Bacterial and sensitivity study of local cases of chronic suppurative otitis media · Rare Periodicals

Title

Bacterial and sensitivity study of local cases of chronic suppurative otitis media

Creator

Ejercito, Napoleon C.

Espiritu-Campos, Lourdes

Tolentino, Felipe Jr.

Language

English

Source

Volume XV (2) October-December 1958

Year

1958

Subject

Ear -- Infections

Otitis media

Otitis media -- Diagnosis

Medicine -- Periodicals

Rights

In Copyright - Educational Use Permitted

Fulltext

BACTERIAL AND SENSITIVITY STUDY OF LOCAL CASES OF CHRONIC SUPPURATIVE OTITIS MEDIA NAPOLEON C. EJERCITO, M.D .. LOURDES ESPIRITU-CAMPOS, M.D. and FELIPE TOLENTINO, JR .. M.D. U.P- P.G.H. Merlical Center and Jnstit·ute of Hygiene Univer.'iity of tl1e Phili'Pfl'ines From available records in the dispensary of the Philippine General Hospital, during the period starting from May 1, 1957 and ending in April, 1958, there were 1,026 cases of otitis media seen and treated. Of these, 659 were of the chronic exudative type. There were 9 cases of tympano-mastoiditis with subperiosteal abscess and 2 with intracranial complications admitted in the hospital. In 1957, there were 779 radical mastoidectomies performed in the Philippine General Hospital. These do not include various tympanoplastic procedures done. Accorrling to Dench (1). "We may assume that a discharge from the middle ear, which has failed to yield to proper therapeutic measures at the end of three months, constitutes a symptom of a chronic inflammatory process." Chronic exudative otitis media usually results in impaired hearing and/or grave complications. Various predisposing factors, such as congenital or acquired anatomical barriers to drainage, allergy, systemic disease an(j low resistance of the patient, play a big rule in its production. The exciting factor is usually bacterial in origin. This paper is chiefly concerned with the determination of the kind of organisms, and their scmlitivitr reactions to various drugs, that mar be encountered in cases of chronic cxudative otitis media. For this purpose, cultures were made of material taken from the middle ear of patients with chronic otitis media. 139 140 ACI' A MEDlCA PBILIPPINA METHOD The external auditory canal was carefully wiped off with a sterile cotton applicator. The middle ear was then swabbed with a fresh, slender sterile cotton applicator and this was immersed in a tube of sterile nutrient broth. Each of the swabs was immediately streaked on one blood agar plate and oD.e plain agar plate. A tube of thioglycolate medium was also inoculated with each swab. All media were incubated at 37°C and examined after 24 hours. Colonies growing in blood agar and plain agar plates wc>re isolated and identified by microscopic, cultural and biochemical characteristics. Growth in thioglycolate medium was examined microscopically, after 24 hours incubation, and again a week later to determine the presence of anaerobic bacteria. The sensitivity of each organism isolated and identified was made, using Bacto-aensitivity discs of low, intermediate, and high concentrations. This was done by preparing pour plate cultures of each organism and arranging 6 to 7 discs equidistally on the surface of the medium. The plates were incubated for 24 hours at 37°C, after which the resul~ were read as follows: Zone of inhibition of bacterial growth in all concentrations - (low, middle, high) - Very Sensitive. Zone of inhibition of bacterial growth in intermediate and high concentrations - Sensitive. Zone of inhibition of bacterial growth in high concentration only - Slightly sensitive. No zone of inhibition of bacterial growth in any of the three concentrations - Resistant. RESULTS The material was obtained from 98 cases of chronic suppurative otitis media with drum perforations. In two of the cases, no organism was recovered, and in three, the organisms could not be identified specifically by smear and by culture. This left only a total of 93 cases with culture results. The recovered organisms are as follows: BACTBBIAL STUDY OF OTITIS MEDIA 141 Organism Number of Ca.ses Proteus ------------------------ 32 Staphylococcus albus ------------- 16 Staphylococcus aureus ----------- 14 Pyocyaneus --------------------- 10 Diphtheroides ------------------- 8 Bacillus subtilis -------------- --- 5 Alpha Streptococcus ------------Yeast ---------- ---- -- ---------Escherichia coli ----------------Sarcina lutea -------------------Staphylococcus citreus ----------Streptococcus hemolyticus _______ _ Total ---------- 93 In 6 cases, staphylococcus aureus was isolated together with other organisms; namely, with diphtheroides in 3 cases, pyocyaneus in another 2 and staphylococcus albus in the remaining case. The results of the sensitivity tests are sununarized in the table below. The figures in the body of the table represent the number of cases in which each isolated organism gave the indicated reaction to the various drugs . PROTEUS Very sensitive Sensitive Slightly iu•n;iith•t• Resistant z . \I ;:: zw ~Ez -" "" rg ~ ~ .... "'0 .... _, 0 .. ~~g Wo .. _, "',. z "'"' - .. w <" "w .. 31~1~ ~I lz WI w w-' 3 < zO " .. -" ~ 5 ~ N !! Z "T g~§ ",.,. ~ 2:: ~ "'~I;] ~~ ~ ~ ~ ~ ;:;:Ii: >o"P:: p:: _, .... _,_, z 553 ii: 0 w w :i ra1~ "'"' < .. .. .. "'"'" ., .... 142 ACTA MEDICA PBILIPPINA STAPHYLOCOCCUS ALBUS Very sensitive Sensitive Slightly sensitive Resistant STAPHYLOCOCCUS AUREUS Very sensitive Sensitive Slightly sensitive Resistant PYOCYANEUS V~ry sensitive Slightly sensitive Resistant In 1 case with diphtheroides, the organism was found slightly sensitive to chloromycetin, dihydrostreptomycin and polymixin, but resistant to the other drugs. In 2 cases with alpha streptococcus, the organism was very sensitive to aureomycin, chloromycetin, erythromycin, penicillin, terramycin and tetracyline; anrl sensitive to rlihyrlrostreptomycin and matromycin. DISCUSSION Walz, Donnellr and Babbit (2) made a bacteriologic surve)· in chronic middle ear infection. Most of the cases showed mixed infection. The prevailing organisms were Strept.ococcus hemoJyticus and Staphylococcus aureus. However, in those cases where the cultures were made by intratympanic aspirations, the prevailing organisms, in order of frequency were the Hemolytic streptococcus, Staphylococcus aureus and Staphylococcus albus. Mortimer and Watterson (3), on the basis of their studies, doubt the importance of Staphylococcus as a primary etiologic agent in otitis media. They considered pneumoeoccus, betaheBACTERIAL STUDY OF OTITIS MEDIA 143 molytic streptococcus and Hemophilus influenzae as the chief offending agents. Their study was made on infants and children of the lower age group. Material was taken from cases of acute exudative otitis media without perforation or prior treatment. Mention was made of the 1950 studies of Bjuggren and Tuneval on children 15 years of age and younger, where each patient had a myringotomy or was discharging pus from the ear when seen. The results in 178 children were as follows: Per cent of Total Beta-hemolytic Streptococcus _ _ _ _ _ _ 48 Pneumococcus -------------------- 21 Coagulase positive Staphylococcus __ 12 Hemophilus influenzae ------------ 8 No p·athogens -------------------- 11 Total ---------- 100 Dysai·t (4) mentions the work of Friedmann (London) who studied experimentally otitis media in guinea pigs to determine whether the principal infecting bacteria had changed in virulence. The animals infected with Pseudomonas pyocyanea and Proteus vulgaris suffered most consistently, Infection frequently caused bony destruction of the mastoid, and sometimes there was cholesteatoma formation. Pneumococcus frequently caused death from meningitis but the clinical symptoms were less frequent. Two strains of Staphylococcus albus (Coagulase negative) caused no infection. None of the strains of streptococci produced fatal infections; most of them caused little or no suppuration. One should note that in our series, the cases involved those with perforations of the ear drum. We could not ascertain which were the actual causes of the infection and which were the contaminants. Such organisms as Bacillus subtilis, Sarcina lutea, diphtheroides and very often Staphylococcus albus are non-pathogenic and therefore they can hardly be considered as the causal agents in the infection. The mere presence of the others, although they are potentially pathogenic, is no assurance that they are responsible for the infection. No efforts wer.e made to look for acid-fast organisms. 144 ACTA MEDICA PHILIPPINA There were only 4 cases in which Staphylococcus aureus showed sensitivity to the various sulfa compounds. The rest of the organisms appeared to be resistant to the sulfas. The patients in this series were out-patients and although they were suffering from a chronic disease, this was the first time they were seen in the Philippine General Hospital Dispensary. Most of them denied any previous medication. 1t would appear from our series that the most effective drugs for Staphylococcus albus infections are Chloromycetin and Tetracyc1ine. For proteus infections, the effective drug appears to be Chloromycetin. For pyocyaneus infections, dihydrostreptomyein and polymixin seem to be the drugs of choice. One must bear in mind though that these assumptions are based on in vitro studies. However, they may provide clues in _the management of chronic suppurative otitis media. Perry (5) mentions that some topical medicament such as ointments containing penicillin, sulfonamides, a Jocal anesthetic or an antihistamine have a high index of skin sensitization. Senturia ( 6) states that "-in the treatment of ear disease, we have been pouring into the ear canal every variety of antibacterial and anti-inflammatory agents. As a consequence of the bactericidal mania, Lo and behold, we have produced for ourselves a vast number of cases of Otomycosis". SUMMARY In the order of frequency, the organisms recovered in this series were mostly Proteus, Staphylococcus albus, Staphylococcus aureus and Pyocyaneus. Although this does not appear to conform with the surveys made abroad, further study is indicated and comparison with the results of other local researchers should be made. The majority of the recovered organisms were resistant to the various sulfa compounds and to some antibiotics. REFERENCES t. DENCH, E.B.: Diseases of tl1e Ear, 1903, D. Appleton & Co., New York, page 197. 2. JACKSON, C. and JACKSON, C.L.: Diseases of the No~e, Throat and Ear, 1947 W. B. Saunders Co., Philadelphia and London, page 290, 3. MORTIMER JR., E. A. and WATTERSON JR., R.L.: A Bacteriologic Investigation of Otitis Media in Infancy, Pediatrics. li: 359 (March). 1956. BACTERIAL STUDY OF OTITIS MEDIA 145 4. DYSART, B. R.: Otitis lledia and Complications, A. M. A. Archives of Otolaryngology. 64: 415-416 (Nov.), 1956. 5. PERRY, E. T.: The Treatment of External Otitis. The Dermatologist's View Point. Transactions of the American Academy of Ophthalmology and Otolaryngology. 6J: 345 (May-June), 1957. 6. SENTURIA, B. H.: What's New in the Treatment of Otitis Extema. The Otologist's View Point., Transactions of the American Academy of Ophthalmology and Otolaryngology. 61: 347 (May-June), 1957.

pages

139-145