Microbiological Profile and Drug Sensitivity Pattern in Atticoantral Type Chronic Suppurative Otitis Media (CSOM) Presenting with Intracranial Complications

Abstract: Background: Chronic Suppurative Otitis Media Atticoantral Disease (CSOM-AAD) involves posterosuperior part of middle ear cleft (attic, antrum and. posterior tympanum and mastoid) and is associated with cholesteatoma, which, because of its bone eroding properties, causes risk of serious complications. A potentially fatal sequalae of CSOM-AAD is its intracranial complications (ICC) which can be life threatening and need to be dealt with caution. Objective: The aim of the study is to determine the clinical presentation of CSOM-AAD patients with ICC and to evaluate the microbiological composition of the causing organisms and their drug sensitivity pattern. Materials and Methods: Retrospective Descriptive, Cross-sectional design study which was conducted in the Department of ENT, Head, and neck surgery, DUHS, DMC, Dr. Ruth K.M Pfau Civil Hospital Karachi. The analysis was made on 40 patients presented to in between 1st January 2017 and 31st December 2024 with Atticoantral type CSOM with any of the intracranial complication were included in the study. Inclusion criteria qualifying patients’ medical records were examined for pertinent information which include demographic data(age, gender, etc.), clinical background pertaining to intracranial problems and CSOM, microbiological data, such as sensitivity testing and culture results and regimens for treatment. Result: Out of 40 patients, 22(55%) were male and 18(45%) were female. The most common presenting complaints other than ear discharge were Headache, n= 32(80%) and fever n=30(75%), otalgia 28(70%) while the most frequent intracranial complication was temporal lobe abscess n =15(37.5%). Of all the bacterial isolates n=13 (32.5%) were Gram Positive microorganisms while n= 27(67.5%) were Gram Negative Bacteria. The commonest organism was Pseudomonas Aeruginosa n=13 (32.5%) followed by Proteus Mirabilis n=11(27.5%). The most sensitive antibiotics against Pseudomonas Aeruginosa and Proteus Mirabilis were imipenem, meropenem, Piperacillin/tazobactam, linezolid and vancomycin. Conclusion: Intracranial complications of CSOM are slightly more common in male and in young age group. The most common intracranial complication is Temporal lobe abscess while most common clinical presentations are headache, fever, and ear pain. Most of the issues are brought on by Gram Negative Bacteria. Carbapenem, vancomycin, linezolid and piperacillin/tazobactam offer empirical support for both Gram-Positive Bacteria and Gram- Negative Bacteria. Keywords: Chronic suppurative otitis media, Atticoantral disease, Cholesteatoma, Microbiological profile, Antibiotic sensitivity.