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Microbiology of chronic and recurrent otitis media with effusion in young infants
Abstract:
Chronic otitis media with effusion (OME) has been assumed to be sterile, since several reports in the literature have described unsuccessful attempts to culture bacteria from it. However, several recent studies have confirmed an earlier report that there is a significant frequency of bacteria in the middle ears of children with chronic and/or recurrent OME. Similar studies in young infants with chronic and/or recurrent OME have not been previously reported. In this study, cultures were obtained at the time of myringotomy and tympanostomy tube insertion from 50 infants aged 1-12 months who had chronic and/or recurrent OME. From the 80 ears of 40 infants without cleft palate, 32% had bacteria isolated from their middle ears; 22% had Streptococcus pneumoniae or Haemophilus influenzae. In 21 of these ears, no effusion was apparent at myringotomy, but in 28% bacteria were isolated from middle ear washings. From the 20 ears of 10 infants with an unrepaired cleft palate, 55% had bacteria present in their middle ear aspirates; 50% had S. pneumoniae or H. influenzae. Even though the significance of bacteria in chronic OME in children, and now in young infants, is unclear at present, a therapeutic trial with an antimicrobial agent prior to surgical intervention would appear to be reasonable until such therapy is tested in a randomized, clinical trial.
Insights
Bacteria are frequently found in the middle ears of infants with chronic otitis media with effusion (OME). This challenges the assumption that OME is sterile, suggesting potential new treatment approaches for this common childhood condition.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Chronic otitis media with effusion (OME) has historically been considered sterile.
- Recent studies indicate bacterial presence in children with chronic/recurrent OME.
- Bacterial presence in young infants with chronic/recurrent OME has not been well-studied.
Purpose of the Study:
- To investigate the frequency of bacterial presence in the middle ears of infants (1-12 months) with chronic and/or recurrent OME.
- To compare bacterial isolation rates between infants with and without cleft palate.
- To explore the implications for potential antimicrobial therapy.
Main Methods:
- Cultures obtained during myringotomy and tympanostomy tube insertion in 50 infants (aged 1-12 months).
- Analysis of middle ear aspirates and washings.
- Comparison of bacterial findings in infants with and without unrepaired cleft palate.
Main Results:
- Bacteria were isolated from 32% of ears in infants without cleft palate and 55% in those with cleft palate.
- Streptococcus pneumoniae or Haemophilus influenzae were found in 22% of ears without cleft palate and 50% with cleft palate.
- Bacteria were detected in 28% of middle ear washings even when no effusion was apparent.
Conclusions:
- The middle ears of young infants with chronic/recurrent OME frequently harbor bacteria, challenging the sterile OME assumption.
- Higher bacterial prevalence in infants with cleft palate suggests a potential link.
- Antimicrobial therapy prior to surgery warrants investigation in randomized clinical trials.