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PubMed1985

Effect of nonsurgical periodontal therapy. VII. Bleeding, suppuration and probing depth in sites with probing attachment loss.

Incisors, cuspids and premolars in 49 patients with advanced chronic periodontitis were treated with initial, nonsurgical periodontal therapy. The results were monitored by probing attachment level measurements for 6 sites of each tooth every 3rd month during a period of 24 months. Amongst sites with initial probing depth greater than or equal to 4.0 mm, sites with probing attachment loss were identified using regression analysis. Scores for plaque, bleeding, suppuration on probing and probing depth, obtained for these sites during the 24-month study, were analyzed to determine whether any of the scores could be used diagnostically as an indicator of probing attachment loss. Diagnostic sensitivity and predictability were calculated for different levels of each of the scores. The results showed that sites with probing attachment loss were more frequent for sites with high scores for plaque, bleeding, residual probing depth and suppuration than in sites with low scores. However, the diagnostic sensitivity and predictability of these clinical indicators was generally low. Thus, records of plaque, bleeding, suppuration and probing depth do not obviate the need for probing attachment level measurements for identification of sites with probing attachment loss following initial, nonsurgical periodontal therapy.

Adult↗

PubMed1994

Cerebellar venous infarction in chronic suppurative otitis media. A case report with review of four other cases.

BACKGROUND: Cerebellar venous infarction is a rare condition. Thus far only four cases have been reported in the literature. We recently encountered a patient with chronic suppurative otitis media complicated by cerebellar venous infarction. The features of cerebellar venous infarction in the other four cases are also reviewed. CASE DESCRIPTION: A 20-year-old man presented with clinical features suggestive of chronic suppurative otitis media. Computed tomographic scan of the brain revealed left mastoiditis with cholesteatoma and moderate communicating hydrocephalus. The patient was subjected to left radical mastoidectomy, and an attico-antral cholesteatoma was removed. Subsequently the patient developed clinical features suggestive of cerebellar abscess. A repeat computed tomographic scan revealed normal posterior fossa. Four-vessel angiography revealed left sigmoid and lateral sinus thrombosis and nonopacification of the left-sided cerebellar veins. Magnetic resonance imaging showed a venous infarct in the left cerebellar hemisphere. The patient was treated with cerebral dehydration measures. The patient subsequently improved and had no neurological deficit 3 months after surgery. CONCLUSIONS: Although cerebellar venous infarction is rare, it can occur in chronic suppurative otitis media, pregnancy, antithrombin III deficiency, and diabetic osmolar coma. Sometimes no cause is found. Treatment includes correction of the underlying cause. The presence of a hemorrhagic lesion on computed tomographic scan and deep coma at presentation indicate poor prognosis.

Adult↗

PubMed1997

Anaerobes and fungi in chronic suppurative otitis media.

Microbiology of 102 ears with chronic suppurative otitis media was studied for aerobes, anaerobes, and fungi. Forty-four percent were pure cultures, 33.3% were mixed, and 18.6% had no growth. Seventy-four percent were aerobes, 25% fungi, and only 0.9% anaerobes. Pseudomonas aeruginosa (22.5%) was the most common isolate, followed by Staphylococcus aureus and the Aspergillus species. The possible reasons for low yield of anaerobes and the pathogenic roles of anaerobes and fungi in chronic suppurative otitis media are discussed. It is advocated that in investigating pathogenic organisms in chronic suppurative otitis media, requests should include anaerobes and fungi.

Aspergillus↗

PubMed1983

Postpneumonic pleural suppuration in children.

Postpneumonic pleural suppuration is a common condition seen in paediatric practice in Nigeria. One hundred and twenty cases seen at the University of Nigeria Teaching Hospital, Enugu, over a 4-year period were reviewed. The patients were aged between 1 1/2 months and 16 years. History of antecedent measles was elicited in 27 of the children, and 70% of the patients presented to the hospital later than 7 days after the onset of symptoms of pleura suppuration. From the pleural aspirates of 106 cases (88.3%) Staphylococcus aureus was cultured in 31.2%, but there were no organisms cultured in 39.4%. Twenty-nine children were treated by chemotherapy only; 11 of them (37.9%) died. Sixty-eight cases had tube drainage of the pleural collections, with 6 deaths (8.8%). Twenty-three patients had thoracotomy, evacuation of the suppurative lesion and decortication of the lung, with no mortality. There was overall hospital mortality of 14.2%, the highest mortality being in children who had associated measles, gastroenteritis, anaemia or malnutrition. Early surgical drainage by tube thoracostomy or by thoracotomy and decortication in addition to appropriate and adequate antibiotic therapy is the treatment of choice.

Adolescent↗

PubMed1993

Salmonella brandenburg: a novel cause of acute suppurative thyroiditis.

A patient with suppurative thyroiditis due to infection with Salmonella brandenburg is reported. Localization of the infection occurred to a pre-existing thyroid nodule after Salmonella bacteremia. S. brandenburg was isolated in pure culture from the fluid obtained by needle aspiration of the suppurated thyroid nodule. Surgical drainage followed by subtotal thyroidectomy was required to cure the disease. No evidence of pyriform sinus fistula was found. Suppurative thyroiditis due to Salmonella ubiquitous serotypes is an extremely rare condition, and infection to the thyroid produced by S. brandenburg is reported now for the first time. Indeed, the isolation rate of S. brandenburg from all human sources is low, and this microorganism is an uncommon agent of bacteremia.

Adult↗

PubMed1991

Chronic suppurative otitis media: complicated versus uncomplicated disease.

To determine prognostic factors in patients with chronic otitis media who develop suppurative complications, we performed a retrospective study of all patients with chronic suppurative otitis media who underwent mastoid surgery between the years 1981 and 1989. Patients who developed complications were compared with those who did not with respect to six prognostic variables. The results indicated that patients with complications were younger (p less than 0.001), had shorter duration of ear discharge (p less than 0.001), were more likely to have pars tensa perforations (p less than 0.05), and had a higher degree of mastoid sclerosis in the operated and contralateral ears (p less than 0.001). The presence of cholesteatoma and the sex of the patient were of no prognostic value. Bacteriology of CSF and pus specimens from patients who developed intracranial complications mostly revealed mixed flora (62.9%). Proteus species was the most frequent isolate (34%) and anaerobes were present in 21.3% of specimens. Mastoid abscess occurred in more than half the patients in the complicated group. Brain abscess (57.4%) was the most frequent intracranial complication. On the basis of our findings we recommend that risk factors in patients with chronic suppurative otitis media be identified early to enable effective measures to be taken to eradicate the disease.

Adolescent↗

PubMed2006

[Group B streptococcal vertebral osteomyelitis following superficial suppurative thrombophlebitis].

An 80-year-old woman with type II diabetes mellitus was admitted to hospital with high-grade fever and leg pain for the previous three days. Physical examination revealed marked distention of the peripheral veins in both lower legs and she complained of pain. Spontaneous superficial suppurative thrombophlebitis was diagnosed and transfusion of cefazolin every 8 hours was started immediately after blood cultures. After 48 hours, the distention of the peripheral veins was improved; however, she suffered from a severe back pain thereafter. Two sets of blood culture yielded Group B streptococcus. Therefore the antibiotic was changed to ampicillin every 6 hours. To investigate the cause of back pain, MRI of the lumbar vertebral body was taken. Saggital gadolinium T1-weighted MRI demonstrated a high signal intensity lesion from Th7 to Th11, suggesting vertebral osteomyelitis following Group B streptococcal bacteremia from superficial suppurative thrombophlebitis. One week later, the clinical symptoms mostly disappeared. After six weeks of treatment, she was discharged. Suppurative thrombophlebitis is an inflammation of the vein wall by microorganisms and sometimes causes secondary metastatic abscess. Aging and diabetes are also risk factors for group B streptococcal invasive infection. This case suggests vertebral osteomyelitis should be taken into consideration during the course of group B streptococcal bacteremia in an elderly patient complaining back pain.

Aged↗

PubMed2002

Pathogenic agents of chronic suppurative otitis media in Ilorin, Nigeria.

OBJECTIVE: To determine the type and pattern of antibiotic susceptibility of the pathogenic micro-organisms causing chronic suppurative otitis media (CSOM) in our environment. DESIGN: A retrospective study of ear discharges from patients presenting consecutively with chronic suppurative otitis media. SETTINGS: University of Ilorin Teaching Hospital, a major referral centre in the Middle Belt region of Nigeria. MAIN OUTCOME MEASURES: Bacterial isolates and their sensitivity patterns. SUBJECTS: Three hundred and seventy five patients aged between eight months and 70 years referred to the ear, nose, and throat clinic of The University of Ilorin Teaching Hospital were enrolled in the study. RESULTS: About 95.5% and 4.5% of the specimens were culture positive and negative respectively. The commonest bacterial aetiologic agents were Pseudomonas aeruginosa (26.0%) and Proteus spp (21.8%). Peak prevalence of 30.5% occurred among the 0-5 years age group. Seventy five per cent of isolates were gram-negative bacteria. Ofloxacin produced 100% sensitivity in both gram positive and gram-negative organisms tested. Colistin, ceftazidime and cefuroxime were highly active (80%) against the gram-negative bacteria while erythromycin and cloxacillin were very effective (80%) against the gram-positive isolates. CONCLUSION: Chronic suppurative otitis media is still highly prevalent in our environment, affecting mainly children. The antibiotic susceptibility pattern of pathogenic isolates is different from those of other regions of Nigeria with increasing resistance recorded for some organisms. Hence, where possible and available, susceptibility tests should guide the management of CSOM in this environment, otherwise, ofloxacin if indicated and cloxacillin/erythromycin may provide relief and delay emergence of resistant strains.

Adolescent↗

PubMed2000

Microbiology of chronic suppurative otitis media with cholesteatoma.

OBJECTIVE: To report the result of causative organisms in chronic suppurative otitis media with cholesteatoma. METHODS: Eighty eight patients clinically diagnosed with chronic suppurative otitis media with cholesteatoma, and confirmed intra-operatively and by histological examination were pre-operatively studied for the causative bacteria and fungi. RESULTS: A single isolate was obtained in 42 (48%) cases, no growth was isolated in 11 (12.5%) cases. Most common bacteria isolated were, Pseudomonas aeruginosa in 51%, Staphylococcus aureus in 31%, and Proteus species in 17%. Among the 15 fungal isolates, 9 (10%) were Aspergillus species and the remaining 6 (7%) were Candida albicans. CONCLUSION: Conventional ear swabs taken under direct vision using an operating microscope are reliable in establishing the microbiological profile of chronic suppurative otitis media.

Adolescent↗

PubMed2002

[Early complications of surgery for chronic suppurative otitis media].

OBJECTIVE: To explore early post-operative complications following surgery for chronic suppurative otitis media. METHOD: From Jan 1992 to July 2000, 291 cases of chronic suppurative otitis media have been treated in our department. 79 cases underwent myringoplasty, 82 cases tympanoplasty, 88 cases modified radical mastoidectomy and 42 cases radical mastoidectomy. RESULT: Facial nerve palsies occurred in 3 cases (1.03%), bone conduction threshold elevation occurred in 13 cases (4.47%), wound infection occurred in 11 cases (3.78%), 7 patients (2.41%) reported symptoms related with chorda tympani trauma, symptoms of jaw discomfort were reported by 7 patients (2.41%) and imbalance or vertigo by 13 patients(4.47%). CONCLUSION: The incidence of early complications of surgery for chronic suppurative otitis media in this report was similar to previous reports.

Adolescent↗

PubMed1999

Chronic suppurative otitis media in a children's hospital in Addis Ababa, Ethiopia.

Our knowledge of chronic suppurative otitis media is scanty in Ethiopia. This hospital-based study was, thus, conducted prospectively over a period of 2 years among children visiting a tertiary facility in Addis Ababa. Demographic, clinical, audiometric and microbiological data were collected using a preformed questionnaire. A total of 391 patients constituting 0.6% of the hospital patient population and 22.3% of those seen at the ear, nose, and throat clinic had chronic suppurative otitis media. Most (82.1%) of them were from Addis Ababa, the male to female ratio was 1.6:1, and their median age at presentation was 5.9 years. Otorrhoea had started before the age of 2 years in 269 (68.8%), was bilateral in 215 (55.0%), recurrent in 285 (72.9%), and continuous in 106 (27.1%). Otalgia was reported in only 18%. Hearing loss was the major presenting symptom and the loss was moderate to severe (grades 2 and 3) in 32 (69.6%) and slight (grade 1) in 14 (30.4%) of the ears tested audiometrically. Malnutrition, nasopharyngitis, measles, HIV infection, tuberculosis, diabetes mellitus, neoplastic diseases, and structural abnormalities were common antecedents. Serious complications included systemic infections, otogenic meningitis, mastoiditis, and tetanus. A total of 106 bacterial isolates were cultured from ear discharges of 80 patients. Proteus species were the commonest, accounting for 40 (37.7%) followed by Staphylococcus aureus, Pseudomonas aeruginosa, and Gram negative enterics. All isolates were highly resistant to the commonly used antibiotics including penicillin, ampicillin, amoxycillin, trimethoprim-sulfamethoxazole, and chloramphenicol. Augmentin, gentamicin, and kanamycin were the only drugs to which most of the pathogens were sensitive. Marked improvement on the discharge was achieved in 64% of the 116 patients who complied with treatment. Awareness about the health implications of the disease seemed to be lacking in among the caretakers. Selective use of antibiotics and continuous aural cleansing need to be promoted. More elaborate epidemiological studies will be required to define the magnitude of the problem and identify optimal therapeutic modalities of suppurative ear disease in Ethiopia.

Child↗

PubMedDate not supplied

[Efficacy of topical ciprofloxacin and tobramycin in combination with dexamethasone in the treatment of chronic suppurative otitis media].

OBJECTIVES: To evaluate the efficacy of topical ciprofloxacin and tobramycin with and without topical dexamethasone in the treatment of chronic suppurative otitis media without cholesteatoma. PATIENTS AND METHODS: The study included 103 ears of 80 patients (49 males, 31 females; mean age 31 years; range 18 to 60 years) with chronic suppurative otitis media without cholesteatoma. The patients were randomly divided into four groups to receive topical applications of either ciprofloxacin and tobramycin alone, or in combination with dexamethasone. Cultures were obtained from the ears preoperatively and 24 hours after treatment. RESULTS: Aerobic bacteria were isolated in 94.1% of patients before the treatment, the most common being Pseudomonas aeruginosa (38.9%). With dexamethasone, the clinical response for ciprofloxacin and tobramycin increased from 80% to 90% and from 70% to 75%, respectively, but this improvement was not significant (p > 0.03). Addition of dexamethasone to ciprofloxacin decreased the recovery period from 14 days to seven days, whereas no change (7 days) was observed with tobramycin. CONCLUSION: The efficacy of ciprofloxacin and tobramycin were similar in the treatment of chronic suppurative otitis media. Addition of dexamethasone to ciprofloxacin decreased the treatment period.

Administration, Topical↗

PubMed2001

[The clinical investigation of bacteriology of chronic suppurative otitis media].

OBJECTIVE: To understand bacteriology of chronic suppurative otitis media (CSOM) and drug sensitivity of isolated bacteria for better treatment of CSOM. METHOD: Secretions of 92 samples with chronic suppurative otitis media were collected and cultured for aerobic and anaerobic bacteria respectively. Drug sensitivity test of isolated bacteria was done. RESULT: Aerobic bacteria was found in 75 of 92 samples (81.5%), the main pathogens were pseudomonas aeruginosa, aureus staphylococcus and bacillus proteus, and their sensitive rates for ciprofloxacin were 89.0%, 88.2% and 85.0% respectively. Anaerobic bacteria was found in 10 samples (10.9%) and the relative sensitive drug was cefoperazone sodium. CONCLUSION: Pseudomonas aeruginosa, aureus staphylococcus and bacillus proteus are the main pathogens of chronic suppurative otitis media, and their sensitive rates for ciprofloxacin are high.

Adolescent↗

PubMedDate not supplied

[Acute suppurative thyroiditis in a patient with prior subacute thyroiditis].

Acute suppurative thyroiditis is an uncommon thyroid disorder usually caused by bacterial infection. The most common route of infection is a fistula that originates from the fundus of the pyriform sinus. Pre-existing thyroid disease, most commonly nodular goiter, has been reported to be present in acute suppurative thyroiditis. A 44 year old man presented a subacute thyroiditis, resolved by nonsteroidal antiinflammatory treatment. One year later, the patient abruptly complained of fever and painful swelling in the thyroid region. A relapse subacute thyroiditis was diagnosed and prednisone treatment was started. A few days later owing to a worsening of the pain and of the clinical features the patient was referred to our department. He presented dysphagia and he was feverish, the overlying skin of the neck swelling was erythematous and warm. There was a neutrophilia (83.7%). Plasma FT4, FT3 and TSH were normal. Anterior neck region ultrasonography showed an enlargement of the left thyroid lobe with poorly defined shapes and inhomogeneous parenchyma while the right lobe of the gland was normal. The 131-I thyroid scan showed a large cold area in the upper part of the left thyroid lobe and preserved radionuclide uptake in the residual parenchyma. The RAIU was normal. We diagnosed acute suppurative thyroiditis and started antibiotics treatment. The day after the patient was still feverish and he gave out from the mouth a great quantity of sero-purulent material with a swelling reduction and improvement of the neck pain. Barium swallow examination did not show any fistula in the cervical esophagus. The fistula opening was demonstrated by indirect laryngoscopy in the postero-lateral side of hypopharynx.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗

PubMed2003

Unilateral submandibular suppurative sialadenitis in a premature infant.

UNLABELLED: Isolated submandibular suppurative sialadenitis is extremely rare in newborn infants and is associated with prematurity and prolonged gavage feeding. This report describes a premature infant who developed a life-threatening airway obstruction due to suppurative submandibular sialadenitis. The diagnosis was made on clinical grounds and confirmed by ultrasonography. Staphylococcus aureus was grown from the pus expressed from the Wharton's duct orifice. Upper airway obstruction and respiratory failure were managed with intubation and mechanical ventilation, and the sialadenitis resolved quickly and completely with flucloxacillin treatment. Possible causes of sialadenitis include dehydration, decreased saliva flow and stasis during gavage feeding, duct obstruction by stones and direct bacterial inoculation. Ultrasonography is the diagnostic imaging of choice to exclude congenital tumours, lymphadenitis, congenital malformations of the Wharton's duct or the gland itself, and subcutaneous fat necrosis. CONCLUSION: Early diagnosis and antibiotic treatment of suppurative submandibular sialadenitis may prevent complications such as abscess formation, septicaemia and respiratory failure.

Ceftazidime↗

PubMed2004

[Evaluation of healing effect for simultaneously tympanoplasty in treating chronic suppurative otitis media with cholesteatoma and/or granulation tissue].

OBJECTIVE: This study was designed to discuss possibility and factors influencing healing effect for simultaneously tympanoplasty of chronic suppurative otitis media with cholesteatoma and/or granulation tissue. METHOD: For 52 cases with chronic suppurative otitis media with cholesteatoma (30 ears) and/or granulation tissue (22 ears), cleaning lesion with simultaneously tympanoplasty was surgical procedure, among them, 12 ears treated with single tympanoplasty, 40 ears treated with mastoidectomy and tympanoplasty. RESULT: All cases had dry ears without recurring cholesteatoma. Among them, hearing of 5 patients improved more than 30 dB, 9 ears improved from 20 to 29 dB, 31 ears improved from 10 to 19 dB and 7 ears improved less than 10 dB. Hearing of no cases reduced than that in preoperation. CONCLUSION: Simultaneously tympanoplasty would be carried out possible in treating chronic suppurative otitis media with cholesteatoma and/or granulation tissue. There were two important factors influencing hearing improvement, which concluded effective area of tympanic membrane concussion, activity of stapes and/or stapes footplate. The main cause for failure in hearing improvement would be eustachian tube obstruction.

Adolescent↗

PubMed2005

[Analysis of preoperative findings and ossicular condition in chronic suppurative otitis media].

OBJECTIVE: To discussion the relationship of preoperative findings and ossicular condition in chronic suppurative otitis media. METHOD: The correlation between the ossicular conditions and classification of tympanic membrane perforation, ear discharge, air conduction pure tone average, air-bone gap, pneumatization, complication, and cholesteatoma in 251 patients(288 ears) with chronic suppurative otitis media was analysed. RESULT: The air-conduction threshold and air-bone gap in patients with ossicular discontinuity are higher than that in patients with ossicular continuity. Ossicular discontinuity in patients with perforation of the pars flaccida of tympanic membrane, persistently draining ears, complications, and cholesteatoma occurred significiantly more frequently than those without these conditions. CONCLUSION: The air-conduction threshold and air-bone gap are the more reliable indications to identify the ossicular conditions in patients with chronic suppurative otitis media. There are significiant correlation between the ossicular conditions in patients with chronic otitis media and their classification of tympanic membrane perforation, ear discharge, complication, and cholesteatoma.

Adolescent↗

PubMed2006

[Microorganisms isolated from middle ear cultures and their antibacterial susceptibility in patients with chronic suppurative otitis media].

OBJECTIVES: This study sought to determine causative microorganisms of chronic suppurative otitis media and their antibacterial susceptibility. PATIENTS AND METHODS: Bacteriologic results of middle ear swabs, agent microorganisms, and their susceptibility to antibiotics were evaluated in 70 patients (65 males, 5 females; mean age 21.1+/-1.3 years; range 19 to 25 years) with chronic suppurative otitis media. RESULTS: No bacteria were isolated in 14% of the patients. Of 60 patients in whom bacteria were isolated, the most common bacteria was Pseudomonas aeruginosa (23%), followed by Staphylococcus aureus (18%), and Proteus spp. (17%). P. aeruginosa strains were susceptible to ceftazidime and imipenem (100%), ciprofloxacin (92%), and amikacin and gentamycin (85%); S. aureus strains were susceptible to methicillin and vancomycin (100%), ciprofloxacin (91%), sulbactam-ampicillin (73%), and gentamycin and trimethoprim-sulfamethoxazole (63%). Proteus strains were susceptible to ciprofloxacin (100%), ceftazidime (90%), and imipenem and gentamycin (70%). CONCLUSION: Appropriate knowledge of antibacterial susceptibility of microorganisms will contribute to rational antibiotic usage and the success of treatment for chronic suppurative otitis media.

Adult↗