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Updated: May 28, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Bacteriome of the Middle Ear in Children and Young Adults With Cholesteatoma and Retraction Pocket: A Pilot Study
Michal Bartos1,2, Milan Urik1,2, Lucie Buresova3
1Department of Pediatric Otorhinolaryngology University Hospital Brno Brno Czech Republic.
Insights
Chronic otitis media (COM) in children shows low bacterial diversity. Retraction pockets (RP) may precede cholesteatoma, as their middle ear bacteriomes differ from healthy ears but resemble cholesteatoma.
Area of Science:
- Otolaryngology
- Microbiology
- Genomics
Background:
- Chronic otitis media (COM) is a prevalent middle ear condition in pediatric populations.
- Eustachian tube dysfunction and bacterial infections are primary etiologies of COM.
- Serious COM forms include cholesteatoma and tympanic membrane retraction pockets (RP).
Purpose of the Study:
- To characterize and compare middle ear bacteriomes in children with cholesteatoma and RP.
- To contrast these bacteriomes with those found in healthy middle ears.
- To investigate the potential of RP as a pre-cholesteatoma stage.
Main Methods:
- An observational, case-control study was conducted.
- Middle ear swabs were collected during surgery from children with cholesteatoma (N=23), RP (N=26), and controls (N=15).
- 16S ribosomal DNA gene sequencing was performed on extracted genomic DNA.
Main Results:
- Bacterial diversity in COM middle ear samples was notably low, often dominated by 1-2 bacterial genera.
- A significant difference in bacterial genus positivity was found between COM patients (38.8%) and controls (6.7%).
- Middle ear bacteriomes in cholesteatoma and RP cases were similar but distinct from controls.
Conclusions:
- Middle ear bacteriomes in cholesteatoma and RP exhibit distinct profiles compared to healthy ears.
- The similarity in bacteriomes between cholesteatoma and RP supports the hypothesis that RP may represent an early stage of cholesteatoma development.
- Further research is warranted to elucidate the role of specific bacterial communities in COM pathogenesis.
Objective:
Chronic otitis media (COM) is a common middle ear disease in children and young adults. Dysfunction of the Eustachian tube and bacterial infection are the main causes. This pilot study aimed to describe and compare bacteriomes of the middle ear in children and young adults with serious forms of COM, such as cholesteatoma and retraction pocket (RP) of the tympanic membrane, with bacteriomes in healthy middle ears.
Study Design:
Observational study.
Setting:
Clinical practice in a tertiary center. From January 1, 2021 to August 31, 2022. Patients aged 0 to 20 years.
Methods:
In this case-control study, middle ears were swabbed during surgery on children with cholesteatoma (N = 23) or RP (N = 26) and on children indicated for cochlear implant (N = 15, controls). Genomic DNA extraction was followed by creation of a 16S ribosomal DNA gene library and sequencing on a MiSeq instrument. Samples with relative abundance of at least one bacterial genus >20% were considered positive for the specific genus.
Results:
Bacterial diversity was generally low in the middle ear samples from patients with COM, with DNA content from 1 or 2 bacteria usually dominating in the sample. A significant difference in positivity for one or more bacterial genera was observed between patients with cholesteatoma or RP (38.8%) versus patients indicated for cochlear implants (6.7%).
Conclusion:
While middle ear bacteriomes in cases of cholesteatoma and RP differed from those of controls, findings in the 2 pathological conditions were similar. These results support the statement that the RP could be a precholesteatoma stage.
