Otitis media: an ongoing microbial challenge

Abstract

Young Australian Indigenous children in remote Northern Territory communities suffer excessively high rates of otitis media (OM) and remain at high risk of suppurative complications with poor audiological and educational sequelae. Efforts to effectively treat this condition are confounded by the frequent failure of standard antibiotic treatment regimens, despite good therapeutic compliance and susceptibility of the major pathogens. OM has a complex, polymicrobial aetiology. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the recognised major pathogens; however, bacteria from at least 15 other genera have been identified in middle ear effusions. It is often unclear whether detection of many of these bacteria is circumstantial, or if they are contributing to the infection either directly, or through competitive or cooperative processes. While culture remains the gold standard for detecting the major pathogens, molecular methods are changing the ways we explore the complex polymicrobial dynamics of OM.