Comparison of the Bacteria Found in the Ear and Nasopharynx in Acute Otitis Media

MANY cases of acute otitis media present with an intact tympanic membrane. Unless a myringotomy is considered necessary, these cases are perforce treated blindly, the infecting organism not being isolated. It is usual in such circumstances to prescribe an antibiotic with a wide range of activity in the hope that the infecting organism will be within the range of sensitivity. To overcome this difficulty it has been the practice of many doctors to swab the nasopharynx either through the nose or the mouth. This procedure is based on the belief that the infecting organisms reach the middle-ear cavity by ascending the eustachian tube either by the lumen or by the veins and lymphatics of the mucous lining. If this theory is correct, a swab of the nasopharynx should reveal the organisms causing the infection in acute otitis media with an intact tympanic membrane. In an attempt to confirm this theory, it was decided to obtain swabs of the nasopharynx and of the aural discharge in each patient admitted to hospital with acute suppurative otitis media with a perforated tympanic membrane.