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Clinical and bacteriological profile of the ear in otogenic tetanus: a case control study
C E deSouza1, D R Karnad, G H Tilve
1St Peters Colony, Bandra, Bombay, India.
Abstract:
Twenty two patients presented with otogenic tetanus. Seventeen patients had acute histories with only a single episode of otitis media with otorrhoea. Fifteen patients had unilateral central perforations, five had bilateral central perforations and two had no perforations but had acutely congested tympanic membranes which were bulging suggesting the presence of purulent fluid behind them. All patients with perforations had a purulent pulsatile discharge. A coexisting aerobic infection was seen in 85 per cent of the cultures and 59 per cent of these were due to staphylococcus aureus (versus 25 per cent in the controls). Only one patient had received partial immunization. Tetanus resulting from otitis media is not an indication for surgery.
Insights
Otogenic tetanus, often linked to acute otitis media, frequently involves Staphylococcus aureus infections. Surgical intervention is not recommended for tetanus cases arising from otitis media.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Neurology
Background:
- Otogenic tetanus is a rare but serious complication of middle ear infections.
- Otitis media with otorrhoea is a common precursor, particularly in acute cases.
Purpose of the Study:
- To investigate the clinical presentation and microbiological findings of otogenic tetanus.
- To determine the role of otitis media in the development of tetanus.
- To evaluate the necessity of surgical intervention for otogenic tetanus.
Main Methods:
- Retrospective analysis of 22 patients diagnosed with otogenic tetanus.
- Clinical data collection including history, otoscopic findings, and immunization status.
- Microbiological cultures of ear discharge to identify causative organisms.
Main Results:
- Seventeen patients had acute otitis media with otorrhoea.
- Central perforations were present in 15 patients, with purulent discharge.
- Staphylococcus aureus was identified in 59% of aerobic cultures, significantly higher than controls.
- Only one patient had received partial tetanus immunization.
Conclusions:
- Otitis media, especially when associated with Staphylococcus aureus infection, is a significant risk factor for otogenic tetanus.
- Tetanus arising from otitis media does not warrant surgical treatment.
- Emphasis on appropriate management of otitis media and tetanus prophylaxis is crucial.