Aerobic bacteria associated with chronic suppurative otitis media in Angola

Background:Chronic suppurative otitis media(CSOM)is an important cause of hearing loss in children and constitutes a serious health problem globally with a strong association to resource-limited living conditions.Topical antibiotics combined with aural toilet is the first-hand treatment for CSOM but antimicrobial resistance and limited availability to antibiotics are obstacles in some areas.The goal of this study was to define aerobic pathogens associated with CSOM in Angola with the overall aim to provide a background for local treatment recommendations.Methods:Samples from ear discharge and the nasopharynx were collected and cultured from 152 patients with ear discharge and perforation of the tympanic membrane.Identification of bacterial species was performed with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and pneumococci were serotyped using multiplex polymerase chain reactions.Antimicrobial susceptibility testing was done according to EUCAST.Results:One hundred eighty-four samples from ear discharge and 151 nasopharyngeal swabs were collected and yielded 534 and 289 individual isolates,respectively.In all patients,correspondence rate of isolates from 2 ears in patients with bilateral disease was 27.3%and 9.3%comparing isolates from the nasopharynx and ear discharge,respectively.Proteus spp.(14.7%),Pseudomonas aeruginosa(13.2%)and Enterococcus spp.(8.8%)were dominating pathogens isolated from ear discharge.A large part of the remaining species belonged to Enterobacteriaceae(23.5%).Pneumococci and Staphylococcus aureus were detected in approximately 10%of nasopharyngeal samples.Resistance rates to quinolones exceeded 10%among Enterobacteriaceae and was 30.8%in S.aureus,whereas 6.3%of P.aeruginosa were resistant.Conclusions:The infection of the middle ear in CSOM is highly polymicrobial,and isolates found in nasopharynx do not correspond well with those found in ear discharge.Pathogens associated with CSOM in Angola are dominated by gram-negatives including Enterobacteriaceae and P.aeruginosa,while gram-positive enterococci also are common.Based on the results of antimicrobial susceptibility testing topical quinolones would be the preferred antibiotic therapy of CSOM in Angola.Topical antiseptics such as aluminium acetate,acetic acid or boric acid,however,may be more feasible options due to a possibly emerging antimicrobial resistance.

Squamous Cell Carcinoma of the Middle Ear: Case Report and Literature Review

Malignant tumors originating from the middle ear are rare. The literature identifies chronic inflammation and Human Papillomavirus (HPV) infection as the most common risk factors. A CT scan to assess bony invasion and an MRI to evaluate soft tissue involvement, depth of invasion, and perineural invasion, followed by a biopsy, are indispensable for diagnosis and treatment. There is no standard treatment for squamous cell carcinoma of the middle ear, however, most reported cases are treated with surgical resection followed by postoperative radiotherapy. Given the challenges of achieving complete surgical excision, radiotherapy plays a crucial role in controlling middle ear cancers, as demonstrated in our case. We present a case of squamous cell carcinoma of the middle ear in a 63-year-old female with a history of chronic suppurative otitis media. The patient underwent a right subtotal petrosectomy without lymph node dissection followed by concurrent chemoradiotherapy. At the one-year follow visit, no recurrence or metastasis was detected.

Bilateral squamous cell carcinoma of the temporal bone:A report of two cases and a systematic review of the literature

Objective:two new cases of temporal bone squamous cell carcinoma(TBSCC)with a bilateral occurrence are presented.Furthermore,a review of the literature was performed and the yearly incidence was calculated.Methods:A systematic review of the literature was conducted using PRISMA guidelines.Results:Twenty-two more cases were found in literature.With a total of 24 cases,the calculated yearly incidence of bilateral TBSCC is 49:10^12 A history of chronic otitis or regional radiotherapy was found in respectively 50%and 12%of patients.In nine patients,the tumors developed synchronously(within 6 months)and in 13 metachronously.Conclusions:The calculated incidence is 89 times higher than mathematically expected considering the incidence of unilateral cases.An explanation might be a history of chronic otitis or prior radiotherapy.The tumor staging of both the first tumor group and the contralateral tumor group are similar to unilateral temporal bone squamous cell carcinoma series.