1 MB,ChB, FIBMS Specialist in ORL-H&N Surgery, Basrah Teaching Hospital

2 Professor of ORL-H&N Surgery, Department of Surgery, College of Medicine, University of Basrah, Basrah, IRAQ.


Abstract Chronic Otitis Media (COM) is a long standing inflammation of the middle ear and mastoid, it is a common health problem. The evidence of microbiology in COM in different studies showed variable frequencies, but little studies showed the role of fungal colonization. This study aimed to identify the microbiology of cholesteatomatous COM concentrating on clarification of fungal colonization. A prospective study was done in otolaryngology department of Basrah Teaching Hospital from June 2018 till July 2019. This study was carried on a randomly collected data of 25 patients diagnosed as COM by a specific designed questionnaire including history and examination. The specimen was collected during mastoid surgery which included any cholesteatoma in the middle ear and mastoid and sent for bacteriological and mycological examination. Statistical study was done by using SPSS v.23 Bacteria were isolated in 84% of the cases in which Pseudomonas aeruginosa was the commonest one (33.3%). Fungi were isolated in 28% cases, in which the Aspergillosis was the commonest (19.3%). There is no recognizable pattern of significant association between the fungi and the reported complications or the stage of the disease. In conclusion, there is significant percentage of fungal colonization in COM with cholesteatoma so it may has a role in inflammatory response of perimatrix, but there is no clear mechanism of this interaction, so may need larger sample and longer duration of study with postoperative follow-up and trail of combined antibiotic-antimycotic treatment. 


Introduction ntire forms of otitis media are considered as a common health problem. Chronic suppurative otitis media (CSOM) is defined as a long standing inflammation in the middle ear and mastoid1 . The most frequent causative organisms in CSOM are; Pseudomonas aeruginosa, Methicillin sensitive Staph. aureus (MSSA), Methicillin resistant staphylococcus aureus (MRSA) and coagulase negative staphylococci with a variable frequency according to different studies2-5 . Other bacteria cultured from chronic draining ears are: Enterobacter, Acinebacter, Proteus, Streptococcus, and Klebsiella. There is evidence of microbiology changing overtime, a study showed increasing in MRSA in CSOM from 0.7% to 11.4% in a period between 1998– 20066 . In chronic diseases such as chronic rhinosinusitis as a classical example in ENT, this shows susceptibility for fungal colonization7 . The usage of topical steroids as a combined topical treatment for CSOM is considered as an important predisposing factor for fungal colonization. Cholesteatoma itself is regarded as an ideal medium for saprophytic fungi because of its keratinous debris content8-12 . This study was designed to identify the microbiology of cholesteatomatous CSOM by using appropriate mycological and bacteriological methods in a group of operated upon patients, and concentrated EClinico-microbiology of cholesteatoma Marwah Faisal Abd Ali & Isam M Al-Shareda Bas J Surg,June, 27, 2021 37 on clarification of the clinical effects of the fungal colonization of cholesteatoma. Patients and methods This prospective study was done in the otolaryngology department at Basrah Teaching Hospital in the period from June 2018 to July 2019. The study sample composed of 25 patients of either gender, their ages ranged from 8–58 years old, the mean is 25 years. The data was collected according to a specific questionnaire. All patients were diagnosed as chronic otitis media by history of the most presenting symptoms and its duration, any complications, congenital anomalies such as cleft palate, chronic medical disease or immunocompromising disease, and preoperative treatment (before 1 week or less). Ear examination included; preoperative auroscope and otomicroscopy to classify the type of COM, fistula test, hearing assessment by tuning fork, PTA, and CT scan. Informed consent was mandatory. The type of surgery performed for patients was determined according to the disease extension and the opinion of the surgeon between mainly; Canal wall down (CWD) and canal wall up (CWU). For staging of cholesteatoma, EAONO/JOS system was used9 which applies to four types of cholesteatoma in the middle ear: Localized in the primary site, involving 2 or more sites, associated with extracranial complications, and associated with intracranial complications. During mastoid surgery, a sterile micro forceps was used to collect the cholesteatoma and maintained in a sterile containers of normal saline, the sample was transported immediately to the mycology laboratory, Collage of Science, University of Basrah. Some samples were sent to the central laboratory, Basrah Teaching Hospital for processing. Fungal analysis was done by direct study of sample onto sterile glass slide containing a drop of 10% KOH, and culture onto sabouraud dextrose agar (SDA) containing 0.05 g/l chloramphenicol. For analysis of bacteria, specimen was inoculated onto nutrient agar, blood agar, and MacConkey agar.

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