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Acute otorrhea: bacteriology of a common complication of tympanostomy tubes
E M Mandel1, M L Casselbrant, M Kurs-Lasky
1Otitis Media Research Center, Children's Hospital of Pittsburgh, PA 15213.
Abstract:
We prospectively followed 246 children with tympanostomy tubes and observed acute otorrhea through a functioning tube at least once in 50% of subjects. Pathogens typical of acute otitis media (Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes) were found in 42% of all episodes; Pseudomonas aeruginosa or Staphylococcus aureus was found in 44% of all episodes. Pathogens of acute otitis media were found in 50.0% of subjects under 6 years old versus 4.4% of subjects 6 years or over at the first episode (p < .001). Pseudomonas aeruginosa was found more often in children 6 years or older (43.5% versus 20.5% at the first episode, p = .052). Pathogens typical of acute otitis media were less prevalent in the summer months (14.7% versus 52.2% for the first episode, p = .001), while P aeruginosa was more prevalent in summer (44.1% versus 16.4% for the first episode, p = .006). This suggests that while many younger children with acute otorrhea may respond to treatment with oral antimicrobials alone, outpatient therapy of older children may involve use of topical antipseudomonal agents that may be complicated by the question of the safety of such medications.
Insights
Acute otorrhea in children with tympanostomy tubes is common. Younger children often have typical acute otitis media pathogens, while older children are more prone to Pseudomonas aeruginosa, especially in summer.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Acute otorrhea is a common complication in children with tympanostomy tubes.
- Understanding the causative pathogens is crucial for effective treatment.
Purpose of the Study:
- To identify the pathogens responsible for acute otorrhea in children with tympanostomy tubes.
- To analyze age and seasonal variations in pathogen prevalence.
Main Methods:
- Prospective follow-up of 246 children with tympanostomy tubes.
- Microbiological analysis of otorrhea episodes.
- Statistical analysis of pathogen distribution by age and season.
Main Results:
- 50% of subjects experienced at least one episode of acute otorrhea.
- Common acute otitis media pathogens (Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes) were found in 42% of episodes.
- Pseudomonas aeruginosa or Staphylococcus aureus was found in 44% of episodes.
- Younger children (<6 years) predominantly had acute otitis media pathogens (50%), while older children (≥6 years) more frequently had P. aeruginosa (43.5%).
- P. aeruginosa prevalence increased in summer months (44.1%).
Conclusions:
- Treatment strategies for acute otorrhea should consider patient age.
- Oral antimicrobials may suffice for younger children, while older children might benefit from topical antipseudomonal agents.
- Further research is needed on the safety of topical agents in children.