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A comprehensive analysis of 2,347 children with discharging ears seen between 1969 and 1972 in New Mulago Hospital, Kampala, is made. The reasons for the rare occurrence of non-suppurative otitis media are given. Finally, some suggestions are made about the aetiology of non-suppurative otitis media in the light of these findings.
One hundred and forty-seven patients with acute suppurative otitis media, were divided into three groups and treated with antibiotics (azidocillin, ampicillin, and cephalexin). The therapeutic effect was assessed bacterioloically by swabbing from the aural discharge and from the nasopharynx on the first, second, third, and seventh day after initiation of treatment. In addition, the concentration of antibiotic in the aural discharge and in the nasopharynx was determined. As compared with other published materials, there was a common occurrence of Haemophilus influenzae and S. Aureus. Hemolytic streptococci are less common than prior to the advent of antibiotics. Pneumococci disappeared in all cases from the aural discharge in the course of the first three days. The effect upon Haemophilus was slower. In the nasopharynx the effect was questionable, and no effect was obtained upon other bacteria. The clinical course could not be correlated to the bacterial findings except that resistant bacteria were found in all cases with persisting discharge.
The ceruminous glands have been studied histologically and histochemically in twenty patients suffering from chronic suppurative otitis media with discharging ears, and in ten patients with dry central perforations, in comparison with normal ears. The present study revealed hyperactivity of the glands initially; later on, atrophy and fibrosis took place. Thus the diminution of wax may be due to: (1) The washing effect of the discharge. (2) Atrophy of the glandular structures. (3) Periglandular fibrosis. As the discharge stops, regeneration of the glands occurs.
Tympanocentesis was performed in 32 pediatric patients with chronic recurrent suppurative otitis media. The aspirate was cultured aerobically and anaerobically. Aerobes were isolated from ten patients (31.2%); anaerobes from one patient; and both aerobes and anaerobes from 21 patients (65.6%). There were 46 aerobic isolates. The aerobes commonly recovered were Pseudomonas aeruginosa (24 isolates) Proteus sp. (5) and Staphylococcus aureus (3). There were 32 anaerobes isolated including anaerobic gram-positive cocci (19 isolates) and Bacteroides sp., the latter of which included Bacteroides fragilis group and Bacteroides melaninogenicus (9). The patients were treated by parenteral carbenicillin 300 to 400 mg per kg per day given in four dosages administered for a period of 12 to 21 days (average 17 days). An aminoglycoside (gentamicin) was added in 15 patients. The clinical response was good in 17 patients and poor in 15. There were no side effects or adverse reactions noted during therapy. The above findings demonstrate the polymicrobial etiology of chronic recurrent suppurative otitis media and suggest that treatment directed against the aerobic and anaerobic isolates is efficacious in more than half of the cases.
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A study on the etiology of bacterial infectious processes of the middle ear in children was carried out in 50 patients with ages between 3 months and 12 years at two of the children's hospitals depending from the Federal District Department. Male infants were found to be preferably affected. In 46% of cases, Staphylococcus aureus was found; also, gram-negative germs appeared in 26%. Comments are made on the possible causes of the variants this report presents in relation with the literature on the etiology of otitis media in pediatrics. Stress is placed on the necessity to support antimicrobial treatment with cultures to determine the etiology of the process.
The effect of myringotomy versus Penicillin therapy in the treatment of patients with acute suppurative otitis media was compared. A third group of patients treated with both myringotomy and Penicillin was included in the investigation. Ten days after institution of the treatment there were significantly more days with secretion/bulging drum in the myringotomy group than in the two other groups. At this time Penicillin therapy was started also in those patients belonging to the myringotomy group. With this reservation the occurrence of such late complications as secretory otitis media and relapses was the same, independent of treatment. No cases of mastoiditis were observed.
(1) The details described below have evidenced that the tubing therapy is an influential treatment for the recurrent infant suppurative otitis media. The tube with a beveled head and split shank is very convenient and effective for the treatment since it is not only easily inserted but also easily removed, preventing it from migration into the tympanum. (2) The treatment must promote the drainage of discharges through the infant auditory tubes which are thick and short and improve the ventilation of the middle ear cavity half permanently. (3) According to the author's experience, the spontaneous extrusion of the ideally set tube after 2 or 3 months is a sign of a perfect cure of this disease.
This is a retrospective study of 100 cases of non-suppurative otitis media among children who presented to the E.N.T. Department at Poole General Hospital between 1975 and 1978. Their histories, investigations and management are reported, with special emphasis on the significance of surgical treatment, and its value in the prognosis of such cases.
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