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Chronic Suppurative Otitis Media: A Case Report
M M Karimi Yazdi1,2, Zohreh Ghalavand2, Alireza K Yazdi3
1Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Background Context:
Chronic Suppurative Otitis Media (CSOM) is a common cause of hearing impairment and disability. CSOM caused by Pseudomonas aeruginosa is usually treated with topical ciprofloxacin and resistance to ciprofloxacin in CSOM isolates has rarely been reported.
Case Presentation:
A 24-year-old male patient with CSOM due to p. aeruginosa was reported. CSOM was prolonged for ten years and physician prescribed topical ciprofloxacin drops, pus suctioning and ear pH alteration. The treatment wasn't effective and the patient came back to the clinic with relapse of suppurative otitis media. P. aeruginosa was isolated as the cause of CSOM and the isolate was resistant to ciprofloxacin, aztreonam, imipenem, gentamicin, doripenem, cefepime, levofloxacin, amikacin and susceptible to colistin and ceftazidime. There were two mutations in gyrA and eight mutations were observed in nfxB genes. Finally, tympanomastoidectomy was done.
Conclusion:
Usually topical antibiotics, especially ciprofloxacin, is effective against ear infections but our case was different and the P. aeruginosa isolated from CSOM was resistant to most of the antibiotics. One reason for CSOM recurrence might be surgery failure. The routine and primary treatment for CSOM did not seem sufficient and tympanomastoidectomy is suggested to be the best treatment approach for these patients.
Insights
Chronic Suppurative Otitis Media (CSOM) caused by Pseudomonas aeruginosa can be resistant to common treatments like ciprofloxacin. This case highlights antibiotic resistance and suggests tympanomastoidectomy for persistent infections.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Medical Microbiology
Background:
- Chronic Suppurative Otitis Media (CSOM) is a significant cause of hearing loss.
- Pseudomonas aeruginosa is a common pathogen in CSOM, typically responsive to topical ciprofloxacin.
- Antibiotic resistance in CSOM isolates is rarely documented.
Observation:
- A 10-year chronic CSOM case in a 24-year-old male due to P. aeruginosa.
- Standard treatment with topical ciprofloxacin, suctioning, and pH alteration failed, leading to relapse.
- The P. aeruginosa isolate exhibited multi-drug resistance, including to ciprofloxacin, but remained susceptible to colistin and ceftazidime.
Findings:
- Genetic analysis revealed two mutations in gyrA and eight in nfxB genes in the P. aeruginosa isolate.
- The observed mutations may contribute to the high level of antibiotic resistance.
- Tympanomastoidectomy was performed as a definitive treatment.
Implications:
- This case underscores the emergence of antibiotic resistance in CSOM pathogens.
- Standard CSOM treatments may be insufficient for resistant strains.
- Tympanomastoidectomy may be a crucial surgical option for refractory CSOM cases.
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