Bacteria in the middle ear and nasopharynx during tympanostomy tube insertion.
OBJECTIVE
To evaluate the efficacy of nasopharyngeal cultures in identifying pathogens in middle-ear effusions as an alternative to cultures obtained through tympanocentesis.


METHODS
The study population consisted of 203 children with middle-ear effusions at the time of placement of tympanostomy tubes for recurrent otitis media or persistent otitis media with effusion. Isolates from the nasopharynx were compared with those from the middle ear to determine sensitivity, specificity, and predictive values for each of the three main pathogens.


RESULTS
The predominant bacterial isolates from both ear and nasopharynx were Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae. Eighty-one percent (42% highly, 39% relatively) S pneumoniae nasopharyngeal isolates were resistant to penicillin. The negative predictive value of the nasopharyngeal cultures was at least 97% for each of these predominant bacteria.


CONCLUSIONS
This study supports the conclusion that tympanocentesis is the most useful means of identifying pathogens in otitis media.
Washington University School of Medicine, St Louis, MO, USA.
R A
RA
Clary
R S
RS
Bahadori
H R
HR
Muntz
R P
RP
Lusk
D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D004432:Ear, Middle / Q000382:microbiology*; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods*; D001936:Moraxella catarrhalis / Q000302:isolation & purification*; D009305:Nasopharynx / Q000382:microbiology*; D010034:Otitis Media with Effusion / Q000382:microbiology* / Q000601:surgery*; D011237:Predictive Value of Tests; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*