevalence of the disease.The present study is aimed at findingout the aerobic organisms causing chronicotitis media by taking the ear swab forculture and sensitivity.MATERIALS AND METHODSOne hundred patients diagnosed withchronic otitis media (COM) of all agegroups and both genders, attending theoutpatient department and those admitted inENT department were selected randomly forthe study after ethical committee clearancefrom the institution. The study was done ina tertiary care hospital over a period of 18months. All clinically discharging ears ofInternational Journal of Research and Review (ijrrjournal.com)Vol.7; Issue: 4; April 2020174
N A Mohammad et.al. Aerobic bacteriology in chronic otitis media & its clinical significancemore than three months duration withtympanic membrane perforation – bothmucosal and squamosal types of COM wereselected. Patients with otitis externa andacute otitis media, who had local/systemicantibiotics for the last 2 weeks wereexcluded from the study. The swab wastaken using sterile precautions and with earspeculum in place to prevent contact withthe outer part of the ear canal. Ear dischargewas inoculated on Blood agar, MacConkey'sagar plates, incubated at 37⁰C and evaluatedat 24/48/72 hours. Specific identification ofthe bacterial pathogens was done based onmicroscopicmorphology,stainingcharacteristics, pigment production, betahaemolysis in blood agar, motility, culturaland biochemical properties using laboratoryprocedures. Susceptibility of bacterialisolates to the commonly used antibiotics isdone by Kirby-Bauer disc effusion method.RESULTS60% of the patients isolated gramnegative organisms, gram positive in 30%and gram staining were not done in theremaining 10% as culture showedcommensals or no growth.Out of the 100 patients evaluated,commonestorganismisolatedwasPseudomonas aeruginosa – 42%, followedby Staphylococcus aureus – 21%, Klebsiella– 9%, Proteus – 5%, Coagulase negativeStaphylococcus aureus – 5%, Acinetobacter– 4% and Escherichia coli – 4%. There wasno growth in 8% of patients andcommensals were found in 2%. (Table I)Table I: Showing the organisms isolatedOrganism isolatedPercentage (%)Pseudomonas aeruginosa42Staphylococcus aureus21Klebsiella9Proteus5Coagulase negative Staphylococcus aureus 5Acinetobacter4Escherichia coli4No growth8Commensals2Out of the 100 patients analysed, organismsisolated showed maximum sensitivity toGentamicin(75%),followedbyCiprofloxacin (70%), Amikacin (66%),Cefotaxime (55%). They were leastsensitive to Doxycycline, Norfloxacin,Tobramycin, Roxithromycin, Cefazolin andChloramphenicol. Klebsiella pneumoniae,PseudomonasaeruginosaandStaphylococcus aureus showed some degreeof resistance across all the antibiotics tested.Moraxella species was tested for amikacinand gentamicin and did not show anyresistance.DISCUSSIONChronic otitis media (COM) is achronic infection of the middle ear cleft.Improperly treated COM can lead to avariety of complications. Hence thediagnosis of the causative organism ismandatory for proper and successfulmanagement of the disease. Due to thechanging pattern of bacteriological profileof otitis media and sensitivity ofmicroorganisms towards antibiotics, it isvery important to find out the organismcausing the disease.4According to the present study, gramstaining of the organisms isolated showedgram negative organisms in majority of thecases (60%) and gram positive organisms in30%. Pseudomonas aeruginosa was thepredominant organism which is comparablewith previous study done by, Poorey V.K. etal in 2002 which suggested that,Pseudomonas is the predominant organismfollowed by Klebsiella 5, Tanmoy Deb et alin 2012, in a study of the bacteriologicalprofile of COM, also suggested that gramnegative bacteria are associated with COMin north east India.6In the present study, the commonestorganism found in the culture wasPseudomonas aeruginosa (42%) followed byStaphylococcus aureus (21%), Klebsiella(9%), Proteus and coagulase negative staphaureus (5%) each and Acinetobacter and E.coli (4%) each. There was no growth in(8%) and 2% are commensals. These resultsare comparable with previous study done byFliss DM et al in 1992, who found thatPseudomonas aeruginosa was the mostInternational Journal of Research and Review (ijrrjournal.com)Vol.7; Issue: 4; April 2020175
N A Mohammad et.al. Aerobic bacteriology in chronic otitis media & its clinical significancecommon isolate. In 48 cases (38%) it wastheonlyisolate.Entericbacilli,Staphylococcus aureus, Streptococci andHemophilusinfluenzawerealsofound.7Atanu Nandy et al in 1991, publisheda series wherein out of 146 cases of COM,comprising of 77 males and 69 females indifferent age groups. Out of the total 192isolates, Pseudomonas species rankedhighest with 43.8% incidence followed bystaphylococcus pyogenes (18.2%), Proteus(12%), Klebsiella (7.3%) and Diphtheroides(6.7%) 8 Erkan M et al in 1994, in a study ofbacteriology of COM in 183 patientsPseudomonas aeruginosa was recoveredfrom 68 patients, other aerobes commonlyrecovered included Staphylococcus aureusand Klebsiella pneumoniae.9 RS Greval et alin 1996, in a study on Bacteriologicalpatterns of COM, in a series of 300 cases ofCOM encountered in Ludhiana, Punjab,Pseudomonas, Staphylococcus and Proteushead the list.10 Gupta V et al in 1998, in astudy of 334 adult patients with COM, thecommonest organisms isolated were P.aeruginosa while S.aureus was found inCOM with cholesteatoma.4 Indudharan R etal in 1999, in his study on antibiotics inCOM and bacteriological study, 382 swabswere examined, the major organism isolatedwere P.aeruginosa (27.2%) followed byS.aureus (23.6%).11 Maji PK et al in 2007,in a study showed that P.aeruginosa is themost prevalent organism.12 Seung Geun Yeoet al in 2007, did a retrospective study of1102 patients with COM in Korea fromJanuary 2001 to December 2005 andreported that most commonly , with the next most prevalentbeing MRSA.13. Kamran Iqbal et al in 2011,in a study on microbiology of COM showedfrom 190 specimens,174 (91.6%) werepositive, and 16(8.4 %) culture negative.There were 167 (87.9%) bacterial isolatesand 7(3.7%) fungi. Pseudomonas aeruginosa(45.9%) was the dominant isolate, followedby S.aureus (26.4%) including 10 isolates ofMRSA.14 Tanmoy Deb et al in 2012, in astudy of the bacteriological profile of COMin Agartala, reported that gram negativebacteria, mostly, Pseudomonas is thecommonest bacteria involved in CSOM inpart of north east India.6 Kabir MS, in astudy with 110 patients, Pseudomonasaeruginosa is the most common organism(43.68%) isolated in pure culture followedby S.aureus (27.59%), E.coli 15However, not every study hasreported pseudomonas as the commonestorganism. In a study by Gupta V, Gupta A,Sivarajan K in June 1998, S. aureus wascommonest organism (30.73%), followed byP.aeruginosa (27.60%) and Klebsiella(9.90%).4 In a study by Vijaya D,Nagarathnamma T in 1998 with 250 casesof COM, S.aureus was the most commonestbacteria isolated (19.9%), followed byKlebsiella species (18.44%)and Fungalisolates were Aspergillus species andCandida albicans.16 V.K. Srivastava et al in1979, in a study of CSOM in childrenshowed that the majority (47.4%) was in theage group of 10-14 years and males(57.9%). S.aureus was the commonestisolate (44.0%) followed by E.coli (11.1%),S, albus (10.2%), Strep. Pyogenes (8.5%).Strep. Viridians (5.9%), Proteus vulgaris(5.9%.) 17 Rao et al in 1994, in a study ofCOM, randomly selected 120 cases wereinvestigated for bacterial and fungalisolates. Total of 145 bacterial isolates wereidentified and their susceptibility to variousantibiotics was tested. S. aureus was thepredominant pathogen isolated (42.5%),followed by P.aeruginosa (21.6%) andProteus species (18.33%). Fungi wereisolated from 7.5% of cases, but no growthwas observed in 10% of specimenscollected.18 BM Ahmad et al in 2003, in aretrospective study of 206 patients withCOM. S.aureus (37.8%), P.aeruginosa(28.9%) and Proteus (18.3%) were the mainisolates.19 Patricia N et al in 2006, In a studyof COM: Bacteriology and Drug SensitivityPatterns at the Quirino Memorial MedicalCenter (2004-2005) showed that from 54 eardischarge samples,42 (78%) were pureInternational Journal of Research and Review (ijrrjournal.com)Vol.7; Issue: 4; April 2020176
N A Mohammad et.al. Aerobic bacteriology in chronic otitis media & its clinical significancecultures and 9(16.7%) were mixed, only3(5.6%) of the submitted samples had nogrowth. There were 42 pure isolates, themost common of which was S.aureus 21(50%),followedbyP.aeruginosa14(33.3%).20 Nikakhlagh S et al in 2008,showed that the most common pathogensfor CSOM, were S.aureus, P.aeruginosa,Klebsiella & Proteus.21 A Yousuf et al in2012, in a study on bacteriological profile ofear discharge and their antibiotic sensitivityin COM in Kashmir, with 125 patients,microbiological culture was positive in 110specimens. The most common causalorganisms isolated were S.aureus (48%)including 8% of MRSA and P.aeruginosa(16%) followed by coagulase negativeStaph aureus.22In the present study, the organismsisolated showed maximum sensitivity toGentamicin followed by Ciprofloxacin,Amikacin, Cefotaxime and is comparablewith studies done by Atanu Nandy et al in1991, in a bacteriological study of COM,out of total 146 cases of COM & out of total192 isolates, showed susceptibility towardsGentamicin followed by Chloramphenicol(31.3%) and Ampicillin (14.8%)8. Rao et alin 1994, investigated a random selection of120 cases of COM for bacterial and fungalisolates. Total of 145 bacterial isolates wereidentified and their susceptibility to variousantibiotics was tested. The majority of thebacterial isolates showed multiple drugresistance. Gentamicin was the drug ofchoice in treating the causative strains ofeither gram positive or gram negativebacteria and tetracycline was found to be theleast effective.18Ciprofloxacin should beconsidered as the most effective drug in themanagement of COM, because it can begiven topically, orally and intravenously. Itis less toxic compared to Gentamicin.It has been proposed that anaerobicorganisms may play a role in squamosaltype of COM with extensive cholesteatomaand granulations and in occasional cases ofmucosal disease. It is advocated that whileinvestigating pathogenic organisms in COMrequests for anaerobic culture should beincluded and the medical therapy should bedirected at the eradication of the pathogenicanaerobic organisms.23 However, we didn’tinclude the anaerobic organisms in the studybecause of lack of financial resources. Thisis one of the limitations of our study apart ofsmall sample size.CONCLUSIONIt is generally considered thatantibiotic or antibiotic/ steroid ear drops areeffective in reducing the discharge in COM.The success rate for Gentamicin andCorticosteroid combination was 65%,compared with 18% with placebo. Acommon adverse effect of topicalaminoglycosides is the development ofallergic sensitivity, which is foundparticularly with Neomycin and Framycetin.Polymyxin B has a broad spectrumbactericidal activity that includes P.aeruginosa.Chloramphenicoloticpreparations have high incidence of localsensitivity reactions. Ciprofloxacin andOfloxacin may have useful topical activityinchroniceardisease.TopicalCiprofloxacin has been used successfully inhumans with COM and dischargingmastoidectomy cavities without any adverseeffects.REFERENCES1. Viswanatha B, Durganna S, Ravikumar R,Vijayashree MS, Vincent P. Bacteriology ofActive Squamous Type of Chronic OtitisMedia with Complications. Research inOtolaryngology. 2014; 3(2): 9-152. Rangaiah ST, Ravi D, Prasad MH, BalajiNK, Sumangala B., Madhuri MG.Bacteriologicalprofileofchronicsuppurative otitis media in a tertiary carehospital. Int J Otorhinolaryngol Head NeckSurg. 2017;3(3):601-53. Ghosh A, Rana A, Prasad S.Risk Factorsand Microbiology of Chronic SuppurativeOtitis Media and its Clinical Significance ina Tertiary Care Setup in Western UttarPradesh, India. Int J of Cur Med and AppSci. 2015;6(3):177-834. Gupta V, Gupta A, Sivarajan K, CSOM - anaerobic microbiological study. Indian J ofOtology 1998; 4:79-82International Journal of Research and Review (ijrrjournal.com)Vol.7; Issue: 4; April 2020177
N A Mohammad et.al. Aerobic bacteriology in chronic otitis media & its clinical significance5. Poorey VK, lyer A. Study of bacterial florain CSOM and its clinical significance.Indian J of Otolaryngol & Head & NeckSurgery. 2002; 54(2):91- 56. Tanmoy Deb, Debabrata Ray. A study ofthe bacteriological Profile of CSOM inAgartala. Indian J of Otolaryngology &Head & Neck Surgery. 2012; 64(4): 326-97. Fliss DM, Dagan R, Meidan N, LeibermanA. Aerobic Bacteriology of CSOM withoutCholesteatoma in Children. Ann OtolRhinol Laryngol 1992;101(54):866-98. Nandy A, Mallya PS, Sivarajan K. CSOM –A bacteriological study. Indian J ofOtolaryngology.1991;43(3):136-89. Erkan M, Asian T, Sevuk E, Guncy E.Bacteriology of CSOM. Ann Otal RhinolLaryngol. 1994;103(5):771-410. Greval RS, Ram S. Bacteriological patternsof CSOM in Ludhiana. Indian J Med Sci.1996; 50(3):192-511. Indudharan R, Haq JA, Aiyar S. Antibioticsin CSOM: A Bacteriological Study. AnnOtol Rhinol Laryngol. 1999; 108(9):440-512. Maji PK, Chatterjee TK, Chatterjee S,Chakrabarty J, Mukhopadhyay BB. Theinvestigation of bacteriology of CSOM inpatients attending a tertiary care hospitalwith special emphasis on seasonal variation.Indian J Otolaryngol Head and Neck surg.2007; 59:128-3113. Seung Geun Yeo, Dong Choon Park, SeokMin Hong, Chang Cha, Myung Gu Kim.Bacteriology of CSOM- a multicentre study.Indian J of otology.2007; 127(10): 1062-714. Kamran Iqbal, Muhammad Ismail Khan,Luqman Satti. Microbiology of CSOM. J ofMed Sci. 2011; 9(2): 65-815. Kabir MS , Joarder AH, Ekramuddaula FM,Uddin MM, Islam M, Habib MA. Pattern ofCSOM. Med J. 2012; 21(2): 270-516. VijayaD,NagarathnammaT.Microbiological Study of CSOM. Indian Jof Otology. 1998; 4(6): 172-417. VK Srivastava, SK Agarwal, GK Malik.CSOM in children. The Indian J ofPaediatrics. 1979; 46(10):363-718. Rao BN, Reddy MS. CSOM – Aprospectivestudy.IndianJofOtolaryngology & Head & Neck Surgery.1994; 46(2):72-7.19. BM Ahmad, MT Kudi, CSOM in Gombe,Nigeria. Nigerian J of Surg Research.2003;16(5):120-320. Patricia N, Ayson MD, Jan Eero G, LopezMD, Erasmo Gonzalo DV Lyanes MD.CSOM: Bacteriology and Drug SensitivityPatterns at the Quirino Memorial MedicalCenter: A preliminary Study. Philipp JOtolaryngol Head Neck Surg. 2006; 21 (1):20-2321. Nikakhlagh S, Khosrani AD, Falipour A,Safarzadeh M, Rahid N. Microbiologicalfindings in patients with CSOM. J MedScience. 2008; 8(5): 503-622. A Yousuf, M Malik, IU Shamas, Z Beigh, SKumari, PRA Pampori. BacteriologicalProfile of Ear Discharge and their AntibioticSensitivity in CSOM in Kashmir, India.Bangladesh J of Med Sci. 2003;11(3):59-6323. Rajat P, Deepak J, Negi V, Pal S, ShamanthA, Sharma M, Sharma S. Microbiology ofChronic Suppurative Otitis Media in aTertiary Care Setup of Uttarakhand State,India. N Am J Med Sci. 2013 Apr; 5(4):282–7How to cite this article: Mohammad NA,Mohammed S, Somayaji G. Aerobicbacteriology in chronic otitis media & itsclinical significance. International Journal ofResearch and Review. 2020; 7(4): 174-178.******International Journal of Research and Review (ijrrjournal.com)Vol.7; Issue: 4; April 2020178
N A Mohammad et.al. Aerobic bacteriology in chronic otitis media & its clinical significance International Journal of Research and Review (ijrrjournal.com) 177 Vol.7; Issue: 4; April 2020 cultures and 9(16.7%) were mixed, only 3(5.6%) of the submitted samples had no growth. There were 42 pure isolates, the
eMedicine ped/1688 [9] emerg/350 [10] MeSH D010032 [11] Otitis externa (also known as "External otitis"[] and "Swimmer's ear"[]) is an inflammation of the outer ear and ear canal. Along with otitis media, external otitis is one of the two human conditions commonly called "earache". It
OTITIS MEDIA 9 LITERATURA 1. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004 May; 113(5):1451-65. 2. Bradley-Stevenson C, O’Neill P, Roberts T. Otitis media in children (acute). BMJ 2007. Available at: PubMed
Aerobic Digestion is a biological process similar to Activated Sludge. Activated Sludge Growth Aerobic Digestion Decay. Aerobic Digestion Processes vs Activated sludge processes Practical Approach To Help Understand the Difference! Activated Sludge Aerobic Digestion . Aerobic Digestion Chemistry 1. Digestion: C 5H 7NO 2 5O
ICD-10 will replace ICD-9-CM as of October 1, 2014. There is a new rumor that ICD-10 will be bypassed with ICD-11. The problem with this . to document was that Steve has OM which is short for otitis media and the coder could select a code for simple OM. That code is 382.9 - Unspecified otitis media, Otitis media: NOS, acute NOS, chronic
aerobic exercise and a control session, in random order and on separate days. After the short-term sessions, all the patients will be randomly allocated into four groups and followed up for 8 weeks (between design): mild aerobic ex-ercise group, moderate aerobic exercise group, high-intensity aerobic exercise group and the control group.
Acute otitis externa Acute otitis media with tubes or perforation Cholesteatoma Acute Otitis Externa 1. Rapid onset (generally within 48 hours) in the past 3 weeks AND 2. Symptoms of ear canal inflammation: Otalgia (often severe) Itching Fullness WITH OR WITHOUT hearing loss or jaw pain 3.
converts sound into electrical signals which are associated with the origin of impulses carried by nerves to the brain where their meanings are appreciated. Why Are More Children Affected by Otitis Media Than Adults? There are many reasons why children are more likely to suffer from otitis media than adults. First, children have more trouble
Abrasive jet machining is a modern machining process in which the Metal Removal takes place due to the impact of High Pressure, High Velocity of Air and Abrasive particle (Al2O3, Sic etc.) on a .
