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Recurrent otorrhea in chronic suppurative otitis media: is biofilm the missing link?

  • Otology
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Abstract

Dispersal of bacteria from a biofilm in the middle ear, serving as a bacterial reservoir, could explain the recurrent and chronic nature of chronic suppurative otitis media (CSOM). The objective of this study is to investigate if the same strains of bacteria could be detected in repeated episodes of otorrhea in CSOM. In a prospective case series at a primary healthcare clinic in Nuuk, Greenland, patients with more than 14 days of otorrhea were included consecutively. Samples for culturing and biofilm analysis were taken at enrollment and at any subsequent episode with otorrhea. Participants were treated with daily saline irrigation and Ciprofloxacin eardrops for 7–14 days. Biofilm was identified in otorrhea in 81% (17/21) of participants at enrollment. Multispecies infections dominated with Non-typeable Haemophilus Influenzae (NTHI), Staphyloccocus aureus, and anaerobes being the most frequent pathogens. After the initial treatment, 19 (90%) had dry ears. Median observation period was 140 days (range 14–280) where 13 participants had one or more recurrences. Median time to first recurrence was 60 days (range 14–197). Among the 13 with recurrence, three individuals had the same genotype of bacteria at a subsequent episode. Another two had the same phenotype (NTHI). The remaining eight had new multispecies infections. We confirmed a high rate of biofilm in CSOM. However, the clinical implication might be of minor importance when treating with irrigation and antibiotic eardrops, as recurrent episodes of otorrhea were dominated by new pathogens in each episode.

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Acknowledgements

We thank Ulla Rydahl Johansen for excellent technical assistance, AdvanDx who generously supplied the PNA-FISH probes, and Helle Krogh Johansen was supported by a clinical research stipend from the Novo Nordisk Foundation.

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Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Ramon Gordon Jensen

  2. Department of Clinical Microbiology, Rigshospitalet, Juliane Maries Vej 22, 2100, Copenhagen Ø, Denmark

    Helle Krogh Johansen

  3. Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen N, Denmark

    Thomas Bjarnsholt & Steffen Robert Eickhardt-Sørensen

  4. Zealand University Hospital, Department of Otorhinolaryngology and Maxillofacial Surgery, Lykkebækvej 1, 4600, Køge, Denmark

    Preben Homøe

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  1. Ramon Gordon Jensen
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Correspondence to Ramon Gordon Jensen.

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Jensen, R.G., Johansen, H.K., Bjarnsholt, T. et al. Recurrent otorrhea in chronic suppurative otitis media: is biofilm the missing link?. Eur Arch Otorhinolaryngol 274, 2741–2747 (2017). https://doi.org/10.1007/s00405-017-4586-8

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  • DOI: https://doi.org/10.1007/s00405-017-4586-8

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