Enterococcus faecalis and otitis media with effusion. How to treat.

Although microorganisms are cultured in only one out of 3 middle ear effusions, viable and non-viable bacteria are presumed to be responsible in part for otitis media with effusion (OME). Because of this association, antibiotics in sublethal, bacteriostatic, or bacteriocidal concentrations are frequently used as non-surgical therapy for OME. Antibiotic treatment is predicated on the assumption that microorganisms responsible for OME are the same ones which produce acute otitis media. This may not always be the case. Enterococcus faecalis (formerly known as beta-hemolytic group D Streptococcus) was isolated in pure culture from 3 middle ears of two patients with OME. The significance of the isolation of this bacteria, an enteric organism which is infrequently found in upper respiratory tracts, is its lack of susceptibility to the usually prescribed oral antibiotics. In each of the children, failure to respond to antibiotics led to tympanocentesis and culture followed by middle ear drainage with insertion of middle ear ventilating tubes. Unless intravenous antibiotics are used, surgical drainage should be the procedure of choice when E. faecalis is found in the middle ear.