1. Flint PW, Haughey BH, Lund VJ, et al. Cummings otolaryngology.
6th edn. In Flint P et al., ed. Head & Neck Surgery. Philadelphia:
Mosby Elsevier; 2015:2336-2344.
2. McCormack A, Edmondson-Jones M, Somerset S, Hall D. A system-
atic review of the reporting of tinnitus prevalence and severity. Hear
3. Meikle MB, Henry JA, Griest SE, et al. The tinnitus functional index:
development of a new clinical measure for chronic, intrusive tinnitus.
Ear Hear. 2012;33:153-176.
4. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for
the process of cross-cultural adaptation of self-report measures.
Spine (Phila Pa 1976). 2000;25:3186-3191.
5. Oron Y, Shushan S, Kreitler S, Roth Y. A Hebrew adaptation of the
tinnitus handicap inventory. Int J Audiol. 2011;50:426-430.
6. Beck AT, Aaron SR. Beck Depression Inventory manual. Philadelphia:
Harcourt Brace, Jovanovich; 1987.
7. Spielberger CD, Goruch RL, Lushene RE. Manual for the State-Trait
Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1977.
8. Clark JG. Uses and abuses of hearing loss classification. ASHA.
9. Rabau S, Wouters K, Van de Heyning P. Validation and translation of
the Dutch tinnitus functional index. B-ENT. 2014;10:251-258.
10. Folmer RL, Griest SE, Meikle MB, Martin WH. Tinnitus severity,
loudness, and depression. Otolaryngol Head Neck Surg. 1999;121:48-
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Accepted: 10 September 2017
Bacterial aetiology of recalcitrant acute otitis media in 62
children—high risk of pathogen colonisation after treatment
Acute otitis media (AOM), common childhood infection that is one of
the leading causes of antibiotic prescriptions for children, is diagnosed
at least once in approximately 80% of pre-school children and 30%-
40% of them have recurrent episodes. Antibiotic treatment of AOM is
usually empiric, without isolation of otopathogens from middle ear
fluid and their antibiotic susceptibility testing.
Due to the improper
antibiotic use, the infection can persist in some cases, termed AOM
treatment failure. Recalcitrant (difficult to treat) AOM includes two
main entities: treatment failure or persistent AOM, defined as lack of
improvement in signs and symptoms for longer than 48-72 hours after
initiation of antibiotic therapy; and recurrent AOM, classified as 3 (or
more) AOM episodes in the previous 6 months or 4 (or more) episodes
in the previous 12 months.
The role of bacterial pathogens in AOM, especially in recalcitrant
(recurrent and treatment failure) cases, has been a matter of concern
and bacteriologic correlations of recalcitrant AOM is still discussed.
Moreover, an increasing rate of antibiotic-resistant bacterial strains
has been reported to be involved recently in the infections of middle
ear, nasal cavity and pharynx in children, causing difficulties in the
This study assessed the bacterial aetiology of AOM and
characterised the resistance of AOM-causing pathogens in children
presenting different episodes of AOM. We also analysed the concor-
dance between results of middle effusion fluid (MEF) and nasopha-
ryngeal samples for the most prevalent bacteria in children with
different episodes of AOM as well as in various age groups.
The Ethical Committee of the Medical University of Lublin approved
the study protocol (No. KE-0254/75/211). From all children’s
parents, informed consent was obtained.
Patients and study procedures
This prospective study enrolled 62 children, aged between 1 and
16 years who were diagnosed with AOM by an ENT specialist dur-
ing 2010-2014 and admitted to Department of Pediatric Otolaryn-
gology, Phoniatrics and Audiology, Medical University of Lublin,
Poland. Eligible children had diagnosis of either recurrent, treatment
failure and a new case of AOM according to Leibovitz.
graphic, and selected clinical data of studied children were shown in
Table 1. Patients were referred to tympanocentesis according to cri-
teria proposed by Bluestone
and extended with recurrent AOM
cases. MEF specimens, nasopharyngeal and oropharyngeal swabs
were collected during AOM visits as well as during two control vis-
its: after the antibiotic therapy (53 patients) and 2 weeks after the
antibiotic therapy (28 patients). A total of 348 microbiological cul-
tures were analysed. Swabs and MEFs were inoculated on standard
selective and non-selective media and bacteria were identified with
use of standard bacteriologic methods. Screening of bacterial suscep-
tibility to b-lactams was performed.
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