We had an opportunity to treat two infants affected with refractory otitis media. The patients were hospitalized for treatment of the infectious disease. We isolated BLNAR(β-lactamasenegative ampicillin-resistant Haemophilus influenzae) from these excretes obtained from patients who were successfully treated with CTRX. The MICs of microbes obtained from the two patients were 8 and 4μg/ml to ABPC. The MIC was 0.06 and 0.25μg/ml in response to CTRX. The two infants recovered from the infection in a week. In our hospital, infectious diseases caused by BLNAR account for more than 20% of Haemophilus influenzae infections. The incidence of BLNAR infections may increase in the future.
The recent increase in resistance to the major antibiotics has required us to reevaluate antibiotictherapy in ear and nasal infections, which are caused mainly by Haemophilus influenzae, Streptococcuspneumoniae and Moraxella catarrharis. The MICs of antibiotics against the first two bacteriawere determined at the time of treatment of ear and nasal infection in 1991, 1996 and 1999and the findings were compared. The MIC, which is a measure of in vitro susceptibility, is theconcentration that inhibits 90% of a collection of isolates. Between 10-15% of H. influenzae areampicillin-resistant. In1996,β-lactamase-negative ampicillin resistant H.influenzae(BLNAR)wasisolated from nasal discharge and increased almost to the same level as BLNAR. In 2000, BLNARaccounts for more than 20% of H. influen,zae. We consider that CTRX given by intravenous administrationand CDTR by oral administration are effective against 80% of H. influenzae based ontheir MICs. Against S. pneumoniae, the rates of PSSP, PISP and PRSP efficacy in 1991 were 75.6%,22.2% and 2.2%, respectively. In 1996, these values were 55.6%, 38.8% and 5.6%. In 1999, theywere 24.2% and 56.4% and 19.4%, respectively. In 1996, PAPM/BP was effective against 100% ofS. pneumonide at the MIC dosage of 0,06μg/ml, whereas in 1999, it was effective against 87% ofthe strains. Seventy-five percent of children from whom infection-resistant S. pneumoniae wereisolated had been administered several antibiotics prior to treatment in our hospital. We considerthat the sensitivity will decrease further in the future, thereby making treatment of the infectiontherapy more difficult.
In patients with recurrent tonsillitis, the detection rates for Bacteroides spp. as well as for Prevotella spp. and Porphyromonas spp. (which are included among the genus Bacteroides spp. in the old classification) were significantly higher in patients aged 13 years or older than in the patients aged 12 years or younger (P<0.01). Bacteroides spp. and Porphyromonas gingivalis were only detected in patients with recurrent tonsillitis. In addition, the detection rate of Peptostreptococcus spp. was significantly higher in patients with recurrent tonsillitis.
Three hundred and eighty-two children were hospitalized in Department of Pediatrics due to bronchitis, pneumonia, or fever of unknown origin from April 1999 to May 2000. Fifty of these children were found to have severe acute otitis media (AOM). Seventy-five children, including the above mentioned 50 children with severe AOM requiring hospitalization, were analyzed. Of these patients,66.7% were 0 or 1-year-old infants,68.0% were male,58.7% were cared for in day care centers, and 65.3% had the chief complaint of fever. Penicillin-resistant Streptococcus pneumoniae were identified in the nasophalynx of one case, but β-lactamase-negative ampicillin-resistant Haemophilus influenzae were not identified.
It is well known that the inner ear and stapes function retain their normal condition and hearing improvement is achieved by carrying out meatoplasty, myringoplasty and ossiculoplasty in patients with congenital ear canal atresia or stenosis. Patients who undergo meatotympanoplasty are expected to have improved daily life because of their young age. Recently, we operated on 8 ears of 6 patients (two bilateral patients), aged from 5 to 16 years,7 with atresia and one with stenosis. Meatotympanoplasty for congenital microtia and auditory canal atresia or stenosis is good news for children suffering from this disease.
A 1-year and 2-month-old-boy was referred to our hospital with a complaint of recurrent episodes of pneumonia, bronchitis and meningitis. His right eardrum was gray and had poor mobility due to middle ear effusion. Temporal bone CT and the inner ear three dimensional MRI showed hypoplasia of the right osseous labyrinth, which was diagnosed as Mondini dysplasia. These findings suggested the existence of abnormal communication between the cerebrospinal fluid space and the middle ear via the internal auditory canal and the inner ear, which resulted in cerebrospinal fluid otorrhea and meningitis. As penicillin-insensitive streptococcus pneumoniae (PISP) was detected from the fluid as well as the nasopharynx at the last episode of meningitis, we carried out exploratory tympanotomy after the eradication of PISP in the nasopharynx There was a bony defect at the center of the footplate of the stapes and pulsative outflow of the cerebrospinal fluid was observed. We plugged the inner ear space with soft tissues through the defect, covercd them with box dust and the periosteum and finally fixed them with fibrin glue. The patient's postoperative course was uneventful and he has not had any severe infectious diseases, including meningitis. This suggests that inner ear anomaly is one of the risk factors of repeated meningitis. For a good vital prognosis and also to prevent labyrinthitis of the contralateral ear caused by repeated meningitis, we concluded that early surgical treatment to close the fistula is important. In addition, the nasopharyngeal pathogens, in particular, drug-resistant bacteria, play a crucial role in the onset and persistence of otogenic meningitis.