ro13-9904 and Otitis-Media--Suppurative

To evaluate the usefulness of antibiotic+steroid irrigation of the middle ear in patients with otitis media with small perforation and pulsatile discharge.. A prospective, randomised, evaluator-blinded study was carried at a single tertiary care centre over eight years, looking at 100 patients with chronic suppurative otitis media involving small tympanic membrane perforations and pulsatile mucopurulent discharge. The patients were randomised and divided into two groups. In group A, the examination under microscope, with suction cleaning of the external canal, was followed by irrigation of the middle ear with antibiotic+steroid solution for up to one week, while group B was prescribed self-administration of the same drops with systemic antibiotics. The patients were followed up daily for 10 days to monitor otorrhoea relief and on a weekly basis subsequently to monitor the healing of the tympanic membrane.. Forty-nine patients in group A had a dry ear after 3-7 days of daily suction and the irrigation of middle ear with the antibiotic+steroid solution and 44 had a healed tympanic membrane after an average three months of follow-up. Five patients with dry ear but persistent perforation underwent tympanoplasty, while only one patient with a persistent ear discharge underwent mastoid exploration. In group B, eight patients on oral antibiotics and self-administration of the same drops had dry ear while 34 had dry ear after receiving intravenous antibiotics. Thirty perforations healed spontaneously and 12 required tympanoplasty. In 8 patients, the tympano-mastoid was explored and these patients had dry, hearing ears only after surgery.. Patients with chronic suppurative otitis media involving small perforations and pulsatile discharge can be managed conservatively with simple suction cleaning + middle ear irrigation with antibiotics + steroid drops.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Dexamethasone; Follow-Up Studies; Glucocorticoids; Humans; Middle Aged; Otitis Media, Suppurative; Prospective Studies; Single-Blind Method; Suction; Therapeutic Irrigation; Treatment Outcome; Tympanic Membrane Perforation; Young Adult

In order to objectively evaluate the efficacy and the safety of ceftriaxone (CTRX) using once daily administration of 1 g to cases of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media, a group comparison study by the envelope method was conducted using cefotiam (CTM) as the control drug (2 g twice daily). The results obtained are summarized as follows. 1. Clinical efficacies evaluated by the committee were 71% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 63% and 60%, respectively, for chronic suppurative otitis media. When all cases were considered both groups evidenced a clinical efficacy of 64%, and no significant difference was observed between the 2 groups. 2. Clinical efficacies evaluated by the physician in charge were 65% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 72% and 60%, respectively, for chronic suppurative otitis media. When all cases were considered efficacies were, respectively, 70% and 64%, showing no significant difference between the 2 groups. 3. Bacteriological efficacies were 88% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 74% and 62%, respectively, for chronic suppurative otitis media. With all cases bacterial eradication rates were, respectively, 76% and 67%. Bacterial eradication rates were always higher for the CTRX group than for the CTM group, but the difference was not significant between the 2 groups. 4. Against infections caused by Staphylococcus aureus alone, CTRX showed equal clinical and bacteriological efficacies to CTM. 5. As side effects, dermatitis, vomiting, and malaise were observed in 5 cases (4%) of the CTRX group and 3 cases (3%) of the CTM group. As clinical testing abnormalities, elevations of GOT, GPT, and Al-P, and thrombocytopenia were noted only in 3 cases (5%) of the CTRX group. Furthermore, all of these abnormalities were temporary and of moderate degree or mild, thus the safety of either drug was considered high. 6. Clinical utilities were 71% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 72% and 62%, respectively, for chronic suppurative otitis media. When all cases were included, they were 72% and 66%, respectively, and there was no significant difference between the 2 groups. It is concluded from the above results that CTRX is a highly useful drug with once daily administration of 1 g in the treatment of suppur

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotiam; Ceftriaxone; Drug Eruptions; Drug Evaluation; Female; Humans; Japan; Male; Middle Aged; Multicenter Studies as Topic; Otitis Media; Otitis Media, Suppurative; Thrombocytopenia; Vomiting

Dural venous sinus thrombosis, especially of the sigmoid sinus, is a known but uncommon intracranial extradural complication of chronic suppurative otitis media. Even rarer is the simultaneous occurrence of bilateral abducens palsy in the same patient. We report the case of an adolescent male who presented with signs of raised intracranial pressure, diplopia and bilateral lateral rectus palsy associated with a history of left ear discharge and neck swelling. Extensive dural sinus thrombosis extending right up to the left internal jugular vein was confirmed on CT imaging. The patient was successfully treated with thrombolytic agents and antibiotic therapy. The pathophysiology of the concurrent complications is discussed.

Topics: Abducens Nerve Diseases; Adolescent; Anti-Bacterial Agents; Ceftriaxone; Chronic Disease; Fibrinolytic Agents; Heparin; Humans; Magnetic Resonance Imaging; Male; Ofloxacin; Otitis Media, Suppurative; Sinus Thrombosis, Intracranial

To identify bacterial agents of chronic discharging ear and determine their antibiotic sensitivities pattern in Ido - Ekiti, Nigeria.. Swab specimens of each chronically (>8 weeks) discharging ears of patients with chronic suppurative otitis media (CSOM) presenting to the Ear, Nose and Throat (ENT) clinic of the Federal Medical Centre, Ido Ekiti were bacteriologically cultured aerobically and the antibiotic sensitivity pattern of the recovered organisms determined by the modified Kirby-Bauer disc-diffusion method over a three year period starting from January 2005.. Seventy eight patients with CSOM whose age ranged between 3 months and 85 years were seen during the study period with 73.1% of them having unilateral disease and majority were children < 15 years (71.8%). Out of 99 ear swabs that were examined, 87.9% were culture positive with 90.8% yielding a single isolate. Coliforms (34.7%) were the most frequent isolated group of organisms. Other isolates included Staphylococcus aureus (26.3%), Proteus spp (24.2%), Pseudomonas spp (9.5%) and Klebsiella spp (5.3%). Sparfloxacin and ciprofloxacin showed highest activity on all the isolates unlike cefuroxime and ceftiaxone to which all isolates were resistant.. Chronic discharging ear is caused by bacteria agents most sensitive to quinolones but resistant to cefuroxime and ceftiaxone. Treatment of patients with CSOM in Ido-Ekiti with the quinolones is recommended except where contraindicated.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cefuroxime; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Bacterial; Enterobacteriaceae; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Humans; Infant; Klebsiella; Male; Microbial Sensitivity Tests; Middle Aged; Nigeria; Otitis Media, Suppurative; Prospective Studies; Proteus; Pseudomonas; Staphylococcus aureus; Young Adult

Topics: Adolescent; Anticoagulants; Ceftriaxone; Chronic Disease; Clindamycin; Emergencies; Humans; Jugular Veins; Lemierre Syndrome; Male; Mastoiditis; Otitis Media, Suppurative; Tomography, X-Ray Computed

Topics: Abscess; Adolescent; Anti-Infective Agents; Ceftriaxone; Drainage; Glomerulonephritis; Humans; Male; Mastoid; Metronidazole; Otitis Media, Suppurative; Sinus Thrombosis, Intracranial; Streptococcal Infections; Streptococcus milleri Group

During the last few decades antibiotics have played an extremely important role in the management of otitis media (OM). Nowadays there are only sporadic reports of its sequelae and complications in the developed countries. Nevertheless, complications of OM still arise and the potential seriousness of this problem emphasizes the need for a high degree of monitoring. We report herewith a case of acute mastoiditis in an 18-month-old infant with chronic suppurative otitis media (CSOM). Repeated cultures from the middle ear and mastoid cavity yielded Salmonella type C. The treatment modality and the pathophysiologic aspects are discussed.

Topics: Acute Disease; Ceftriaxone; Combined Modality Therapy; Female; Humans; Infant; Mastoiditis; Otitis Media, Suppurative; Salmonella Infections; Tomography, X-Ray Computed