• Shahid Farooq Khattak CMH Abbottabad
  • Nadeem Ahmed Sheikh
  • Adil Aleem


Background: Chronic otitis media is described as a tympanic membrane perforation and ear discharge for more than six weeks duration. Ascending infection from the nasopharynx into the middle ear cleft has been attributed to prevent resolution of chronic otitis media. This research aims to determine the association between the microbiological flora of the nasopharynx with that of the middle ear in patients suffering from chronic (active) mucosal otitis media. Methods: Our study is a hospital-based cross-sectional survey. It was conducted from December 2015 to February 2017 at the Department of ENT, Combined Military Hospital, Abbottabad. Ear and nasopharyngeal swabs were obtained from 65 patients of chronic active mucosal otitis media and sent for microbiological analysis. Microbiological culture and sensitivity test was performed to identify the microbial spectrum of each specimen. Performa bearing the result of otoscopy, aspirate and swabs were completed for middle ear and the nasopharyngeal culture with reference to each patient. Descriptive statistics and Pearson’s chi square analysis were performed using SPSS-22. Results: Staphylococcus aureus and Pseudomonas aeruginosa are foremost micro-organisms found in otorrhea culture isolated from patients of chronic active mucosal otitis media. Majority of the cultures from nasopharynx of these patients did not reveal any growth after incubation for 48 hours. Conclusion: A statistically insignificant association exists between the microbiological spectrum of the middle ear and the nasopharynx of patients suffering from chronic active mucosal otitis media. Micro organisms’ exposure from a perforated tympanic membrane remains leading cause of persistent otorrhea, rather than ascending infection through the Eustachian tube.Key words: Otitis, otitis media; suppurative; culture techniques; microbiology


Matsuda Y, Kurita T, Ueda Y, Ito S, Nakashima T. Effect of tympanic membrane perforation on middle-ear sound transmission. J Laryngol Otol 2009;123(Suppl 31):81–9.

Vilchez-Madrigal LD, Osborn AJ. Management of the Child with Otorrhea. In: Infectious Diseases in Pediatric Otolaryngology. Springer; 2016. p.3–13.

McKenzie W, Brothwell D. Disease in the ear region. Diseases in Antiquity London, UK: Charles C Thomas Publisher. 1967;464–73.

Browning GG. Etiopathology of inflammatory condition of the external and middle ear. Chapter 3. Scott-Brown. Otolaryngology 6 ed. Vol 3 London Arnold; 1997.

da Costa SS, Paparella MM, Schachern PA, Yoon TH, Kimberley BP. Temporal bone histopathology in chronically infected ears with intact and perforated tympanic membranes. Laryngoscope 1992;102(11):1229–36.

Acuin J, WHO. Chronic suppurative otitis media: burden of illness and management options; 2004.

Mirza IA, Ali L, Arshad M. Microbiology of chronic suppurative otitis media-experience at Bahawalpur. Pak Armed Forces Med J 2008;4:372–6.

Browning GG, Gatehouse S. The prevalence of middle ear disease in the adult British population. Clin Otolaryngol Allied Sci 1992;17(4):317–21.

Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D. Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol 2008;122(5):442–6.

van der Veen EL, Schilder AG, van Heerbeek N, Verhoeff M, Zielhuis GA, Rovers MM. Predictors of chronic suppurative otitis media in children. Arch Otolaryngol Head Neck Surg 2006;132(10):1115–8.

Chadha SK, Agarwal AK, Gulati A, Garg A. A comparative evaluation of ear diseases in children of higher versus lower socioeconomic status. J Laryngol Otol 2006;120(1):16–9.

Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Otitis media—principles of judicious use of antimicrobial agents. Pediatrics 1998;101(Suppl 1):165–71.

Sade J. Ciliary activity and middle ear clearance. Arch Otolaryngol 1967;86(2):128–35.

Winther B, Hayden FG, Arruda E, Dutkowski R, Ward P, Hendley JO. Viral respiratory infection in schoolchildren: effects on middle ear pressure. Pediatrics 2002;109(5):826–32.

Brook I, Burke P. The management of acute, serous and chronic otitis media: the role of anaerobic bacteria. J Hosp Infect 1992;22(Suppl A):75–87.

Bluestone CD, Stephenson JS, Martin LM. Ten-year review of otitis media pathogens. Pediatr Infect Dis J 1992;11(Suppl 8):S7–11.

Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente vaccine study center group. Pediatric Infect Dis J 2000;19(3):187–95.

Eskola J, Kilpi T, Palmu A, Jokinen J, Haapakoski J, Herva E, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001;344(6):403–9.

Casey JR, Pichichero ME. Changes in frequency and pathogens causing acute otitis media in 1995-2003. Pediatric Infect Dis J 2004;23(9):824–8.

Mansoor T, Musani MA, Khalid G, Kamal M. Pseudomonas aeruginosa in chronic suppurative otitis media: Sensitivity spectrum against various antibiotics in Karachi. J Ayub Med Coll Abbottabad 2009;21(2):120–3.

Anwar-us-Salam AS, Abdulla EM. Suppurative otitis in Karachi: An audit of 510 cases. Pak J Otolaryn 1997;13:66–9.

Ahmed B, Hydri AS, Ejaz A, Farooq S, Zaidi SK, Afridi AA. Microbiology of ear discharge in Quetta. J Coll Physicians Surg Pak 2005;15(9):583–4.

Leach AJ, Boswell JB, Asche V, Nienhuys TG, Mathews JD. Bacterial colonization of the nasopharynx predicts very early onset and persistence of otitis media in Australian aboriginal infants. Pediatric Infect Dis J 1994;13(11):983–9.

Faden H, Duffy L, Wasielewski R, Wolf J, Krystofik D, Tung Y. Relationship between nasopharyngeal colonization and the development of otitis media in children. J Infect Dis 1997;175(6):1440–5.

Harabuchi Y, Faden H, Yamanaka N, Duffy L, Wolf J, Krystofik D. Nasopharyngeal colonization with nontypeable Haemophilus influenzae and recurrent otitis media. J Infect Dis 1994;170(4):862–6.

Aniansson G, Alm B, Andersson B, Larsson P, Nylen O, Peterson H, et al. Nasopharyngeal colonization during the first year of life. J Infect Dis 1992;(Suppl 1):S38–42.

Faden H, Qaz MJ, Bernstein JM, Brodsky L, Stanievich J, Oqra PL. Nasopharyngeal flora in the first three years of life in normal and otitis-prone children. Ann Otol Rhinol Laryngol 1991;100(8):612–5.

Trottier S, Stenberg K, Svanborg-Eden C. Turnover of nontypable Haemophilus influenzae in the nasopharynges of healthy children. J Clin Microbiol 1989;27(10):2175–9.

Pelton SI, Loughlin AM, Marchant CD. Seven valent pneumococcal conjugate vaccine immunization in two Boston communities: changes in serotypes and antimicrobial susceptibility among Streptococcus pneumoniae isolates. Pediatric Infect Dis J 2004;23(11):1015–22.