Bacterial otitis media in sub-Saharan Africa: a systematic review and meta-analysis

Determinants of Acute Otitis Media in Children: A Case-Control Study in West Java, Indonesia

Background and Objectives: Acute Otitis Media (AOM) is a leading cause of morbidity in children, characterized by fever, otalgia, and hearing loss. If untreated, AOM may progress to chronic complications requiring surgical management. Globally, factors such as allergies, environmental tobacco smoke, and nutritional deficiencies are well-established risk factors, but in Indonesia, particularly rural areas like Bandung Regency, limited awareness and data exacerbate the burden of disease. Smoking prevalence and low immunization rates further increase risks for AOM. Materials and Methods: This case-control study, conducted between September 2019 and February 2020 in Bandung Regency, evaluated risk factors for AOM in children aged 24-59 months. Data were collected through structured questionnaires, anthropometric assessments, and ENT examinations. A total of 168 AOM-positive and 367 AOM-negative children were recruited from primary healthcare facilities. Results: Multivariable analysis identified significant associations with AOM: allergic rhinitis (AOR 1.92), cigarette smoke exposure (AOR 1.79), stunted growth (AOR 1.48), and incomplete basic immunizations (AOR 1.77). These findings highlight the importance of addressing modifiable factors such as nutrition and immunization to reduce AOM incidence. Conclusions: The rhinitis allergy and exposure to cigarette smoke are among the well-established risk factors that our results validate. Additional research is necessary to validate if our findings involving two modifiable risk factors, stunted children and insufficient basic vaccination, may increase the risk of AOM.

Bacterial etiologies, antimicrobial susceptibility profiles and associated factors among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Western Ethiopia: A cross-sectional study

BACKGROUND

Otitis media is among the leading causes of illnesses responsible for causing hearing problems and adding significant costs to the public health system. Bacteria are the most common causative agents for otitis media. Currently, there is little information on the prevalence and antimicrobial susceptibility patterns of pathogenic bacterial isolates from patients with otitis media in Ethiopia.

METHODOLOGY

A laboratory - based cross-sectional study was conducted from June to September 2023 among 242 patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center. Sociodemographic and clinical data were obtained by trained nurses and/or health officers in face-to-face interviews using structured questionnaires. Middle ear discharge samples were collected by Ear, Nose and Throat (ENT) specialists (Otolaryngologist) following all aseptic techniques. Conventional culture, different biochemical tests and antimicrobial susceptibility testing were performed for all the isolated bacteria. Reference strains were used as a positive and negative controls. The data were checked for completeness and consistency, entered into EpiData version 4.6.06 and analyzed by SPSS version 25. Logistic regression analysis was performed to determine the associated factors of otitis media. Adjusted odds ratio was used to determine strength of association. Statistical significance was obtained at p-value of below 0.05. The data were interpreted using graphs, tables, and results statements.

RESULTS

A total of 242 middle ear discharge samples were collected and cultured from which 212 (87.6%) were culture positive. A total of 228 pathogenic bacterial isolates were recovered. The predominant bacterial isolates were S. aureus 92 (40.4%) followed by P. aeruginosa 33 (14.5%) and E. coli 24 (10.5%). One hundred and fifty-one (66.2%) bacterial pathogens were multidrug resistant. Piperacillin-tazobactam and tobramycin were relatively common drugs to which most of the isolates were susceptible while they were most resistant to ampicillin and tetracycline. Purulent discharge (p-value = 0.001), middle ear discharge ≥ 14 days (P-value = 0.000) and a history of active/passive smoking (P-value = 0.043) were significantly associated with otitis media.

CONCLUSION

The prevalence of bacterial pathogens, most of which were multidrug-resistant, was high among patients with otitis media. A significant association was observed with purulent ear discharge, chronic otitis media, and passive or active smoking. Choosing the proper antibiotic for the treatment of bacterial infection is crucial.

Bacteriological profile, antibiotic susceptibility, and biofilm formation in children with chronic suppurative otitis media

BACKGROUND

Chronic suppurative otitis media is predominantly caused by aerobic bacterial infections, complicated by antibiotic-resistant strains and biofilm formation. This study aims to identify the aerobic bacterial pathogens in chronic suppurative otitis media among children and assess their antibiotic susceptibility patterns. The potential link between biofilm formation and antibiotic resistance is also evaluated.

METHODS

A cross-sectional study was conducted on 457 children with chronic suppurative otitis media. Middle ear discharge samples were collected and aerobic bacteria were isolated and identified using standard microbiological methods. Antibiotic susceptibility was determined by the agar dilution method, and biofilm formation was assessed using the microtiter plate assay.

RESULTS

Of the 457 cases, 89.72 % were monomicrobial infections. The most prevalent Gram-negative bacterium was Pseudomonas aeruginosa (35.71 %), while Staphylococcus aureus (26.27 %) was the leading Gram-positive pathogen. Pseudomonas aeruginosa demonstrated high resistance, with 96.77 % resistant to cefuroxime and 92.26 % to amoxicillin/clavulanic acid. Similarly, Staphylococcus aureus showed significant resistance to ampicillin (83.33 %) and amoxicillin (78.07 %). A strong correlation (p < 0.001) was observed between biofilm formation and antibiotic resistance, with Gram-negative bacteria resisting an average of 4.24 ± 1.769 antibiotics and Gram-positive bacteria resisting 5.13 ± 1.535 antibiotics.

CONCLUSION

A high prevalence of antibiotic-resistant pathogens has been observed in children with chronic suppurative otitis media, with a significant association between biofilm formation and antibiotic resistance.

Microbiome in the External Auditory Canal of Hearing Aided Patients with Pruritis

Background

Hearing aids are the most common conventional devices used to manage sensorineural hearing loss. Although safe and reliable methods, Hearing aids have some minor or moderate side effects that may be inconvenient for those patients and may result in patient non-compliance or even abandonment of their usage. One of the most common is ear irritation and itching. Although itching is attributed to several causes including athetosis and skin allergy, however, Both Bacterial and fungal infections are considered the major leading cause. This study aims to determine the microbiological profile of the external ear in hearing-aided patients presented with itching.

Methods

150 hearing-aided patients presented with itching were recruited for the study all underwent history taking, full clinical examination, and external canal swabs were taken. Then swabs were cultivated for both bacterial and fungal growth.

Results

15 samples (8.6%) were free from infection while 159 samples (91.4%) were positive for infection. There was a statistically significant difference between the free and infected samples (either bacterial or fungal). Out of the infected samples, 135 samples (77.6%) had a bacterial infection and 24 samples (13.8%) had a fungal infection.

Conclusion

Microbial growth is the major factor in the development of external ear itching and pruritis, being mainly staphylococcal infection either staphylococcus Aureus or coagulase-negative species, however, gram-negative bacteria and fungal infection are not considered uncommon. The duration of hearing aid usage was found significant in the development of such infection. These findings shed light on the importance of frequent cleaning of both the external ear molds and proper hygiene of the external canal.

Prevalence of bacterial ear infections and multidrug resistance patterns among ear infection suspected patients in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Otitis media is an inflammation of the middle ear that affects both adults and children, leading to hearing loss and impacting intellectual performance, especially in developing countries. Key factors contributing to its development include lack of vaccination, inadequate breastfeeding, overcrowding, and malnutrition. Major bacterial pathogens involved are Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae, Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.This systematic review and meta-analysis revealed the pooled prevalence of bacterial ear infections and multidrug resistance in Ethiopia.

METHODS

Thorough searches were conducted across electronic databases and grey literature using precise entry terms or phrases. Eligible studies were compiled into MS Excel and imported into STATA version 14 software for statistical analysis. The collective prevalence of bacterial ear infections and multidrug resistance patterns were calculated using a random-effect model, with heterogeneity assessed via the I2 value. Publication bias was examined using a funnel plot and Egger's test. Sensitivity analysis was performed to gauge the impact of individual studies on the overall effect size.

RESULT

Seventy studies met the criteria for qualitative analysis, with 14 selected for the meta-analysis. These studies reported a total of 3,667 bacterial isolates. The prevalence of bacterial ear infections varied significantly, ranging from 28.2% to 98.2% across individual studies. In this systematic review and meta-analysis, the pooled prevalence of bacterial ear infections in Ethiopia was found to be 73.39% (95% CI: 65.15-81.63), demonstrating substantial heterogeneity (I2 = 98.5%, p < 0.001). Additionally, the pooled prevalence of multidrug resistance among bacterial ear infections was 72.45% (95% CI: 66.86-78.04). The most frequently identified isolate was Staphylococcus aureus, with a pooled prevalence of 68.87% (95% CI: 13.94-123.79), followed closely by Proteus spp. at 68.55% (95% CI: 3.15-140.26), Pseudomonas aeruginosa at 48.15% (95% CI: 1.84-94.45), and Escherichia coli at 37.15% (95% CI: 14.03-88.34).

CONCLUSION

The pooled prevalence of bacterial ear infections in Ethiopia is alarmingly high, accompanied by significant levels of multidrug resistance. These findings highlight the urgent need to reevaluate empirical treatment strategies due to the rising antimicrobial resistance.

Cross-sectional Hospital-based Investigation on Clinical Characteristics of Pediatric Staphylococcus aureus Isolates in a Beijing Hospital from 2013 to 2022

Background

Staphylococcus aureus (S. aureus) was a prevalent pathogenic bacterium among children. Due to the extensive use of antibiotics, the sensitivity of S. aureus to these drugs has gradually declined. Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged and spread worldwide, becoming a primary cause of both healthcare-associated (HA) and community-acquired (CA) infections. This retrospective study aimed to highlight the significance of S. aureus among bacteria isolated from children in Beijing, China, and to elucidate its antimicrobial resistance patterns.

Methods

Data on all S. aureus infections from 2013 to 2022 were collected from the microbiology department of Beijing Children's Hospital. Only the first isolate from the same kind of specimen was analyzed. Antimicrobial susceptibility tests were carried out by Vitek 2 automated system (bio Mérieux, France) or Kirby-Bauer disc diffusion method, according to the guidelines recommended by the Clinical and Laboratory Standards Institute (CLSI).

Results

During the decade-long research period, a total of 47,062 bacterial isolates were isolated from 433,081 submitted specimens, with 6477 of these isolates identified as S. aureus. The majority of patients with S. aureus infections belonged to the age group of infants under one-year-old, accounting for 37.9% of cases. S. aureus isolates were predominantly found in the Pneumology Department, and the most common source of these isolates was lower respiratory tract specimens, comprising 34.3% of the total. The resistance rates of S. aureus to penicillin and erythromycin were notably high, at 89.5% and 73.8%, respectively. In contrast, the resistance rates to linezolid, vancomycin, rifampicin, and moxifloxacin were remarkably low, at 0.0%, 0.0%, 1.3%, and 3.9%, respectively. The detection rate of MRSA was 27.8%. MRSA isolates were predominantly found in the newborn group, ICU, and sterile body fluids.

Conclusion

In our study, the most prevalent specimen type was derived from the lower respiratory tract, whereas the highest positive rate was observed in ear secretions. These findings underscored the pressing necessity for ongoing antimicrobial resistance (AMR) surveillance and the revision of treatment guidelines, particularly given the elevated detection of MRSA in ICU wards, sterile body fluids, and the neonatal age group. MRSA exhibited significant resistance to all β-lactam antibiotics, erythromycin, and ciprofloxacin. Therefore, future research endeavors should prioritize examining specific antimicrobial resistance populations and potential intervention strategies, as these were vital in mitigating the dissemination of antimicrobial-resistant isolates.

Molecular Typing of Pseudomonas aeruginosa Isolates Collected in Abidjan Hospitals (Côte d'Ivoire) Using the Multiple-Locus Variable Number of Tandem Repeats Method

Background/objectives:Pseudomonas aeruginosa can cause community-acquired infections affecting various body sites. The present retrospective study investigated the genetic diversity of 173 isolates (166 clinical, 7 environmental) of P. aeruginosa collected from clinical pathology laboratories in Abidjan, Côte d'Ivoire (2001-2011). Methods: Multiple-Locus Variable Number of Tandem Repeats (VNTR) Analysis (MLVA) using 13 loci was applied to all isolates and compared to published MLVA data. The antibiotics status of the isolates was compiled when available and compared to published profiles. Results: Among 95 isolates analyzed for their antibiotics status, 14 displayed concerning resistance profiles: five multidrug-resistant (MDR) and nine extensively drug-resistant (XDR). MLVA typing revealed a high genetic diversity (>130 genotypes), with many genotypes represented by a single strain. Notably, thirteen clusters (≥4 related isolates) were observed. Some clusters displayed close genetic relatedness to isolates from France, Korea, and well-studied strains (ST560, LES and PA14). Comparative analysis suggested the presence of international high-risk MDR clones (CC233, CC111) in Côte d'Ivoire. Importantly, MLVA clustering revealed a close relationship of CC235-MDR strains with a locally identified cluster (group 9). Conclusions: These findings support MLVA as a reliable and cost-effective tool for low-resource settings, allowing the selection of relevant strains for future whole genome sequence analyses. This approach can improve outbreak investigations and public health interventions aimed at curbing MDR P. aeruginosa transmission within hospitals and at the national level.

Aetiologies of Ear Infections Among Patients Who Visited King Fahad Hospital in Al-Baha, Saudi Arabia

Background Ear infections encompass otitis media (OM) which is a significant cause of hearing loss and otitis externa (OE) which may affect the surrounding tissues leading to serious complications. This study reports the common pathogens causing ear infections. Methods Microbiological, clinical, and demographic data of ear-infected patients who visited King Fahad Hospital in Al-Baha, Saudi Arabia, during the period from January 2019 to June 2023 were enrolled in this study. Result  This study enrolled 307 patients aged 1-94 years, with a median age of 40 years (IQR=22-57). Overall, the detectable infection rate was 81.1% (n=249), while 18.9% (n=58) had no identified aetiology. Of all isolates, 178 (58%) were bacterial, while 71 (23.1%) were fungal. Staphylococcus aureus (S. aureus) followed by Pseudomonas aeruginosa (P. aeruginosa), Enterobacteriaceae, andcoagulase-negative Staphylococcus (CoNS) were the main bacterial isolates. Of the total 63 S. aureus isolates, 21 (33%) were methicillin-resistant (MRSA). A cohort of 227 subjects were diagnosed with either OM (n=178; 79.5%), OE (n=46; 20.5%), or both OM and OE (n=3; 1%). Of those with OM, children constituted 89.1% (41/46) as compared to 75.3% (134/178) of adults (p=0.041). The main isolates from OM patients were S. aureus followed by P. aeruginosa and fungi. Of 49 OE patients, 16 (32.7%) had no identified pathogen, while 15 (30.6%) had fungi, and 13 (29.5%) had P. aeruginosa. Conclusions Ear infections in general were mainly bacterial followed by fungal with a considerable proportion of unidentified aetiology. A significant proportion of S. aureus isolates were MRSA. S. aureus followed by P. aeruginosa and fungi were the main causes of OM, while fungi followed by P. aeruginosa were the main causes of OE.

Gram-negative Bacteria are Associated With Sensorineural Hearing Loss in Chronic Otitis Media

OBJECT

Chronic otitis media (COM) is an inflammatory disease that commonly presents with otorrhea and hearing loss. Bacteria-induced inflammation can cause inner ear damage, leading to sensorineural hearing loss (SNHL). This study aimed to compare the prevalence and severity of SNHL in patients with gram-negative versus gram-positive cultures and examine associations between the concentrations of circulating monocytes and neutrophils with bacteria species and SNHL.

METHODS

This was a retrospective study. Cholesteatoma or chronic suppurative otitis media patients with otorrhea were enrolled. Middle ear secretions were collected using sterile swabs under an otoscope, and sent for bacterial detection within 30 min. Pure tone audiometry and circulating leukocyte counts were recorded and analyzed in patients infected with different pathogens. Logistic regression analysis was used to identify the risk factors associated with SNHL.

RESULTS

A total of 137 patients were enrolled, including 45 patients infected with gram-negative bacteria, 41 with gram-positive bacteria, 20 with polymicrobial infection, and 31 with no bacterial growth. Logistic regression analysis showed that bacterial culture positive infections (OR = 7.265, 95% CI 2.219-23.786, p = 0.001) were an independent risk factor for SNHL. Patients with gram-negative bacteria had higher risks of SNHL (p < 0.0001) and more severe hearing loss (p = 0.005) than those with gram-positive bacteria. COM patients infected with gram-negative bacteria showed an increase in circulating monocytes, which correlated with the occurrence of SNHL (p = 0.0343).

CONCLUSION

Gram-negative bacteria are associated with elevated circulating monocyte counts and have a higher risk of severe SNHL.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:3335-3341, 2024.

Antibiogram and molecular characterization of extended-spectrum β-lactamase-producing pathogens implicated in chronic suppurative otitis media

Introduction

beta-lactamase-producing bacteria, especially extended-spectrum beta-lactamase (ESBL) producers have strong clinical relevance and have been implicated in chronic suppurative otitis media (CSOM) treatment failures. This study aimed to determine the frequency, antibiogram, and molecular characteristics of ESBL-producing gram-negative bacterial (GNB) pathogens isolated from patients with CSOM.

Methods

three hundred (300) ear swab samples collected from patients with active CSOM were analysed using standard microbiological techniques. Antibiogram of pathogens was determined by Kirby-Bauer disk diffusion technique. Phenotypic detection and molecular characterization of ESBL-producing GNB pathogens were performed by double disk synergy test (DDST) and polymerase chain reaction (PCR).

Results

Escherichia coli and P. aeruginosa were more prevalent among CSOM patients with a duration of discharge >2 weeks. The frequency of ESBL producers among the GNB pathogens was 18.3%. Isolates were generally multidrug-resistant but very susceptible (100% - 70.4%) to ciprofloxacin, imipenem, and amikacin. Multiple antibiotic resistance values of the isolates ranged from 0.7-0.8. Polymerase chain reaction showed that blaSHV (47.6%) was the most predominant ESBL genotype. This was followed by blaTEM (25.2%) and blaCTX-M (10.7%) as the least predominant ESBL gene. Concomitant expression of ESBL gene was observed in 13.6% of the isolates.

Conclusion

this study reported the occurrence and spread of β-lactamase-producing bacteria in patients with CSOM infections. It is therefore very crucial to screen for antibiotic-resistant pathogens at early stages of CSOM infections, for proper antimicrobial therapy and to curb the increasing spread of antimicrobial resistance.

Detection of FOX-AmpC-β-lactamase gene and antibiogram of AmpC-beta-lactamase-producing pathogens isolated from chronic suppurative otitis media patients in Nigeria

Background and Objectives

AmpC-producing Gram-negative bacterial (GNB) pathogens are distributed worldwide, especially in clinical settings. This study aimed to determine the antibiogram and the type of AmpC-β-lactamase gene harboured by GNB pathogens implicated in chronic suppurative otitis media (CSOM) cases.

Materials and Methods

Ear swab samples (300) collected from patients with active CSOM were analysed using standard microbiological techniques. Phenotypic and molecular detection of AmpC β-lactamase production was done by cefoxitin/cloxacillin double-disk synergy test and PCR respectively. Antibiogram was determined by disk diffusion technique.

Results

Among the GNB pathogens isolated from CSOM patients, P. aeruginosa was the most predominant (36.3%); followed by K. pneumoniae (22.3%), and E. coli (13.7%). Patients with active CSOM showed increased bacteria isolation rate from bilateral ear discharges than unilateral ear discharges. E. coli and P. aeruginosa were more prevalent among patients with duration of discharge >2 weeks; recording 9.0% and 20.3% respectively. AmpC β-lactamase producers accounted for 14.0%; they were highly resistant (60%-100%) to cephalosporins, trimethoprim-sulfamethoxazole, ofloxacin, amoxicillin, and tetracycline, but very susceptible (70.4%-100%) to ciprofloxacin, imipenem, and amikacin. Multiple antibiotic resistance indices of isolates ranged from 0.7-0.8. FOX-AmpC-β-lactamase gene was detected in 3.9% of the isolates.

Conclusion

The detection of AmpC β-lactamase-producing multidrug-resistant GNB pathogens harbouring FOX-AmpC-β-lactamase gene among patients with CSOM infections in our study is a serious public health problem which needs urgent intervention.

Factors Associated with Otitis Media Among Pediatrics in Two Government Hospitals in Arba Minch, Southern Ethiopia

Background

Bacterial otitis media (OM) is a common infection among the pediatric community worldwide and is the first reason for prescribing antibiotics in pediatric practices. However, if not promptly diagnosed and appropriately treated, it may persist and cause severe intra- and extra-cranial hard-to-cure complications. Hence, knowing the magnitude, etiology, and antibiotic susceptibility profile is very important for the proper management.

Methods

A cross-sectional study was carried out in 312 pediatrics (1 to 18 years) attending the Ear Nose Throat outpatient departments of the two title hospitals from 25 February to 30th August 2022. Patients were chosen through a systematic random sampling method. Data were obtained by means of a semi-structured questionnaire. Samples were collected to identify the causative bacteria as per microbiological guidelines. The antibiotic susceptibility test was done according to the Kirby-Bauer disc diffusion; SPSS version 25 was used for the analysis.

Results

The overall prevalence of otitis media was 67.3% (n=210); CSOM showed a slight preponderance (n=107) Gram-negative bacteria and Gram-positive bacteria were present in 59.8% (n=137) and 40.1% (n=92), respectively. Otitis media was predominantly caused by S. aureus (n=52, 56.5%), followed by Proteus spp. (n=33, 24%). Gram-negative bacteria were highly resistant to co-trimoxazole, amoxicillin-clavulanic acid, piperacillin, and tetracycline, whereas their positive counterparts were considerably penicillin and co-trimoxazole resistant. Overall, 61.5 and 19.2% of the isolates were MDR and XDR, respectively. MRSA, MR-CoNs, and VRE were 38.4% (n=20), 17.1% (n=5), and 58.3% (n=12), respectively; 19.7% (n=25) of Gram-negative bacteria produced ESBL, and 7% (n=9) were carbapenem-resistant. History of exposure to loud noise [AOR=3.4; CI=1.14-10.23; P-value=0.028] and family history of smoking at home [AOR=2.9; CI=1.18-7.25; P-value=0.020] have the greatest odds of otitis media.

Conclusion

Overall, the prevalence of otitis media is showing an upward trend, and MDR among bacterial isolates is increasing alarmingly.

Otitis Media in Children with Down Syndrome Is Associated with Shifts in the Nasopharyngeal and Middle Ear Microbiotas

Background: Otitis media (OM) is defined as middle ear (ME) inflammation that is usually due to infection. Globally, OM is a leading cause of hearing loss and is the most frequently diagnosed disease in young children. For OM, pediatric patients with Down syndrome (DS) demonstrate higher incidence rates, greater severity, and poorer outcomes. However, to date, no studies have investigated the bacterial profiles of children with DS and OM. Method: We aimed to determine if there are differences in composition of bacterial profiles or the relative abundance of individual taxa within the ME and nasopharyngeal (NP) microbiotas of pediatric OM patients with DS (n = 11) compared with those without DS (n = 84). We sequenced the 16S rRNA genes and analyzed the sequence data for diversity indices and relative abundance of individual taxa. Results: Individuals with DS demonstrated increased biodiversity in their ME and NP microbiotas. In children with OM, DS was associated with increased biodiversity and higher relative abundance of specific taxa in the ME. Conclusion: Our findings suggest that dysbioses in the NP of DS children contributes to their increased susceptibility to OM compared with controls. These findings suggest that DS influences regulation of the mucosal microbiota and contributes to OM pathology.

Influence of pneumatization on morphology of temporal bone-related vasculatures and their morphometric relationship with ear regions: a computed tomography study

Anatomical variations in the location and position of temporal bone-related vasculature are routinely encountered in clinical practice, contributing to clinical syndromes and complexities in ear-related and neurological surgeries. Pneumatization of the temporal bone (TB) is one of several factors that have been hypothesized to influence the variabilities and variations of these vessels. This study aimed to investigate the association between the degree of pneumatization and the morphologies of some TB-related vessels, as well as their morphometrical relationship with ear regions. Observational retrospective chart review of 496 TBs computed tomographic scans were examined. Different degrees of pneumatization were observed, with hyper-pneumatization being the most common and hypo-pneumatization being the least. Various anatomical variants of the sigmoid sinus (SS), jugular bulb (JB), and internal carotid artery (ICA) were observed. Distances of SS and JB to ear regions were observed to have significant differences (p < 0.05) in laterality. These distances increased relative to increased air cells, showing a significant association (p < 0.05). A significant association (p < 0.001) was also observed between the degree of pneumatization and variants of JB and ICA. High JB, JB dehiscence, and ICA dehiscence were significantly associated with increased pneumatization, while flat JB was significantly associated with decreasing pneumatization. However, no significant association (p = 0.070, p = 0.645) was observed between the degree of pneumatization and morphologies of SS. This study concludes that the degree of pneumatization influences only the jugular bulb variants and ICA dehiscence, as well as the distances of SS and JB to ear regions.

Microbiology and Drug Susceptibility Pattern of Bacterial Isolates from Patients with Chronic Suppurative Otitis Media at a Tertiary Care Hospital in Somalia

Background

This study aimed to determine the microbiological profile and antibiotic susceptibility pattern of bacterial isolates obtained from patients with chronic suppurative otitis media (CSOM) presenting to the otorhinolaryngology clinic of a tertiary care hospital in Mogadishu, Somalia.

Methods

A total of 225 patients diagnosed with chronic suppurative otitis media were included in the study. Samples of middle ear discharge were collected from each patient and cultured using standard microbiological techniques, and bacterial identification was performed. Drug susceptibility pattern was assessed according to the Clinical and Laboratory Standards Institute criteria.

Results

The study sample (n=225) comprised 122 females and 103 males. Among 225 samples tested, bacterial growth was present in 200 (88.9%) and absent in 25 (11.1%) samples. Of 200 samples with bacterial growth, monomicrobial growth was detected in 176 (88%). Gram-positive bacteria were observed in 40 (22.7%) and Gram-negative bacteria in 136 (77.3%) samples. The bacteriology of the samples with monomicrobial growth consisted of (in decreasing frequency) Pseudomonas spp, Staphylococcus aureus, Escherichia coli, Coagulase-negative staphylococci, Proteus mirabilis, and Klebsiella sp. A high rate of resistance was detected against penicillin antibiotics, erythromycin, tetracycline, and co-trimoxazole. Resistance to cephalosporins, clindamycin, vancomycin, linezolid, daptomycin, quinupristin/dalfopristin, levofloxacin, meropenem, and ertapenem was low.

Conclusion

While the frequencies of isolated bacterial species were consistent with other reports from the region, differences were observed in the antibiotic resistance of bacterial isolates when examined individually for each antibiotic. Further studies are warranted in the same region and different parts of Somalia, coupled with ongoing assessment of antibiotic susceptibility patterns in CSOM.

The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone

BACKGROUND

Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world's population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors.

METHODOLOGY AND PRINCIPAL FINDINGS

EVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p < 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p < 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss.

CONCLUSIONS AND SIGNIFICANCE

This study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.

Distribution and Antimicrobial Resistance Profiles of Bacterial Aetiologies of Childhood Otitis Media in Accra, Ghana

Background:

Otitis media (OM), also known as middle ear infection, is a clinically significant childhood disease. In sub-Saharan Africa, there is a paucity of contemporary reports on it is bacterial aetiologies and antimicrobial resistance among them.

Aim:

To investigate the OM bacterial aetiologies and their antimicrobial resistance patterns among children visiting the Ear, Nose, and Throat clinics of 3 healthcare facilities in Accra, Ghana – Princess Marie Louise Children’s Hospital, 37 Military Hospital, and Mamprobi Hospital.

Methods:

This cross-sectional study involved 100 children below 13 years old with suppurative otitis media. Following standard bacteriological methods, sterile ear swabs were used to take middle ear discharges from the study participants for culture and antimicrobial susceptibility testing. A standard questionnaire was also used to collect data on socio-demographic and clinical characteristics.

Results:

The major OM bacterial aetiologies were Pseudomonas aeruginosa (38.5%), Klebsiella pneumoniae (19.8%), Proteus mirabilis (11.5%), and Staphylococcus aureus (10.4%). The majority of the bacteria demonstrated low to moderate resistance (0%-33.3%) to most of the antibiotics. Eight of the bacteria (4 each of Klebsiella pneumoniae and Escherichia coli) were extended-spectrum beta-lactamase (ESBL) producers; 6 ampicillinase (Amp C)-producing organisms (4 Citrobacter spp. and one each of Morganella morganii and Serratia marcescens) were also identified, and they showed high antibiotic resistance.

Conclusions:

The predominant OM aetiologies were Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus aureus, and they were generally susceptible to most of the antibiotics tested. Amikacin, cefepime, ciprofloxacin, and meropenem could be valuable in the empirical management of childhood OM.

Temporal bone pneumatization: A scoping review on the growth and size of mastoid air cell system with age

The interest in the mastoid air cell system arose from the association between temporal bone aeration and otitis media. Its size and growth have been considered when planning chronic and middle ear surgeries. The objective of this review was to explore the literature on the size of mastoid air cells with age, highlighting various growth rates reported and mapping out areas yet to be fully understood for further research. A three-step systematic search was conducted for available literature on the subject matter viz; Google Scholar, Medline, Cochrane Library, and PubMed. Eligibility criteria guided the study selection, and eligible studies were subjected to appraisal using screening and quantitative criteria of mixed-method appraisal tool. A data extraction form was developed to extract information from eligible studies. Nine studies met the eligibility criteria. 55.6% of the included studies were conducted among the east and south Asian population, 33.3% were conducted among Scandinavians, and 11.1% in South America. Age groupings varied among studies; 33.3% utilized 1-year age grouping, 33.3% utilized 5-year age grouping, 11.1% utilized 10-year age grouping. In reporting the size of mastoid air cells across age groupings, 66.7% utilized area, 22.2% utilized volume, while 11.1% utilized both area and volume. Findings from this review showed that the mastoid air cells' size with respect to age differs among populations of different origins. The most common measurements were the area of air cells. The highest growth rate was reported up to 30 years. Findings also show the influence of sex on the size of mastoid air cells and growth rate with age, as females were reported to have larger air cells with rapid growth until puberty. However, the male mastoid air cell system continues a steady growth after puberty and becomes larger. Information still lacks in the volume of air cells in pediatric pneumatization.

Isolation and Identification of Pathogenic Bacteria Causing Otitis Media in Misan Governorate

This study examined 150 ear swab samples from patients with otitis media who consulted at Al-Sadr Teaching Hospital from January to April 2021 in Misan, Iraq. The participants were aged 14–50 years, among which the infection rate was highest in participants aged 14–22 years and lowest in those aged 40–50 years. Subsequently, bacterial isolates were identified based on their morphology in various culture media and using biochemical tests. Six bacterial species were identified, namely Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Staphylococcus epidermidis. Staphylococcus aureus had the highest infection rate (30%), whereas Staphylococcus epidermidis had the lowest infection rate (8.55%). When the sensitivity of each isolate to antibiotics was determined, Escherichia coli was the most sensitive to trimethoprim (TMP), whereas Pseudomonas aeruginosa was the most resistant to 75% of the tested antibiotics.

Bacterial Etiologies of Ear Infection and Their Antimicrobial Susceptibility Pattern at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia: A Six-Year Retrospective Study

BACKGROUND

An ear infection is responsible for up to 40% of preventable hearing impairment; one of the reasons for frequent and unwise antibiotic usage, especially in the developing world. Since the incidence of antibiotic resistance is increasing, especially in resource-limited countries, up-to-date knowledge on the susceptibility of ear-discharge isolates to antibiotic is important for better patient treatment. Therefore, this study aimed at determining the bacterial etiologies and their antibiotic susceptibility profiles among patients suspected with ear infections.

METHODS

We collected retrospective data from bacteriological results of ear discharge samples from 2013 to 2018. Sample collection, culture preparation, and bacterial identification were performed using standard microbiological techniques. Antimicrobial susceptibility testing was performed following Clinical and Laboratory Standard Institute (CLSI) guidelines. We extracted and inputted the data using Epi-info version 7 and exported it to SPSS version 20 for analysis.

RESULTS

The overall ear-discharge culture positivity rate was 283/369 (76.7%) (95% CI = 72.4-81.3), with 14/283 (4.95%) mixed infections. Staphylococcus aureus (27.9%), Proteus spps (20.8%), Streptococcus spps (10%), and Pseudomonas spps (8.92%) were the main isolates. High-level resistance rates for tetracycline (77.6%), penicillins (67.2%), erythromycin (52.6%), and co-trimoxazole (52%), and low-level resistance rates for fluoroquinolones (23.3%), aminoglycosides (23.7%), and cephalosporins (29.8%) were observed. More than 45% of isolates, with 50.9% of Gram-negative and 37.3% of Gram-positive, were multidrug-resistant.

CONCLUSION

Staphylococcus aureus, Proteus mirabilis, Proteus vulgaris, Escherichia coli, and Pseudomonas aeruginosa were the leading cause of ear infections. The presence of high number of multidrug-resistant strains calls for the need for periodic and continuous follow-up of antibiotic usage in the study area. Further studies are recommended to explore the types of ear infections, with their etiologic agents and possible risk factors.

Molecular Characteristics, Antimicrobial Resistance, and Biofilm Formation of Pseudomonas aeruginosa Isolated from Patients with Aural Infections in Shanghai, China

PURPOSE

To investigate molecular characteristics, antimicrobial resistance, and biofilm formation ability of Pseudomonas aeruginosa strains isolated from patients with aural infections.

METHODS

Isolates (n = 199) were collected from ear discharges of patients with aural infections from January 2019 to December 2020. Antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines. All isolates were subjected to multilocus sequence typing (MLST) with amplification and sequencing of seven housekeeping genes. Biofilm formation and eradication were quantitatively assessed in microtiter plates. Genes associated with biofilm formation and the quinolone-resistance-determining region (QRDR) of genes gyrA and parC were investigated using polymerase chain reaction amplification and sequencing.

RESULTS

Of the 199 P. aeruginosa strains isolated, 109 (54.77%) were from females and 90 (45.23%) were from males. The isolates exhibited very low rates of resistance to most antibiotics tested, including piperacillin (1.51%), ceftazidime (0.50%), and imipenem (3.52%); however, the quinolones ciprofloxacin (80.40%) and levofloxacin (82.91%) were notable exceptions. The QRDR sequence results of the quinolone-resistant P. aeruginosa isolates showed Thr83Ile (n = 155) was the most common amino acid mutation in gyrA (n = 165), while Ser87Leu (n = 157) was widely detected in parC (n = 165). MLST analysis identified 34 sequence types (STs) with most isolates belonging to ST316 (73.87%). Almost all of the P. aeruginosa isolates (96.98%) produced biofilms and biofilm-forming genes algD (98.49%), pslD (96.98%), and pelF (96.48%) were highly prevalent.

CONCLUSION

The P. aeruginosa strains isolated from aural discharges in this study exhibited very low rates of resistance to most antibiotics tested, except for the resistance rates to quinolones, which were relatively high. The isolates also exhibited a strong biofilm formation ability and low susceptibility to eradication, indicating that more effective drugs and treatment methods are needed to combat these infections.

Management and Outcomes of Paediatric Intracranial Suppurations in Low- and Middle-Income Countries: A Scoping Review

Introduction: Intracranial suppurations account for a significant proportion of intracranial masses in low- and middle-income countries (LMICs), particularly among children. The development of better imaging equipment, antibiotics, and surgical techniques has enabled significant progress in detecting and treating intracranial abscesses. However, it is unclear whether these advances are accessible and utilised by LMICs. In this review, we aimed to describe the landscape of paediatric intracranial suppurations in LMICs. Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, WHO Global Index Medicus, AJOL and Google scholar were searched for relevant articles from database inception to January 18th, 2021. Publications in English and French were included. Results: Of the 1,011 records identified, 75 were included. The studies, on average, included 18.8 (95% CI = 8.4-29.1) children (mean age: 8.2 years). Most children were male (62.2%, 95% CI = 28.7-95.7%). Intracranial suppurations were most commonly (46.5%) located in the supratentorial brain parenchyma. The most prevalent causative mechanism was otitis (37.4%) with streptococcus species being the most common causative organism (19.4%). CT scan (71.2%) was most commonly used as a diagnostic tool and antibiotics were given to all patients. Symptoms resolved in 23.7% and improved in 15.3% of patients. The morbidity rate was 6.9%, 18.8% of patients were readmitted, and the mortality rate was 11.0%. Conclusion: Most intracranial suppurations were complications of preventable infections and despite MRI being the gold standard for detecting intracranial suppurations, CT scans were mostly used in LMICs. These differences are likely a consequence of inequities in healthcare and have resulted in a high mortality rate in LMICs.

Organizational Aspects and Outcomes of a Hearing Screening Program Among First-Grade Children in the Mazovian Region of Poland

Purpose The purpose of this study is to describe and assess a hearing screening program of first-grade children in Poland. The program aimed to detect hearing disorders and increase awareness among parents of hearing problems. Method A hearing screening program was conducted in all elementary schools of the biggest region in Poland. A total of 34,618 first-graders were screened. The hearing screening protocol included video otoscopy and pure-tone audiometry. The program also included an information campaign directed to the local community and educational meetings between parents and medical staff. Results The estimated prevalence of hearing loss was 11%. Unilateral hearing loss was more common than bilateral hearing loss. Mild hearing loss was more frequent than moderate (or worse) hearing loss. In otoscopy, the most common positive result was otitis media with effusion. Parents and medical staff took part in 1,608 educational meetings, broadening the parents' knowledge of how to care for hearing. Conclusions A hearing screening program not only provides data on the prevalence of childhood hearing problems but is also an avenue for providing the local community with valuable knowledge about how to care for hearing. This study demonstrated the importance for systematic monitoring of children's hearing status and of increasing awareness among parents and teachers of the significance of hearing loss. The hearing screening of children starting school should become a standard part of school health care programs.

Antibiotic Susceptibility Patterns of Bacterial Isolates from Routine Clinical Specimens from Referral Hospitals in Tanzania: A Prospective Hospital-Based Observational Study

Introduction

Antimicrobial resistance is one of the biggest threats of modern public health. Although sub-Saharan Africa is highly burdened with infectious diseases, current data on antimicrobial resistance are sparse.

Methods

A prospective study was conducted between October 2018 and September 2019 to assess the antibiotic susceptibility patterns of clinical bacterial isolates obtained from four referral hospitals in Tanzania. We used standard media and Kirby-Bauer disc diffusion methods as per Clinical and Laboratory Standards Institute (CLSI) standards.

Results

We processed a total of 2620 specimens of which 388 (14.8%) were culture-positive from patients with a median (IQR) age of 28 (12–44) years. Of the positive cultures, 52.3% (203) were from females. Most collected specimens were ear pus 28.6% (111), urine 24.0% (93), wound pus 20.6% (80), stool 14.9% (58), and blood 8.3% (32). Predominant isolates were S. aureus 28.4% (110), E. coli 15.2% (59), P. aeruginosa 10.6% (41), P. mirabilis 7.0% (27), V. cholerae 01 Ogawa 6.2% (24), Klebsiella spp. 5.2% (20) and Streptococcus spp. 4.6% (18). Generally, the isolates exhibited a high level of resistance to commonly used antibiotics such as Ampicillin, Amoxicillin-Clavulanic acid, Erythromycin, Gentamicin, Tetracycline, Trimethoprim, third-generation Cephalosporins (Ceftriaxone and Ceftazidime), and reserved drugs (Clindamycin and Meropenem). S. aureus isolates were resistant to most of the antibiotics tested; 66.7% were classified as MRSA infections.

Conclusion

Antibiotic resistance to commonly prescribed antibiotics was alarmingly high. Our findings emphasize the need for comprehensive national control programs to combat antibiotic resistance.

Microbiology of Chronic Suppurative Otitis Media: An update from a Tertiary Care Hospital in Bangladesh

Objectives:

Chronic suppurative otitis media is a major cause of acquired hearing impairment, especially in children of developing countries. The study sought to explore the bacteriological profile and their antimicrobial susceptibility among patients of chronic suppurative otitis media from a tertiary care hospital in Bangladesh.

Methods:

A cross sectional microbiological study was conducted at the Department of Microbiology, Rajshahi Medical College, Bangladesh from January to December 2019. Aural swabs were collected aseptically from clinically suspected patients irrespective of age and gender attending the ear, nose and throat outpatient department of Rajshahi Medical College Hospital. Aerobic bacterial culture was done and isolates were identified through standard bacteriological identification scheme. Antimicrobial susceptibility testing of isolates was done by modified Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines.

Results:

Of 96 swabs, culture yielded a total of 73 bacterial isolates from 68(70.8%) culture-positive plates including 63 (65.6%) unimicrobial and 5 (5.2%) polymicrobial (mixed growth of a pair of bacteria) growths. Frequency distribution revealed, 40(55%) gram-negative and 33(45%) gram-positive bacteria with Staphylococcus aureus was the leading isolate (37%) followed by Pseudomonas aeruginosa (31.5%), Escherichia coli (13.7%), coagulase-negative Staphylococcus (8.2%), Klebsiella pneumoniae (5.5%) and Proteus spp. (4.1%). Gram-positive bacteria were found to be highly susceptible (100%) to Linezolid and Vancomycin followed by Imipenem (83 to 96.3%), while moderate to high resistance (44 to 67%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime, Amoxicillin/Clavulanate and Clindamycin. For gram-negative bacteria, susceptibility ranged from 67 to 100% to Imipenem, 67 to 96% to Piperacillin/Tazobactam and 67 to 83% to Gentamicin, while moderate to high resistance (50 to 75%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime and Amoxicillin/Clavulanate.

Conclusion:

Moderate to high level of multidrug-resistance especially to 3^rd generation cephalosporins, Ciprofloxacin and Amoxicillin/Clavulanate is an alarming situation. It warns reinforcement of judicious antibiotic prescription and introduction of antibiotic stewardship program in the tertiary care hospitals.