Asheesh Dora Ghanpur1, Dipak Ranjan Nayak2, Kiran Chawla3, V Shashidhar4, Rohit Singh5. 1. Junior resident, Department of Ear, Nose and Throat, Kasturba Medical College, Manipal, Karnataka, India. 2. Professor, Department of Ear, Nose and Throat, Kasturba Medical College, Manipal, Karnataka, India. 3. Professor and Head, Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India. 4. Associate Professor, Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India. 5. Associate Professor, Department of Ear, Nose and Throat, Kasturba Medical College, Manipal, Karnataka, India.
Abstract
INTRODUCTION: Acute Otitis Externa (AOE) is also known as swimmer's ear. Investigations initiated during World War II firmly established the role of bacteria in the aetiology of Acute Otitis Externa. AIM: To culture the microbiological flora of the normal ear and compare it with the flora causing AOE and to know the role of normal ear canal flora and anaerobes in the aetiology. MATERIALS AND METHODS: A prospective observational study was conducted on 64 patients clinically diagnosed with unilateral AOE. Ear swabs were taken from both the ears. Microbiological flora was studied considering diseased ear as test ear and the normal ear as the control. Aerobic and anaerobic cultures were done. Severity of the disease was assessed by subjective and objective scores. Effect of topical treatment with ichthammol glycerine pack was assessed after 48 hours and scores were calculated again. Patients with scores < 4 after pack removal were started on systemic antibiotics and were assessed after seven days of antibiotics course. Data was analysed using Paired t-test, Wilcoxon signed ranks test and Chi-square test. A p-value < 0.05 was considered significant. RESULTS: Pseudomonas aeruginosa (33%) was the most common bacteria cultured from the ear followed by Methicillin Resistant Staphylococcus aureus (MRSA) (18%). Patients with anaerobic organism in the test ear had severe symptoms and needed systemic antibiotic therapy. CONCLUSION: Most of the cases may respond to empirical antibiotic therapy. In cases with severe symptoms and the ones refractory to empirical treatment, a culture from the ear canal will not be a tax on the patient. This helps in giving a better understanding about the disease, causative organisms and helps in avoiding the use of inappropriate antibiotics that usually result in developing resistant strains of bacteria.
INTRODUCTION: Acute Otitis Externa (AOE) is also known as swimmer's ear. Investigations initiated during World War II firmly established the role of bacteria in the aetiology of Acute Otitis Externa. AIM: To culture the microbiological flora of the normal ear and compare it with the flora causing AOE and to know the role of normal ear canal flora and anaerobes in the aetiology. MATERIALS AND METHODS: A prospective observational study was conducted on 64 patients clinically diagnosed with unilateral AOE. Ear swabs were taken from both the ears. Microbiological flora was studied considering diseased ear as test ear and the normal ear as the control. Aerobic and anaerobic cultures were done. Severity of the disease was assessed by subjective and objective scores. Effect of topical treatment with ichthammol glycerine pack was assessed after 48 hours and scores were calculated again. Patients with scores < 4 after pack removal were started on systemic antibiotics and were assessed after seven days of antibiotics course. Data was analysed using Paired t-test, Wilcoxon signed ranks test and Chi-square test. A p-value < 0.05 was considered significant. RESULTS: Pseudomonas aeruginosa (33%) was the most common bacteria cultured from the ear followed by Methicillin Resistant Staphylococcus aureus (MRSA) (18%). Patients with anaerobic organism in the test ear had severe symptoms and needed systemic antibiotic therapy. CONCLUSION: Most of the cases may respond to empirical antibiotic therapy. In cases with severe symptoms and the ones refractory to empirical treatment, a culture from the ear canal will not be a tax on the patient. This helps in giving a better understanding about the disease, causative organisms and helps in avoiding the use of inappropriate antibiotics that usually result in developing resistant strains of bacteria.
Authors: Peter S Roland; Michael G Stewart; Maureen Hannley; Rick Friedman; Spiros Manolidis; Greg Matz; Leonard Rybak; Peter Weber; Fred Owens Journal: Otolaryngol Head Neck Surg Date: 2004-03 Impact factor: 3.497