Nasopharyngeal Flora of Children Requiring Pressure Equalizing Tubes

Background and Objectives: Children with recurrent middle ear disease (RMED) that is refractory to medical treatment often require ventilation tubes insertion. This may be due to host, environment or microbes related factors. The latter can present a challenge either due to their resistance to antimicrobials or for being uncommon causative pathogens. The aims of this study are to evaluate nasopharyngeal flora in RMED, and to identify associated predictive clinical parameters >Materials and Methods: Consecutive children with RMED undergoing tubes insertion were prospectively recruited. Demographic, clinical and intraoperative data collected. Punch biopsy from adenoid bed was sent for culture. The Kruskal Wallis test was used to compare the different parameters. Analysis was conducted using SPSS software. Results: We enrolled 84 patients; aged 1 ? 9 yrs (mean 3.62). Recurrent respiratory tract infections coincided with RMED in 36.9%. We recovered Hemophilus influenza type b in 23.6%, Moraxella catarrhalis in 14.6%, and Streptococcus pneumoniae in 5.5%. Uncommon RMED bacteria (e.g β Hemolytic streptococcus, Staphylococcus aureus) formed 21.8%; 4.5% of all cultures grew Hemophilus influenza, non-type b. Patients with RMED coinciding with respiratory tract infections, and those with chronic purulent rhinorrhea were more likely to have uncommon RMED organisms (P<0.05). Conclusion: Children with RMED associated with chronic purulent rhinorrhea, or upper respiratory tract infections may benefit from nasopharyngeal culture to properly guide treatment with antibiotics. This may be an important step before deciding placing tubes in these children.