RESUMEN
Chronic Otitis Media is characterized by distinct bacteriology compared with Acute Otitis Media, with COM being highly likely to harbor multiple bacteria of anaerobic and aerobic types of organisms (Cameron and Hussam K. El-Kashlan, xxx). In some patients, chronic infection with otorrhea will persist despite aggressive medical therapy. With the large number of cases of COM which presents to Sanjay Gandhi Memorial Hospital, and a majority being resistant to the common medications, we decided to undertake this study to have a better understanding of the bacterial epidemiology, the resistance, and what antibiotic to use in such cases. To determine the prevalence of different bacteriological agents and their antibiotic sensitivity pattern in patients of Chronic Otitis Media-Active Mucosal Disease presenting to ENT OPD at Sanjay Gandhi Memorial Hospital, Mangolpuri, Delhi. An observational cross-sectional study of 200 patients. After an initial examination, two sterile cotton swab sticks were introduced to collect pus samples from the medial part of the external auditory canal. The swabs were sent to the microbiology lab for Gram Staining, Culture, and Biochemical Tests, for identification of the different bacteriological agents and their antibiotic sensitivity patterns. Most common organism seen was Pseudomonas aeruginosa, followed by Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, mixed bacterial growth, and Candida spp. If regular monitoring of bacteriological profile is done in each hospital, this will help us to choose the antibiotics in a better manner and hence prevent the appearance of newer resistant strains.
RESUMEN
This study aims to describe the current epidemiological and etiological trends for deep neck space infections (DNIs) with an objective to understand the intricacies of their management. In this retrospective analytical study records of 52 patients with DNIs were reviewed. Patients having superficial abscess, peritonsillar abscess and abscess due to trauma/surgical procedure were excluded. Various epidemiological and etiological parameters (Demography, site, presentation, etiology, association with co-morbidities, bacteriology) and management guidelines (need for surgical interventions for DNIs and airway management, hospital stay duration, treatment outcome and complications) were reviewed and analyzed. Study recorded preponderance of DNIs in males (male:female = 1.6:1) and in younger generation (50% of patients presenting in first 2 decades). Commonest etiology being odontogenic infections (38.46%) followed by URTIs and tonsillopharyngitis (19.23%). Submandibular space involvement was noted in 42.3% cases followed by parapharyngeal space involvement in 21.15%. Nearly 55% cases of submandibular space involvement were because of odontogenic causes. 69.23% culture specimens reported no growth. 61.53% patients were diagnosed with anaemia. Up to 80% required open surgical drainage. All received broad spectrum antibiotics as a starting regime. No severe complications were recorded. Understanding the current epidemiological and etiological trends can help in early and definitive diagnosis of DNIs. Empirical starting treatment regime including broad spectrum antibiotics (till sensitivity pattern is availed) and maintaining low threshold for required surgical intervention are required to manage DNIs satisfactorily. Selected cases should be given conservative trials with close monitoring.
RESUMEN
A mucocele of a paranasal sinus is a mucus filled cystic mass lined by epithelium filling the involved sinus whose ostium is obstructed. While frontoethmoidal mucoceles are common, Onodi cell mucoceles are less frequently seen. Due to its anatomic proximity to optic nerve, it can lead to devastating visual complications. A 29 year old female presented with progressive loss of vision in right eye since 20 days leading to complete loss of vision since 12 days without any nasal complaints. Endoscopy showed fullness in right spheno-ethmoidal region. Computed Tomography scan revealed a mucocoele of the right Onodi air cell causing compression of intracanalicular part of right optic nerve. Despite urgent surgical decompression of mucocele, vision could not be restored. Poor visual acuity at presentation may be associated with bad prognosis. Hence, a high index of suspicion followed by appropriate imaging (CT scan and/or MRI nose and paranasal sinus) is crucial for early diagnosis in case of unexplained progressive diminution of vision, even in setting of no nasal complaints.
