Bacteriological study of paediatric and adult chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) is one of the commonest illnesses in ENT practice which requires medical attention all the more in children of poor socio-economic status having in past inadequate treatment and negligent medical care. The present study was conducted to find out the various aerobic and anaerobic microorganisms associated with CSOM in paediatric and adult cases and their current antimicrobial susceptibility pattern as a guide to therapy. Samples were collected from 109 clinically diagnosed cases of CSOM and processed according to standard protocols. Out of 74 paediatric CSOM cases, 72 (97.2%) were bacterial culture positive while out of 35 adult CSOM cases, 28 (80%) were culture positive. Bilateral CSOM was slightly more common in adults (25%) than paediatric (21.4%) age group. Polymicrobial nature of CSOM was noted in both paediatric (70.8%) and adult (71.4%) cases while number of organisms isolated per lesion was slightly higher in adults (2.5) as compared to paediatric (1.95) cases. In paediatric CSOM, Staphylococcus aureus was the commonest aerobic isolate while in adult CSOM, Pseudomonas aeruginosa was the commonest one. Among anaerobes Peptostreptococcus spp. was commonest in CSOM where as Prevotella melaninogenica in adult CSOM. Sensitivity of S. aureus to cefuroxime was 72.2% while that of gram negative bacilli was higher to cefotaxime (90 to 100%). Among anaerobes higher sensitivity was seen to metronidazole (98.6%), clindamycin (95.7%) and chloramphenicol (98.6%). In view of the polymicrobial etiology of CSOM, prompt appropriate antimicrobial therapy can effectively reverse the disease process thereby preventing longterm sequelae.

Wegener's granulomatosis: a case with laryngeal involvement.

A patient of Wegener's granulomatosis (WG) with laryngeal involvement and respiratory difficulty has been described. Direct laryngoscopic biopsy led to the diagnosis of Wegener's granulomatosis. The patient underwent a tracheostomy and was subsequently treated with cyclophosphamide and corticosteroids to which he responded.

Effect of adeno-tonsillectomy on hearing threshold and middle ear pressure.

Out of 50 children (100 ears) undergoing adeno-tonsillectomy, 34 ears had hearing threshold 20-50 dB (20 dB is normal) and 32 ears showed negative middle ear pressure of 100 to 400 mmH2O (100 mmH2O is normal). Post-operatively only 7 ears had hearing threshold of 20-30 dB and negative middle ear pressure of 100 to 200 mmH2O. Thus adenoidectomy improves eustachian tube functions.

Nasal mucociliary clearance & mucus pH in patients with diabetes mellitus.

Nasal mucociliary clearance (NMC) time and nasal mucus pH were studied in 50 patients suffering from diabetes mellitus and in a group of 50 healthy non-smokers and non-alcoholic controls. NMC time and pH values were found to be significantly increased in diabetics (NMC = 18.02 +/- 5.08 and pH = 7.96 +/- 0.75) as compared to controls (NMC = 7.49 +/- 1.06 and pH 6.43 +/- 0.67). The increase in NMC and pH was much more in patients having insulin dependent diabetes mellitus (IDDM) (NMC - 20.87 +/- 4.71 and pH -8.38 +/- 0.56) than in non-insulin dependent diabetes mellitus (NIDDM) (NMC - 15.16 +/- 3.67 and pH -7.53 +/- 0.687) and also when the duration of disease was more than 10 yr (NMC - 22.36 +/- 4.36 and pH -8.47 +/- 0.607). This impairment was attributed to osmotic diuresis with loss of water and electrolytes from all parts of the body and also small vessel abnormalities encountered in diabetes.

Tuberculosis of middle ear cleft.

Three cases of tuberculosis of middle ear cleft who presented with ear discharge, postaurale swelling post-aural fistula and facial nerve palsy in one case are reported. Audiometry showed conductive deafness in two cases and sensorineural deafness in one case. Roentgenograms revealed bony erosion of the mastoid bone in two cases and coalescence of mastoid air cells in one case. Modified radical mastoidectomy was done in all the three cases and histopathology of tissue removed on operation revealed tuberculosis. All the symptoms except facial nerve palsy improved and post-aural wound healed completely with anti-tubercular therapy. Early recognition and specific therapy may avoid these complications like fistula formation, facial nerve palsy and deafness and may well reduce the need for surgical procedure.