Albert Rita Ruby Anbuselvi, Job Anand, Kuruvilla George, Joseph Richard, Brahmadathan K N, John Alice
Department of ENT, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
J Laryngol Otol. 2005 Oct;119(10):774-8. doi: 10.1258/002221505774481219.
To detect the presence of bacteria in mastoid granulations and compare its prevalence in both types of chronic suppurative otitis media (CSOM). To find out if stage of disease activity, age, duration of disease, and aditus patency relate to obtaining positive cultures.
A prospective, parallel group study done at a tertiary care referral centre. Mastoid granulations from 79 patients with CSOM undergoing mastoidectomy were processed for anaerobic and aerobic bacteria.
Aerobes were isolated from 57.55 per cent of the tubotympanic and 74.4 per cent of atticoantral disease (p=0.18). Anaerobic cultures were positive in one case from each group. Monomicrobial growth was detected in 37.5 per cent of tubotympanic and 48.5 per cent of atticoantral disease. Polymicrobial growth occurred in 20 per cent and 25.6 per cent in the tubotympanic and atticoantral groups, respectively. The predominant aerobic isolate was coagulase negative Staphylococcus, followed by Pseudomonas aeruginosa, Staphylococcus aureus, non-fermenting Gram-negative bacteria, Enterobacter and Enterococcus, Proteus species, Citrobacter, non-pathogenic Neisseria, aerobic spore formers were grown only in atticoantral disease. A single isolate of Aspergillus was grown. Correlating the state of disease activity of the ears with positive mastoid granulation cultures, six out of the eight inactive ears were culture positive along with seven out of the nine active and 10 out of the 23 quiescent ears. Positive mastoid granulation cultures were obtained in 60 per cent of those with blocked aditus and 42.9 per cent with patent aditus.
In this study, we found that mastoid granulations are not sterile but harbour polymicrobial pathogens. Positive cultures were obtained irrespective of stage of disease activity, age, duration of disease and aditus patency. The pattern of organisms cultured from safe and unsafe CSOM and also from ears in active, quiescent and inactive stages, were similar. These findings suggest that these organisms may be responsible for mastoid granulations. We also noted that positive cultures had no statistical correlation with aditus patency and duration of disease. We suggest further studies to evaluate the significance of asymptomatic mastoid granulations harbouring organisms and whether opening the mastoid antrum and achieving aditus patency, irrespective of the stage of disease activity, will help improve the long-term surgical outcome and also prevent recurrence of ear discharge.
检测乳突肉芽中细菌的存在情况，并比较其在两种慢性化脓性中耳炎（CSOM）中的患病率。探究疾病活动阶段、年龄、病程及鼓窦入口通畅情况是否与培养结果阳性相关。
在一家三级医疗转诊中心进行的前瞻性平行组研究。对79例接受乳突切除术的CSOM患者的乳突肉芽进行厌氧和需氧菌处理。
在咽鼓管鼓室型疾病中，74.4%的病例分离出需氧菌，在鼓窦乳突型疾病中这一比例为57.55%（p = 0.18）。每组各有1例厌氧培养结果为阳性。咽鼓管鼓室型疾病中37.5%检测到单一微生物生长，鼓窦乳突型疾病中这一比例为48.5%。咽鼓管鼓室型和鼓窦乳突型组中分别有20%和25.6%出现多种微生物生长。主要的需氧菌分离株是凝固酶阴性葡萄球菌，其次是铜绿假单胞菌、金黄色葡萄球菌、非发酵革兰氏阴性菌、肠杆菌、肠球菌、变形杆菌属、柠檬酸杆菌、非致病性奈瑟菌，需氧芽孢杆菌仅在鼓窦乳突型疾病中培养出来。培养出1株曲霉菌。将耳部疾病活动状态与乳突肉芽培养阳性结果进行关联分析，8只非活动耳中有6只培养结果为阳性，9只活动耳中有7只，23只静止耳中有10只。鼓窦入口堵塞的患者中60%乳突肉芽培养结果为阳性，鼓窦入口通畅的患者中这一比例为42.9%。
在本研究中，我们发现乳突肉芽并非无菌，而是含有多种微生物病原体。无论疾病活动阶段、年龄、病程及鼓窦入口通畅情况如何，均能获得阳性培养结果。从安全型和非安全型CSOM以及处于活动期、静止期和非活动期耳部培养出的微生物模式相似。这些发现表明这些微生物可能与乳突肉芽形成有关。我们还注意到阳性培养结果与鼓窦入口通畅情况和病程无统计学相关性。我们建议进一步研究以评估无症状携带微生物的乳突肉芽的意义，以及无论疾病活动阶段如何，开放乳突窦并实现鼓窦入口通畅是否有助于改善长期手术效果并预防耳漏复发。
