What Are The Causative Organisms Of Haemorrhagic Otitis Media?

Posted on Sat, 19 Apr 2014

Question: Hi I am suffering from chronic mastoiditis for last 2 years. There is no drainage from my ear. I had 3 mastoidectomies in last 2 years. I have the following questions - 1. It started with an ear infection in which there was an abcess on my ear drum and blood behind my ear drum. That abcess ruptured and blood came flowing through my ear canal. What are the causative organisms of such haemorrhagic otitis media? 2. During my first mastoidectomy I had a culture but that did not reveal any organism. Now doctors don't have any clue on what can be the causative organism. I have been given antibiotics on guess work. As mentioned in question 1 above that haemorrhagic otitis media is the only clue I have now. In my 3rd mastoidectomy a histopathology was done which says some bone degenaration and inflammed fibrocollagenous tissue. At the end report says - "Non-specific pathology". What does this all mean? 3. If culture does not reveal anything in that case what do doctors do ? I mean what antibiotic is normally given? - I have tried ciplox, levofloaxcin, pipercillin, amikacin. Not of much use. 4. My 3rd mastoidectomy report says "chronic mastoiditis with petrous apicitis". The surgeon said he has opened the petrous air cells. There was insipissated pus there in cells close to petrous. What does that mean? Is it an active infection? He also got grannulation tissues there. Thanks, XXXX

Answered by Dr. Deepashree (1 hour later)

Brief Answer: chronic mastoiditis with petrous apicitis Detailed Answer: Hi XXXXXXX in my opinion you are suffering from chronic infection of the mastoid bone. Initially you had a middle ear infection where there was pus behind the ear drum which has spread to mastoid bone causing chronic infection. Haemorrahgic otitis media is usually caused by bete haemolytic streptococcus bacteria, second being pneomococcus, and pseudomonas bacteria Antibiotics is usually decided based on culture report, but your culture shows no organism, so antibiotics which will cover all the bacteria will be given. Your 3 rd mastoidectomy report says there is chronic infection of mastoid bone also chronic infection of tip of petrous bone , that is called petrous apicitis. Mastoid is a part of petrous bone which gets infected first, then the infection spreads to apex. Because of chronic infection there is granulation tissue grown in the petrous apex and also some collected pus in the petrous apex region. Thia was cleared in the 3 rd mastoidectomy, so there are less chances of recurrences of infection. Histopathology report shows some chronic inflammatory changes, but not specific for any particular disease or infection. There is no active infection now so not to worry. Treatment will be now with antibiotics since the doctor has cleared the petrous apex there are less chances of recurrences. Dont worry you will be fine

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Deepashree (2 hours later)

Can you please let me know which antibiotic covers all these that you stated? I was on linzolid a few days back. Presently I am on amikacin 500mg once daily dose. If you mention the name I can consult with my doctor to get the appropriate dosage and duration. I am from a remote area of india where there are very few good doctors. You said there is no active infection. How to know if it is all gone? I still have pain. The doctor said he has opened the petrous apex. What does that mean?

Answered by Dr. Deepashree (21 minutes later)

Brief Answer: piperacillin with sulbactum, good surgical treatment. Detailed Answer: Hi XXXXXXX in my opinion, amikacin is a good antibiotic commonly given in ear infection. Other antibiotics are piperacillin with sulbactum combination. In 3 rd mastoidectomy they have gone from mastoid bone upto the petrous apex or petrous tip. This petrous tip is part of temporal bone which is present in centre of your skull.any ear infection can easily spred till centre of your skull through the bone. Suspecting that the infection has spread till there they have opened the petrous apex bone and there they have found that there was collected pus and some granulation tissue. They drained the pus and cleared the granulation. This was the foci of infection which was not cleared in prevous surgeries. That is the reason your problem kept recurring. Now it cleared as per your surgeon explanation. Your pain will go gradually, but how much your mastoid cavities are healed , how ia your wound now, we cant tell it without seeing. Mastoid cavity takes atleast 4 to 6 weeks to heal, or even more if it is major surgery like yours is. So keep in touch with your doctor, continus treatment and have faith in them. In my opinion, you will be fine after a week.dont worry.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Deepashree (43 hours later)

Hi Maam, A few more questions: - During my first 2 mastoidectomies doctors observed that my aditus was blocked. How long does the aditus take to open after surgery? - Is the aditus and middle ear seen at the time of cortical mastoidectomy? - Is the aditus enlarged at the time of mastoidectomy? - How long does it take for the middle ear to clear off the blood clots after surgery? If they don't clear what can be done? - All my mastoidectomies were cortical. The last one doctor said was complete cortical mastoidectomy. When is Modified Radical Mastoidectomy advised? - Why do doctors generally don't do modified radical? - I heard that my ear and mastoid are self cleaning. What does that mean? - I have tried pipercillin but not of much use. Is there any other suitable medicine? Thanks, XXXX

Answered by Dr. Deepashree (25 hours later)

Brief Answer: hi XXXXXXX sorry for delayed reply. Detailed Answer: Hi XXXXXXX cortical mastoidectomy is done for chronic infection of mastoid cavity with middle ear infection. In cortical mastoidectomy the middle ear, aditus, mastoid cavity extending upto petrous apex is cleared off the infections, pus, granulation tissue, etc. While doing cortical mastoidectomy if the aditus is blocked by granulation tissue then , The granulation tissue is removed and aditus is made patent. The aditus is made patent at time of surgery only. blood clots in middle ear after surgery are self resolving, they take atleast 4 to 6 weeks to resolve it. There is no treatment if it doesn't get resolved. If blood is pooled in middle ear causing hematoma not resolving then we operate and remove it. Mastoid cavity and middle needs to be cleaned periodically twice a week upto 4 weeks regularly to prevent infection. If it is self cleaning, that's good. We won't meddle with it. Modified radical mastoidectomy is done if there a cholesteatoma / skin sac in the attic. Its a different disease and different procedure. Not related to your disease. Continue with amikacin, gentamycin, can also be tried.

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj