Suppurative otitis in Karachi: an audit of 510 cases

ABSTRACT

Suppurative disease of the middle ear is a constant challenge for otologists to treat. "Watchful waiting" may be acceptable for a few cases, but possibly all patients with chronic otitis media should receive antimicrobial therapy to minimize mastoid pathologies. Selection of a potentially effective drug, however, in the absence of discharge culture analysis, depends on the regional prevalent microflora. In a multicentre study of 596 consecutive ear-swab referrals processed during a 10-month period ending July 1997. Staph. aureus [40.4%] and Pesudomonas [29.6%] accounted for 70% of isolates among 10 bacterial species. Aspergillus [6.2%] and Candida [3.1%] were additional irritants. However, approximately 14.4% of swabs were culture-negative, suggesting possible other or non-infective aetiology. The finding that pseudomonas was increasingly implicated in recent months warrants tailored drug prescription; moreover, 37.9% of our Staph isolates were beta-lactamase producers and methicillin-resistant, necessitating the choice of "enzyme-stable" antibiotics for first-line use. The high number of gram-negative aerobes isolated from our cases of otitis media casts serious doubt on the role of the nasopharynx as the major contributor to this infective process; an alternate presumption that the faecal-aural route is often involved, seems more practical in our environment