Clinical and Microbiological Profile of Active Tubo Tympanic Disease

Annie, Johnny (2007) Clinical and Microbiological Profile of Active Tubo Tympanic Disease. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Chronic suppurative otitis media and its complications are among one of the most common conditions seen by otorhinolaryngologist, pediatrician and general practitioner. It is disease of multiple etiology and is well known for its persistence and recurrence inspite of treatment. Chronic suppurative otitis media is a long standing inflammation of the middle ear cleft. From early days of otology, it is divided into two clinical types. Tubotympanic and atticoantral disease. Tubotympanic disease is characterised by perforation in pars tensa. As it follows a more benign clinical course, term `safe' is applied to it, though it is not always true. It is called active when in addition to tympanic membrane defect, middle ear mucosa is inflammed and edematous with production of excess of mucus or mucopus. Even with newer antibiotics being licenced for use almost every year, chronic suppurative otitis media largely remains unconquered and continues to be one of the major causes of otologic morbidity. Its clinical significance is particularly related to its propensity to cause infectious complications as acute and chronic mastoiditis, petrositis, intracranial infections, and non-infectious sequel as chronic perforation of tympanic membrane, ossicular erosion, labyrinthine erosion, tympanosclerosis, which are the major causes of hearing loss through out the world. Management of CSOM begins with accurate documentation of tympanic membrane defect, preferably with operating microscope. Assessment of hearing loss by tuning fork test and pure tone audiometry is necessary as most of patients have associated conductive hearing loss. Appropriate therapy for otorrhea involves identification of offending organism by means of culture and sensitivity of middle ear discharge. Almost all aspects of disease have been well studied over past few decades, but exhaustive review of available literature shows many authors focussed their attention primarily on bacterial flora, with comparatively fewer reports on mycological aspects, importance of which has been increasing in recent years because of excessive use of broad spectrum antibiotics, corticosteriods, and immune deficiency states. Number of Indian reports on this aspect have been meagre. Causative bacterial flora and their sensitivity patterns are also subjected to change from time to time with emergence of multiple drug resistant strains. As for selection of first line therapy, it must be made by individual physician based on regional susceptibility data of bacterial pathogens. By this study an attempt is made to reevaluate the role of bacterial and fungal pathogens in CSOM, with regional antimicrobial susceptibility data, so as to suggest management guidelines based on these observations. AIMS AND OBJECTIVES: This study was conducted with following objectives: 1. To study clinical profile of active tubotympanic chronic otitis media cases at upgraded Institute of otorhinolaryngology, Chennai. 2. To asses prevalence and distribution of bacterial and fungal organisms in CSOM. 3. To analyze antibiotic sensitivity and resistance pattern of bacterial isolates causing Chronic Suppurative Otitis Media (CSOM). 4. To suggest practical recommendations based on the observations. MATERIALS AND METHODS: Study design: Hospital based clinical observational study. Setting: ENT out patient division of Upgraded Institute of otorhinolaryngology, Madras Medical College and Government General Hospital, Chennai. Duration: Specimen collection and analysis 1st January 2006 to 30th June 2006. Evaluation and data interpretation 1st July 2006 to 30th September 2006. Sample case selection: 100 cases of active Tubotympanic Chronic Suppurative Otitis Media by systemic random sampling method. Inclusion criteria: 1. Adult patients with active tubotympanic type of CSOM i.e. Chronic (more than 3 months) continous or intermittent otorrhea through permanent defect in parstensa, with inflammed and edematous middle ear mucosa producing excess mucus or mucopus. 2. Perforation should be moderate / large sized. 3. History of partial or no response to prior treatment with commonly used ototopical agents like gentamicin, Neomycin, Polymyxin, Ciprofloxacin, before consultation. Exclusion criteria: 1. Pediatric age group – less than 15 yrs. 2. Clinically unsafe ears – i.e. with cholesteatoma granulations or aural polyps. 3. Overt clinical evidence of otitis externa with CSOM i.e external canal congested, inflammed, with otomycotic debries, Tragal tenderness. 4. Discharging ear through a pin hole perforation. 5. Cases undergone previous ear surgeries. 6. Suspected complications of CSOM. 7. Patients with clinical evidence of chronic sinusitis chronic tonsillitis. 8. Known or treated cases of pulmonary tuberculosis. 9. Known immune deficiency states – Diabetes mellitus, AIDS, renal diseases, bronchectasis. All patients evaluated by detailed history and examination. Initially, collected discharge in external canal was cleaned by dry mopping method using sterile cotton wool tipped applicators. Otoscopic examination done, findings were documented. Audiologic evaluation done by Tuning fork tests and pure tone audiometry. Pure tone average and bone conduction at 4 KHZ recorded. SUMMARY AND CONCLUSIONS: 1. Gender distribution of CSOM shows no male : female preponderance. 2. Duration of symptoms in more than 77% patients were more than 2 years. 3. Majority of cases were unilateral (79%). 4. All patients with otorrhea, next common symptom being hard of hearing. 5. Mean pure tone average, was 40, No significant sensory neural hearing loss detected among the 100 cases. 6. Pseudomonas aeruginosa was the most common isolate. Klebsiella and aceineto bacter showed an increased incidence of 13% & 11% in the this study. 7. 30% cases showed positive results with fungal culture. i.e one in 3 patients may have superimposed fungal infections in active chronic suppurative otitis media. 8. Most common fungal isolate was Aspergillus flavus. 9. Antibiotic with maximum sensitivity to all isolates was cefoperazone –sulbactam. Ofloxain and amikacin also showed remarkable sensitivities. (more than 90%) to all isolates. Most of isolate found to be resistant to commonly used antibiotics as cefotaxime, gentamicin.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical and Microbiological Profile ; Active Tubo Tympanic Disease.
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 27 Mar 2018 01:49
Last Modified: 27 Mar 2018 03:13

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