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What Causes Acute Otitis Media?
Question: Hi
I am suffering from chronic ear and mastoid problem from last 2 years. I had 3 mastoid surgeries during which doctors found inspisated pus and lot of granulation tissues in my mastoid. Since the pus was thick and not liquid they did not send it for culture. A biopsy report says there was some degenerated bone and inflamed fibro-collagen in my ear and mastoid cavity. Drilling was done till petrous apex for air cells. Now my problem is a continuous headache and ear ache which has made my life miserable.
No one knows what antibiotic is suitable for me.
Only clue that I have about it is this all started with haemmoraghic otitis media. I had blisters on my ear drum and my middle ear was filled with a bloody fluid.
So I have the following questions -
1. What are the bacterial agents for such haemmoraghic otitis media and blisters?
2. I have been given the following antibiotics - augmentin, cipro, pippercillin, ceftrioxone (got some benefit), rifampin, levofloaxcin, ceftum, amikacin.
What is the best antibiotic which can cover most agents in haemmoraghic otitis?
3. Doctors are of opinion that there might be some brain irritation due to this. If so what antibiotics can suitably reach such deep spots in the brain?
4. I am continuously taking pain killers and cipro. Pain killers help me to reduce the pain for sometimes. but my liver is getting spoiled. If germs get immune to one antibiotic of a class - say ceftrioxone, will I get benefited if I take another antibiotic of the same class - say cefepime?
Both my ESR and CRP are high - ESR 40, CRP 30
I stay in a remote area of the country where there are no good doctors who can suggest good antibiotics. So I really require help in this regard so that I can atleast go to my ENT (who is not comfortable about antibiotics) and discuss with him the suggestions given here. My ENT told that I need a long term antibiotic (he is continuously giving me cipro but it is of no use to me).
Since there is no way to know what is the causative agent any suggestion for a good empiric therapy I can go and discuss with my ENT surgeon.
Thanks,
XXXX
I am suffering from chronic ear and mastoid problem from last 2 years. I had 3 mastoid surgeries during which doctors found inspisated pus and lot of granulation tissues in my mastoid. Since the pus was thick and not liquid they did not send it for culture. A biopsy report says there was some degenerated bone and inflamed fibro-collagen in my ear and mastoid cavity. Drilling was done till petrous apex for air cells. Now my problem is a continuous headache and ear ache which has made my life miserable.
No one knows what antibiotic is suitable for me.
Only clue that I have about it is this all started with haemmoraghic otitis media. I had blisters on my ear drum and my middle ear was filled with a bloody fluid.
So I have the following questions -
1. What are the bacterial agents for such haemmoraghic otitis media and blisters?
2. I have been given the following antibiotics - augmentin, cipro, pippercillin, ceftrioxone (got some benefit), rifampin, levofloaxcin, ceftum, amikacin.
What is the best antibiotic which can cover most agents in haemmoraghic otitis?
3. Doctors are of opinion that there might be some brain irritation due to this. If so what antibiotics can suitably reach such deep spots in the brain?
4. I am continuously taking pain killers and cipro. Pain killers help me to reduce the pain for sometimes. but my liver is getting spoiled. If germs get immune to one antibiotic of a class - say ceftrioxone, will I get benefited if I take another antibiotic of the same class - say cefepime?
Both my ESR and CRP are high - ESR 40, CRP 30
I stay in a remote area of the country where there are no good doctors who can suggest good antibiotics. So I really require help in this regard so that I can atleast go to my ENT (who is not comfortable about antibiotics) and discuss with him the suggestions given here. My ENT told that I need a long term antibiotic (he is continuously giving me cipro but it is of no use to me).
Since there is no way to know what is the causative agent any suggestion for a good empiric therapy I can go and discuss with my ENT surgeon.
Thanks,
XXXX
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. By hemorrhagic otitis media, I believe you are referring to Acute Otitis Media (AOM). AOM responds to broad spectrum antibiotics such as the penicillin group. Blisters or bullous myringitis is frequently viral and antibiotics usually play a secondary role. Mastoidectomy is rarely required now-a-days to manage AOM. I hope that your first attack was not herpes zoster. This would explain the persistent severe pain.
2. Broad spectrum penicillin group antibiotics are the first line treatment for AOM. Exact sensitivity can only be determined by culture and sensitivity of the pus discharge.
3. If the brain irritation is due to the petrosectomy, it may not only be due to infection. You should get an MRI for Cholesteatoma (a special MRI Scan) and an HRCT Temporal Bones done. The details of thee three surgeries and the latest scan will help.
4. Ciprofloxacin may not work unless there is any contamination of the ear by gram negative (and few gram positive) bacteria. Antibiotic resistance usually applies to the full class. Ceftriaxone and cefepime are both cephalosporins which are a part of the beta lactam (penicillin) group. hence cross resistance is likely to be present.
5. Bone has a very poor blood supply. Hence antibiotics such as vancomycin are used in deep seated bone infections (osteitis). Some antibiotics that may work in very resistant cases are Meropenem (Imipenems) and Linezolid (Oxazolidone).
If you have any further questions, I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. By hemorrhagic otitis media, I believe you are referring to Acute Otitis Media (AOM). AOM responds to broad spectrum antibiotics such as the penicillin group. Blisters or bullous myringitis is frequently viral and antibiotics usually play a secondary role. Mastoidectomy is rarely required now-a-days to manage AOM. I hope that your first attack was not herpes zoster. This would explain the persistent severe pain.
2. Broad spectrum penicillin group antibiotics are the first line treatment for AOM. Exact sensitivity can only be determined by culture and sensitivity of the pus discharge.
3. If the brain irritation is due to the petrosectomy, it may not only be due to infection. You should get an MRI for Cholesteatoma (a special MRI Scan) and an HRCT Temporal Bones done. The details of thee three surgeries and the latest scan will help.
4. Ciprofloxacin may not work unless there is any contamination of the ear by gram negative (and few gram positive) bacteria. Antibiotic resistance usually applies to the full class. Ceftriaxone and cefepime are both cephalosporins which are a part of the beta lactam (penicillin) group. hence cross resistance is likely to be present.
5. Bone has a very poor blood supply. Hence antibiotics such as vancomycin are used in deep seated bone infections (osteitis). Some antibiotics that may work in very resistant cases are Meropenem (Imipenems) and Linezolid (Oxazolidone).
If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
Thanks for your answers.
1. Augmention, Piperacillin, Ceftrioxone, Ceftazidime, Cipro, Azithromycin did not work. I was given vancomycin but on first dose I developed reddening of upper part of body so that was discontinued. I had a bone scan which showed increased uptake in mastoid and above the ear. This was before any surgery. I was told that I need a long term oral antibiotic. But nobody knew which one. So doctors went on giving me cipro. Which is a good broad spectrum oral antibiotic that I can take for a long time and will cure my illness?
2. I suppose haemorrhagic otitis media with blisters on the ear drum can give some hint about the bacterial pathogen involved. So that way can I get an antibiotic other than penicillin group?
3. I forgot to mention earlier that I also had been given clindamycin. 2 oral doses daily of 300 mg each. How is that in my case?
4. My doctor says that because bone scan is positive I have some infection. Meropenem is too costly and does not have any oral form. Can I get some alternative which will act like meropenem but less costly? Maybe a combination of two antibiotics acting synergistically.
5. I have been on the following IV antibiotics - pippercillin, ceftrioxone, ceftazidime, amikacin. But none were much helpful in curing my condition fully. Can such bone infections be treated and cured only by IV or is it possible to cure them by oral meds? IV is having bad effect on my liver and kidney.
Thanks
Thanks for your answers.
1. Augmention, Piperacillin, Ceftrioxone, Ceftazidime, Cipro, Azithromycin did not work. I was given vancomycin but on first dose I developed reddening of upper part of body so that was discontinued. I had a bone scan which showed increased uptake in mastoid and above the ear. This was before any surgery. I was told that I need a long term oral antibiotic. But nobody knew which one. So doctors went on giving me cipro. Which is a good broad spectrum oral antibiotic that I can take for a long time and will cure my illness?
2. I suppose haemorrhagic otitis media with blisters on the ear drum can give some hint about the bacterial pathogen involved. So that way can I get an antibiotic other than penicillin group?
3. I forgot to mention earlier that I also had been given clindamycin. 2 oral doses daily of 300 mg each. How is that in my case?
4. My doctor says that because bone scan is positive I have some infection. Meropenem is too costly and does not have any oral form. Can I get some alternative which will act like meropenem but less costly? Maybe a combination of two antibiotics acting synergistically.
5. I have been on the following IV antibiotics - pippercillin, ceftrioxone, ceftazidime, amikacin. But none were much helpful in curing my condition fully. Can such bone infections be treated and cured only by IV or is it possible to cure them by oral meds? IV is having bad effect on my liver and kidney.
Thanks
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. You have received many antibiotics, hence you may not be dealing with infection here.
2. The hemorrhagic, bullous myringitis may have been viral. The best choice in AOM is a penicillin group (beta-lactam) antibiotic.
3. Clindamycin attains high concentration in saliva and hence is usually reserved for salivary gland infections, It is a good antibiotic.
4. A positive bone may also be due to inflammation. The cost of Meropenem has recently decreased substantially. You may request your physician to add Linezolid. Also consider chronic infections such as tuberculosis.
5. Most of these antibiotics are IV. Linezolid is an oral antibiotic.
If you have any further questions, I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. You have received many antibiotics, hence you may not be dealing with infection here.
2. The hemorrhagic, bullous myringitis may have been viral. The best choice in AOM is a penicillin group (beta-lactam) antibiotic.
3. Clindamycin attains high concentration in saliva and hence is usually reserved for salivary gland infections, It is a good antibiotic.
4. A positive bone may also be due to inflammation. The cost of Meropenem has recently decreased substantially. You may request your physician to add Linezolid. Also consider chronic infections such as tuberculosis.
5. Most of these antibiotics are IV. Linezolid is an oral antibiotic.
If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply.
A few more questions:
1. Immediately after my first mastoidectomy, pain in front of my ear just above the ear was gone. That proves that it was due to some kind of infection. But there is still a pain in deeper areas of the ear at the top. With no way left to know what has caused this infection the only way left now is to try antibiotics on guess work. As you said linezolid is a good antibiotic to try and I spoke to my doctor. He is of the opinion that linezolid is only bacteriostatic and won't do much in my case. What other suggestion do you have?
2. I don't have fever. Infact I never had fever throughout this infection. Is fever a must for infection?
3. What I feel is some area deep inside my head is swollen. MRI shows mastoiditis. There were lot of granulation tissues removed at the time of surgery. My biopsy report says non-specific pathology. What does these mean?
4. If swelling is not because of any infection then why is it not going and what should I do so that it goes?
5. As I don't want to get hospitalized again to try another antibiotic, can you suggest an antibiotic (maybe IV) which can be taken from home? I suppose Meropenem requires hospitalization.
6. From a long time before the ear infection started I had been suffering from chronic tonsillopharangitis. Can such a thing trigger this infection and headache? If so what is a suitable drug for that?
7. I had been taking penicillins since my childhood for my tonsil problem. So I suppose these penecillins don't work for me any more. Augmentin never works. Does that mean drugs like Piperacillin, or any cephalosporin will be useless for me?
Thanks
A few more questions:
1. Immediately after my first mastoidectomy, pain in front of my ear just above the ear was gone. That proves that it was due to some kind of infection. But there is still a pain in deeper areas of the ear at the top. With no way left to know what has caused this infection the only way left now is to try antibiotics on guess work. As you said linezolid is a good antibiotic to try and I spoke to my doctor. He is of the opinion that linezolid is only bacteriostatic and won't do much in my case. What other suggestion do you have?
2. I don't have fever. Infact I never had fever throughout this infection. Is fever a must for infection?
3. What I feel is some area deep inside my head is swollen. MRI shows mastoiditis. There were lot of granulation tissues removed at the time of surgery. My biopsy report says non-specific pathology. What does these mean?
4. If swelling is not because of any infection then why is it not going and what should I do so that it goes?
5. As I don't want to get hospitalized again to try another antibiotic, can you suggest an antibiotic (maybe IV) which can be taken from home? I suppose Meropenem requires hospitalization.
6. From a long time before the ear infection started I had been suffering from chronic tonsillopharangitis. Can such a thing trigger this infection and headache? If so what is a suitable drug for that?
7. I had been taking penicillins since my childhood for my tonsil problem. So I suppose these penecillins don't work for me any more. Augmentin never works. Does that mean drugs like Piperacillin, or any cephalosporin will be useless for me?
Thanks
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for writing back.
1. Linezolid is bacteriocidal for some bacteria due to its strong bacteriostatic effect. Used in combination with other antibiotics , it gives excellent results.
2.Fever is the body's response to infection. Overwhelming infection and septicemia may not present a s fever.
3. All these signs point to inadequate surgery, resistant infection or inflammation.
4. Try the combination of medication suggested.
5. Meropenem does not require prolonged hospitalization. You may request IV on OPD basis after a couple of days. Linezoled is oral.
6. What are your symptoms due to chronic tonsillopharangitis?
7. Yes, these are all beta-lactam antibiotics from the same class and hence cross resistance is seen.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for writing back.
1. Linezolid is bacteriocidal for some bacteria due to its strong bacteriostatic effect. Used in combination with other antibiotics , it gives excellent results.
2.Fever is the body's response to infection. Overwhelming infection and septicemia may not present a s fever.
3. All these signs point to inadequate surgery, resistant infection or inflammation.
4. Try the combination of medication suggested.
5. Meropenem does not require prolonged hospitalization. You may request IV on OPD basis after a couple of days. Linezoled is oral.
6. What are your symptoms due to chronic tonsillopharangitis?
7. Yes, these are all beta-lactam antibiotics from the same class and hence cross resistance is seen.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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