Skip to main content
  • Original article
  • Open access
  • Published:

Could fungi be detected in the fluid of persistent otitis media with effusion?

En

Abstract

Background

Otitis media with effusion (OME) often is considered a direct extension of the inflammatory process that occurs during long-lasting or recurrent episodes of acute otitis media. The observations above suggest that OME has an infectious etiology. Most bacterial and viral cultures of middle ear fluid that had been performed were often negative suggesting that other infectious agents may be involved such as fungi.

Materials and methods

Thirty patients (group A) suffering from chronic secretory otitis media (OME) were enrolled in this study. Three samples were collected and investigated using PCR assay with universal fungal primers and Sabouraud agar. The first sample was obtained from the fluid of the middle ear before insertion of the ventilation tube; the second sample was obtained from nasal secretions; and the third sample was obtained from the ipsilateral peritubal area of the nasopharynx. Thirty patients (group B) with comparable age group without history of ear diseases scheduled for tonsillectomy or adenotonsillectomy were added as a control group. Samples from peritubal area of the nasopharynx of patients and nasal secretion were tested using PCR assay with universal fungal primers and Sabouraud agar.

Results

PCR examination of the middle ear aspirate in group (A) cases was positive in 7 cases (23.3%), in nasal secretions samples 2 cases only (13.3%) were positive and no positive cases were detected in nasopharyngeal swab samples. In group (A), Sabouraud agar culture was positive for fungal culture of middle ear aspirates in 5 cases (16.6%) but in no cases for nasal secretion samples. Group A showed also negative (N0) growth in 30 (100%) patients for nasopharyngeal swab on Sabouraud agar. In group B, the findings of nasopharyngeal swab were negative (N0) growth in all examined samples on Sabouraud agar, and nasal secretions were also negative for fungal DNA detection using PCR assay.

Conclusion

In this study, fungal DNA could be detected in the middle ear fluid in seven (23.3%) of 30 patients with persistent OME using PCR assay, and fungi could be detected in five (16.6%) patients on Sabouraud agar. A significant relationship was found between detection of fungi in the middle ear fluid and the duration of the disease, associated adenoid, and history of asthma.

References

  1. Teele DW, Klein JO, Rosner B, Bratton L, Fisch GR, Mathieu OR, et al. Middle ear disease and the practice of pediatrics. Burden during the first five years of life. JAMA 1983; 249: 1026–1029.

    Article  CAS  Google Scholar 

  2. Bluestone CD, Klein JO. Otitis media in infants and children. Philadelphia, PA: WB Saunders; 1988.

    Google Scholar 

  3. Yang CY, Cheng MF, Tsai SS, Hung CF, Lai TC, Hwang KC. Effects of indoor environmental factors on risk for acute otitis media in a subtropical area. J Toxicol Environ Health A 1999; 56: 111–119.

    Article  CAS  Google Scholar 

  4. Ponikau JU, Sherris DA, Kern EB, Homburger HA, Frigas E, Gaffey TA, Roberts GD. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 1999; 74: 877–884.

    Article  CAS  Google Scholar 

  5. Kim EJ, Catten MD, Lalwani AK. Detection of fungal DNA in effusion associated with acute and serous otitis media. Laryngoscope 2002; 112: 2037–2041.

    Article  CAS  Google Scholar 

  6. Atsushi MR, Takesi TG, Kensuke WA. Middle ear effusion and fungi: annals otology. Ann Otol Rhinol Laryngol 2012; 121: 609–614.

    Article  Google Scholar 

  7. Hall-Stoodley L, Hu FZ, Gieseke A, Nistico L, Nguyen D, Hayes J, et al. Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media. JAMA 2006; 296: 202–211.

    Article  CAS  Google Scholar 

  8. Catten MD, Murr AH, Goldstein JA, Mhatre AN, Lalwani AK. Detection of fungi in the nasal mucosa using polymerase chain reaction. Laryngoscope 2001; 111: 399–403.

    Article  CAS  Google Scholar 

  9. Jalali MM, Rezaie SE, Kausha AI, Saadat FT, Banan RD. Detection of fungal DNA in the middle ear effusion of patients suffering from otitis media with effusion. Iranian J Publ Health 2008; 37: 109–113.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Waleed R. Jabri MD.

Additional information

Conflicts of interest

None declared.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farag, M.E., Jabri, W.R., Wageh, W.N. et al. Could fungi be detected in the fluid of persistent otitis media with effusion?. Egypt J Otolaryngol 31, 30–35 (2015). https://doi.org/10.4103/1012-5574.152705

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1012-5574.152705

Keywords