Objective:The objective of this study is to analyze the detection rate, the pathogenic fungus distribution, risk factors and drug sensitivity of fungal infection of external auditory canal in patients diagnosed with chronic otitis media. Methods:The data of a total of 419 patients with chronic suppurative otitis media or middle ear cholesteatoma who were admitted from January 2019 to February 2023 were retrospectively analyzed. Results:A total of 419 patients were included, and 71 patients（16.9%） were positive for fungal culture. The disease mostly occurred in subjects aged 51-60 years old, and patients over 60 years old（47 cases, 66.2%）. From the fungal culture of external auditory canal secretions, 48 cases（11.4%） of Aspergillus and 14 cases（3.3%） of Candida were identified. The prevalence of fungal cultures in patients with chronic suppurative otitis media（20.8%） was significantly higher than that in patients with middle ear cholectestoma（4.9%）. The detection rate of Fungal was significantly increased after topical treatment with antibiotic ear drops（47.0% vs 13.6%）. Most of the isolated fungal strains are wild-type, and they are the sensitivity to voriconazole and fluconazole was the highest（97.2%）. For patients with positive fungal culture, iodoform gauze with triamcinolone acetonide and econazole cream was used to fill the external auditory canal during surgery. There was no significant difference in the tympanic membrane healing rate between patients with positive fungal culture and patients with negative fungal culture at 3 weeks after surgery（98.6% vs 97.7%）. Conclusion:Fungal infections of external auditory canal in patients with chronic otitis media tend to occur in older patients, which is more common in patients with chronic suppurative otitis media. Long-term topical treatment with antibiotic ear drops is an independent risk factor for fungal infection of external auditory canal in patients with chronic otitis media. The isolated fungal strains were highly sensitive to antifungal drugs. Therefore, it is advisable to refrain from employing topical antibiotic treatment for elderly patients with chronic suppurative otitis media/middle ear cholesteatoma, abuse of local antibiotic therapy should be avoided, and Fungal-related pathogenic examinations should be actively performed and anti-fungal drugs should be added if necessary.
Humans ; Middle Aged ; Female ; Male ; Risk Factors ; Retrospective Studies ; Chronic Disease ; Otitis Media, Suppurative/microbiology* ; Ear Canal/microbiology* ; Antifungal Agents/therapeutic use* ; Adult ; Mycoses/epidemiology* ; Aspergillus/isolation & purification* ; Candida/isolation & purification* ; Otitis Media/complications* ; Aged ; Cholesteatoma, Middle Ear/microbiology*

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of ear infections. We attempted to evaluate the clinical usefulness of arbekacin in treating chronic suppurative otitis media (CSOM) by comparing its clinical efficacy and toxicity with those of vancomycin. Efficacy was classified according to bacterial elimination or bacteriologic failure and improved or failed clinical efficacy response. Ninety-five subjects were diagnosed with CSOM caused by MRSA. Twenty of these subjects were treated with arbekacin, and 36 with vancomycin. The bacteriological efficacy (bacterial elimination, arbekacin vs. vancomycin: 85.0% vs. 97.2%) and improved clinical efficacy (arbekacin vs. vancomycin; 90.0% vs. 97.2%) were not different between the two groups. However, the rate of complications was higher in the vancomycin group (33.3%) than in the arbekacin group (5.0%) (P=0.020). In addition, a total of 12 adverse reactions were observed in the vancomycin group; two for hepatotoxicity, one for nephrotoxicity, eight for leukopenia, two for skin rash, and one for drug fever. It is suggested that arbekacin be a good alternative drug to vancomycin in treatment of CSOM caused by MRSA.
Adult ; Aged ; Anti-Bacterial Agents/administration & dosage ; Chronic Disease ; Dibekacin/administration & dosage/*analogs & derivatives ; Female ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus/*drug effects ; Middle Aged ; Otitis Media, Suppurative/diagnosis/*drug therapy/microbiology ; Staphylococcal Infections/diagnosis/*drug therapy/microbiology ; Treatment Outcome ; Vancomycin/*administration & dosage ; Young Adult

OBJECTIVE: To study the correlation between the bacterial biofilm formation and bacterial culture in chronic otitis media. METHOD: As a prospective reserch, we used scanning electron microscopy to examinate patients samples which collected from 32 cases of patients with chronic suppurative otitis media and middle ear cholesteatoma in the operations, and performed the middle ear secretions bacterial culture. According to the different types of chronic otitis media group, we analysised the relationship between chronic otitis media bacterial biofilm formation and the bacterial culture results. RESULT: Chronic suppurative otitis media (activity) and middle ear cholesteatoma bacterial biofilm formation rate were 87.5%, 81.3%, chi-square (P > 0.05). Compared bacterial biofilm results with the results of bacterial cultured in chronic otitis media, sensitivity was 70.37%, specificity was 60.00%, the misdiagnosis rate was 40.00%, the missed diagnosis was 29.63%, positive predictive value was 90. 46%, negative predictive value was 27.27%, accuracy was 68.75%. Youden index was 30. 37%, and Pearson correlation coefficient was 0.232 (P > 0.05). CONCLUSION Chronic suppurative otitis media (activity) and middle ear cholesteatoma bacteria had a higher biofilm formation rate. The routine bacterial culture results can't reflecte bacterial biofilm formation in chronic otitis media. We need to explore more reliable experimental methods to accurately reveal the infection status of chronic otitis media.
Adolescent ; Adult ; Bacteria ; growth & development ; Biofilms ; Cholesteatoma, Middle Ear ; microbiology ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Otitis Media, Suppurative ; microbiology ; Sensitivity and Specificity ; Young Adult

OBJECTIVE: Detecting the sensitivities of bacterium in the inactive stage of chronic suppurative otitis media, to guide a clinical rational drug use after the type I tympanoplasty. METHOD: Collecting 148 hospitalized patients from Guangdong General Hospital diagnosed as inactive stage of chronic suppurative otitis media, who had been dry ear for more than 1 months. Analyse the results of drug sensitivity on the mucosa surfaces of the middle ear. RESULT: There are 16 species of bacterium, including Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter cloacae etc. Total positive rate of bacteria was 33.1%, the detectable rate of gram-positive bacteria was 69.4%, gram-negative bacteria was 30.6%. Drug sensitive test demonstrated that vancomycin, linezolid, teicoplanin, rifampicin etc were effective in gram positive bacteria, piperacillin/tazobactam, cefoperazone/sulbactam etc were effective in gram-negative bacteria. CONCLUSION Patients with dry ears,who were going to take type I tympanoplasty, still had potential pathogens. Bacterial cultivation and drug sensitive test before operation can guide the clinical medication and prevent infection.
Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; pharmacology ; Chronic Disease ; Drug Resistance, Bacterial ; Female ; Gram-Negative Bacteria ; drug effects ; Gram-Positive Bacteria ; drug effects ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Otitis Media, Suppurative ; microbiology ; Young Adult

OBJECTIVE: To establish the rat model of chronic suppurative otitis media and observe the formation of bacterial biofilm in middle ear mucosa of animal models and discuss the role of bacterial biofilm in the pathogenesis of chronic suppurative otitis media. METHOD: Twenty-eight rats were divided into six experimental groups and a control group evenly. All rats in experimental groups were infected with pseudomonas aeruginosa solution in 1 X 10(6) cfu/ml concentration through the tympanic membrane puncture approach to bilateral middle ear cavity. On the first, sixth, tenth, fifteenth and twenty-first st day after inoculation respectively, four rats in one experimental group were narcotized, then two-sided tympanic membrane of each rat were observed by using electric otoscope. We rated on the severity of the inflammation from the general pathology level (0 for normal, four for the most serious). After the execution, the two-sided otocysts were obtained. The left was made to SEM specimen and the shape of bacterial biofilm in middle ear mucous was observed. The right was observed by CLSM. Control group were executed at the beginning of the experiment. RESULT: (1) Bacterial biofilm in line with their respective criteria were found at the six days after the inoculation, and were more typical in shape after ten days. Then the states maintained stably within three weeks. (2) By observing tympanic membrane under electric otoscope, it can be seen that the inflammation severity of otitis media aggravated gradually in the first ten days and achieved the peak, then the state continued to the third week. The differences of tympanic membrane rating between one day group and six day group, six day group and ten day group were statistically significant (P < 0.05, P < 0.01). CONCLUSION (1) In this experiment, the process of bacterial biofilm development in rats model is: from beginning to the five days, the bacteria adhere and accumulates. After six days, the 3D structure of bacterial biofilm preliminary formatted. After ten days, the bacterial biofilm achieves the mature and steady state. (2) With the growth and maturity of bacterial biofilm in middle ear mucosa, the inflammation of otitis media is gradually increasing, which suggests that the inflammation severity of otitis media and the maturation of bacterial biofilm in middle ear mucosa are closely related.
Animals ; Biofilms ; growth & development ; Disease Models, Animal ; Mucous Membrane ; microbiology ; Otitis Media, Suppurative ; microbiology ; Pseudomonas aeruginosa ; Rats ; Rats, Wistar

The origin of methicillin-resistant Staphylococcus aureus (MRSA) strains from otolaryngology outpatients has not been evaluated yet in Korea. We analyzed epidemiologic and genetic characteristics of MRSA isolates from the ear discharge of 64 outpatients with chronic otitis media in a Korean University Hospital during 2004. MRSA strains were grouped as either from the initial visit (n=33) or the follow-up visit (n=31) based on the timing of isolation. Healthcare-associated risk factors were frequently present among patients of the initial visit group, especially prior visit to primary clinic (79%) and antibiotic use (73%). SCCmec typing and multilocus sequence typing results showed that two genotypes, ST5-MRSA-II and ST239-MRSAIII, were prevalent in both the initial visit (73% vs. 24%) and the follow-up visit (55% vs. 42%). Pulsed-field gel electrophoresis identified eight types, including two major types shared by both groups. We conclude that majority of MRSA strains from ear discharge of chronic otitis media belonged to nosocomial clones that might be circulating in the community. This is the first report of the genetic analysis of MRSA strains from otolaryngology practices in Korea.
Adolescent ; Adult ; Aged ; Bacterial Typing Techniques ; Child ; Child, Preschool ; Chronic Disease ; Female ; Genotype ; Humans ; Infant ; Male ; Methicillin-Resistant Staphylococcus aureus/*genetics ; Middle Aged ; Otitis Media, Suppurative/complications/epidemiology/*microbiology ; Polymorphism, Restriction Fragment Length ; Risk Factors ; Staphylococcal Infections/complications/epidemiology/*microbiology