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International Journal of Research in Medical Sciences

Vaghela AA et al. Int J Res Med Sci. 2016 Jul;4(7):2656-2660
www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161927
Research Article

An analysis of ear discharge and antimicrobial sensitivity used
in its treatment
Mukund M. Vaghela1*, Hiren Doshi2, Sneha Rajput1

1
Department of ENT, SMTNHL Medical College, Ahmedabad, Gujarat, India
2
Department of ENT, AMCMET, Medical College, Ahmedabad, Gujarat, India

Received: 27 May 2016
Revised: 10 May 2016
Accepted: 03 June 2016

*Correspondence:
Dr. Mukund M. Vaghela,
E-mail: akansha_prajapati@yahoo.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Ear discharge is one of the cardinal symptoms of ear infection along with progressive deafness, pain,
tinnitus and vertigo. Main objectives of the study were to study the various causes of ear discharge, isolate and
identify the microorganisms associated with different causes of ear discharge and study the antibiotic sensitivity
patterns of the isolated organisms.
Methods: All the patients matching the inclusion criteria were enrolled and sample of ear discharge was collected.
This sample was sent to the microbiology laboratory for isolation of microorganism and antimicrobial sensitivity
testing.
Results: In present study 115 samples of ear discharge were examined for the presence of microorganisms. Out of
115, 93 (80.86%) samples were positive for growth of microorganisms and 22 (19.13%) samples were sterile. Out of
93% positive samples 61 (65.59%) samples were pure-bacterial growth, 8 (*8.60%) samples showed pure fungal
growth and 24 (25.80%) showed mixed growth of both bacteria anti fungi.
Conclusions: Overall bacterial isolates were higher than fungal and pseudomonas appeared to be most common. It
was found sensitive to ceftazidime, amikacin, imipenem, colistin and aztreonam.

Keywords: Ear infection, Antimicrobial sensitivity

INTRODUCTION Anatomy of the EAR

Ear discharge is any fluid that comes out from the As the matter of fact ear performs two sensory function:
external ear, also known as otorrhea. It could be in the hearing and maintenance of equilibrium balance of the
form of blood, wax, pus or mucous fluid. body. Ear can be divided in to three parts: outer ear,
middle ear and inner ear.2
Ear discharge is one of the cardinal symptoms of ear
infection along with progressive deafness, pain, tinnitus Outer ear
and vertigo.
It consists of two parts, pinna and external auditory
Infection of the ear can be classified depending upon the meatus. The external auditory meatus extends up to the
site: otitis externa (infection of external ear) and otitis tympanic membrane (ear drum). Pinna and external
media (infection on middle ear).1

International Journal of Research in Medical Sciences | July 2016 | Vol 4 | Issue 7 Page 2656

macconkey’s agar. Hence. hot air oven. Thus management of every case of ear sebaceous glands.  Cleft palate  Loss of cerumen Instruments required are microscope. invasion of microorganism which may also open the nutrient agar. AMC MET Medical College. condition of external auditory canal for the presence of congestion. growth: triple sugar iron. glucose phosphate people worldwide have hearing loss where major cause is broth. Sample collection Written informed consent was taken from all the patients Figure 1 Anatomical representation of ear. teasing needles and sterile swab. Various Any of the above predisposing factors can lead to culture media used: sabouraud dextrose agar (SDA). citrate agar slant.  Nasal allergy Specimen was sent to microbiology department for  Tumors of nasopharynx further morphological study and antibiotic sensitivity. International Journal of Research in Medical Sciences | July 2016 | Vol 4 | Issue 7 Page 2657 . The coiled portion of discharge comprising bacteria and fungus so as to study labyrinth is called cochlea. A standard case record  Chronic rhinitis and sinusitis form was filled up by the doctor for each enrolled patient. Int J Res Med Sci. Inclusion criteria All patients were included in the study consecutively after the initial clinical examination of the patients with clinical history as per performa. Malleus knowing this aspect has been increasing because of is attached to the tympanic membrane and stapes is excessive use of broad spectrum antibiotics. discharge and perforation. Ear infection in any form has a varied microbial etiology. General Hospital and Department of Microbiology. With this METHODS brief understanding of the anatomy of the ear. apparatus which is made up of three semi-circular canals and otolith organ containing saccule and utricle. After  Recurrent attacks of common cold thorough examination discharge material was collected  Infections of tonsils and adenoids with two clean sterile swab stick. chocolate route to middle ear infection.4(7):2656-2660 auditory meatus possess fine hairs and wax secreting otitis media. India. 2016 Jul. debris. Study was conducted from 22nd December 2014 to March 2015. blood agar. Eustachian tube corticosteroids and cytotoxic chemotherapy. agar. malleus. Biochemical medium for identification of bacterial which influences the selection of an efficacious anti. incubator. Vaghela AA et al. let us now discuss the different infections of the ear and its This study was conducted in OPD patients visiting microbiological nature.2 connects the middle ear cavity with pharynx. yeast nitrogen based medium (YNB). urea slant. autoclave. tryptophan broth. discharge becomes utmost important. attached to the oval window of cochlea. but very less is known about Contains three ossicles.3 Main objectives of the study were to study the various Inner ear causes of ear discharge and to isolate and identify the microorganisms associated with different causes of ear Inner ear contains complex system called vestibular discharge. Maninagar Ahmedabad. Proper examination was done by the clinician of the ENT department to assess the Ear infection in presents with lots of different etiology. incus and stapes are mycological aspects of this.4 Middle ear Many studies have been conducted focusing bacterial flora of ear discharge.G. this study was undertaken with the objective of Labyrinth consists of two parts: bony part which is a identification and isolation of etiological agents in series of channels and membraneous part which is filled patients coming to ENT OPD with the complain of ear with fluid called endolymph. According to WHO survey 42 million phenylalanine slant. In recent past importance of attached to one another in a chain-like fashion. before recruiting in the study. The organ of corti is a the resistance pattern of microorganisms and provide a structure located on the basilar membrane containing hair guideline for empirical antibiotic therapy. Department of ENT at L. Gujarat. microbial agent. cells which act as an auditory receptors.

The test. organisms inclded: Staphylococcus aureus 20.33%.28% were gram negative bacteria and 34.34% Tinnitus 53 46. Int J Res Med Sci. lactophenol cotton blue. Day 3: Identification and result of antibiotic sensitivity A total of eight different organisms were isolated. Klebsiella pneumoniae 8.38% and Citrobacter freundii 1. coli 4. of resistant Out of 93% positive samples 61 (65.42%. microorganisms and 22 (19. Number of patient Complains Percentage (%) (total=115) Earache 66 57. Vaghela AA et al.40% were fungal species.59%) samples were iolates isolates pure-bacterial growth. 93 (80. Out of 115. 64. 2016 Jul. Day 2: Process for identification and antibiotic sensitivity test according to gram staining Figure 3: Percentage of microorganisms. Protes Mirabalis 2. for fungus: 10% Following table shows most common complains of potassium hydroxide.21% The pattern of microbial isolates showed that 41.19%.4(7):2656-2660 Reagents used were gram staining kit.38%.86%) samples were positive for growth of Table 2: Sensitivity of pseudomonas to antibiotics.80%) showed mixed growth of Colistin 36 2 both bacteria anti fungi. Pseudomonas RESULTS aeruginosa 45. Acinobacter spp. patients with ear discharge: Laboratory investigation of ear discharge Table 1: Complains of patients.23%.23%.13%) samples were sterile. examined for the presence of microorganisms.60%) samples showed pure Ceftazidime 35 3 fungal growth and 24 (25. In present study 115 samples of ear discharge were 2.08% Decreasing 23 20% hearing Deafness 6 5. 8 (*8.39% Earwax 5 4. International Journal of Research in Medical Sciences | July 2016 | Vol 4 | Issue 7 Page 2658 . Minocycline 7 3 Imipenem 35 3 Piperacillin/ 35 3 tazobactum Levofloxacin 30 8 Ciprofloxacin 27 11 Aztreonam 35 3 Cefoperazone/ 36 2 sulbactum Amikacin 34 4 Figure 2: Percentage of samples showing growth of Cefotaxime 25 13 microorganism. E.of sensitive No.65% of total isolate were gram positive bacteria.76%. Coagulase negative staphylococci 21. Antibiotic No.

13% 19. tinnitus and Neck Surg. Indian Journal of In conclusion. Mccartney.33% 9.34%. Int J Pediatrician.40% 23. Elsevierr publication. candida albicans.9:77-87. develoing countries due to overcrowding. Philadelphia : PAWB .13% samples were sterile. Practical Medical Microbiology- Institutional Ethics Committee 14th edition. fungal and pseudomonas appeared to be most common. In this study Vancomycin 17 9 80. 6. Poorey VK.35%) Candida sp.25% imipenem.86% which was similar to the study Linezolide 17 17 conducted by Ariyal c et al7 (82. poor sanitation and poor ducation. 2001:79-1014. The changing pattern of otitis Funding: No funding sources media in Korea.4% Sterile 19. 1985. Among mostly resistant to cefuroxamine.of sensitive No. International Journal of Research in Medical Sciences | July 2016 | Vol 4 | Issue 7 Page 2659 .6% Common age group 21-30 years 0-30 years 0-20yr Total bacterial isolates recoverd 91. Kim CS. tigecycline. Totalbacterial Tetracycline 16 1 isolates were 90. 3rd edition. Noh KT.65% Pseudomonas Stapylococcus aureus Staphylococcus aureus Most common bacterial isolates aeruginosa (45. decrease hearing.34% Total fungal isolates 34. 6.86% 80.4(7):2656-2660 Out of 8 isolates 46. Saunders. Iyer Arti. Any organismcan can infect the ear if the defence barrier Table 3: Antibiotic sensitivity for mecchanism are breached. amikacin. It 2002.86% 90. Int J Res Med Sci. 2016 Jul. fluroquinolone. In otitis colistin and aztreonam. Etiology and pathogenesis of chronic of hearing impairment. levofloxacine.60% 2.6%).32% and total fungal isolates were Cefotaxime 16 1 30.23%) (37. Microbioligy. Kenna M.62% were Klesbsiella was 100% sensitive to ceftazidime. Study of bacterial flora in CSOM and its clinical significance. only be used after culture sensitivity tests. aztreonam.6%) CONCLUSION REFERENCES Otitis media found to be more prevalant during high humidity environment and one of the commonest cause 1. 4.23%) (42. Arch Otolarnygol Head patient having ear discharge were earache.54:91-5. 1998.87% were aspergillus. Vaghela AA et al. Blue stone CD. was found sensitive to ceftazidime.6%) Commonet fungus Candida albicans (25%) Aspergillus niger (17.86% samples were positive for the microorganism Ciprofloxacin 8 1 growth and 19. Incidence of ear Cotrimoxazole 0 0 discharge as more common in females which was also similar to the above mentioned study. Theseresults were comparable to the study Gentamicin 15 2 conducted bt Oni AA et al.6 In present study postive growth was Clindamycin 17 0 found in 80. Most common complain of suppurative otitis media. It was were other (scopulariopsis and chrysosporium).It was Penicillin G 0 17 intended to cover all the aspects related to ear discharge Oxacillin 15 5 and microrganism involved in itand sensitivity pattern Erythromycin 12 0 amongst bacteria. Mackie.25% were dermatophytes.39% 97. Antibiotics and antifungal should media in infants and children.97(2):16-7.32% 76. imipenem. overall bactrial isolates were higher than Otolaryngology and Head and neck surgery. It is reported to occur in Staphylococcus aureus.5 No. of resistant Antibiotic iolates isolates Present study was carried out in 115 patients. 3. India 2008. Conflict of interest: None declared Otorhinolaryngology.8 Table 4: Comparison of the study. Klein JO. 2. 40. Ethical approval: The study was approved by the 5. Observation Presnt study Nageshwari et al9 Arti agrawal et al10 Culture positive cases 80. (1. 85 bacterial isolated pseudomonas aeruginosa was most common bacterium isolated followed by staphylococcus DISCUSSION aureus.

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