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Otitis media with effusion is not a sterile inflammatory process: scanning electron microscope evidence

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

We aimed to demonstrate whether chronic otitis media with effusion (OME) is a sterile condition or biofilms-related disease through direct visualization of middle ear mucosa by Scanning electron microscopy (SEM) and culture of the effusion.

Methods

This case–control study included 60 children in two groups; the case group included 50 patients undergoing ventilation tube insertion (VTI) for Chronic OME (COME), and the control group included ten patients undergoing cochlear implantation (CI) surgery presenting normal middle ear mucosa. Biopsies from both groups' middle ear mucosa were evaluated for biofilm formation using scanning electron microscopy (SEM). Middle ear effusion (MEE) samples from COME patients were cultured on blood agar to detect and identify any bacterial growth. The adenoid size was evaluated and correlated to the biofilm formation in COME patients.

Results

There was a significant difference between case and control groups regarding biofilm formation (p-value < 0.001*). Biofilm was evident in 84% of the COME patients (cases group) and absent in the control group. Only 12 COME patients (24%) had positive MEE culture, however, 76.2% of patients with biofilm had a negative culture. Streptococcus pneumonia was the most common otopathogen found either alone or combined with other otopathogens. There was a significant negative correlation between adenoid size and biofilm grade among the studied patients.

Conclusion

The visual identification of middle ear biofilms indicated their role in chronic OME. Middle ear biofilms need to be expected in children with OME, especially those who do not need adenoid surgery.

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Availability of data and materials

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors have no funding or financial relationships to disclose.

Author information

Authors and Affiliations

  1. Otorhinolaryngology, Faculty of Medicine, Kafrelsheikh University, El-geish street, Kafrelsheikh, 33155, Egypt

    Saad Elzayat & Ibrahim A. Abdulghaffar

  2. Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

    Nahla Nosair

  3. Pathology (Microbiology & Immunology Unit), College of Medicine, Jouf University, Sakaka, Saudi Arabia

    Amany A. Ghazy

  4. Microbiology and Immunology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

    Amany A. Ghazy

Authors
  1. Saad Elzayat
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  2. Nahla Nosair
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  3. Amany A. Ghazy
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  4. Ibrahim A. Abdulghaffar
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Contributions

All authors contributed to the study conception and design. Idea formulation, Methodology, Data collection and Supervision were performed by SE. Material preparation, Writing review and editing were performed by NAEN. Data analysis, Statics and final revision were performed by AAG. The first draft of the manuscript and reference collection were performed by IAA. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ibrahim A. Abdulghaffar.

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Conflicts of interest

There is no conflict of interest.

Ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research editorial boards and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Formal consent was signed by the parents or guardians of the participants to share in this study.

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Additional informed consent was obtained from all participants' parents or guardians to share and publish their data in this article.

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The work was done in Otolaryngology, Clinical pathology and Microbiology Departments, Faculty of Medicine and Nanotechnology department, faculty of science, Kafrelsheikh University, Egypt.

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Elzayat, S., Nosair, N., Ghazy, A.A. et al. Otitis media with effusion is not a sterile inflammatory process: scanning electron microscope evidence. Eur Arch Otorhinolaryngol 278, 2713–2721 (2021). https://doi.org/10.1007/s00405-020-06338-4

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  • DOI: https://doi.org/10.1007/s00405-020-06338-4

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