Bacteremia during canal wall up mastoidectomy in cases of cholesteatoma

Background: Otitis media refers to a group of complex infectious and inflammatory diseases affecting the middle ear. Bacteremia is the presence of viable bacteria in the circulating blood. It has been reported that it is associated with some surgical procedures. Objective: To investigate the risk of bacteremia development during surgery in patients who underwent mastoidectomy for chronic otitis media. Patients and Methods: This was a prospective study carried out at Hearing and Speech Institute, Egypt during the period between March and December 2019. The study included 30 patients with chronic otitis media (17 males and 13 females) who were scheduled for mastoidectomy. Preoperative routine ENT examination and microscopic examination were done. Blood samples were taken before and after the operation for the evaluation of microorganisms. Smear cultures were obtained, and the growing microorganisms were identified with the traditional method. Results: Cholesteatoma was the major complaint among all patients, 27 cases (90.0%) complained of intermittent ear discharge, 16 cases (53.3%) complained of hearing loss and only 3 cases (10.0%) complained of tinnitus. The results showed that 19 cases (63.3%) developed bacteremia postoperatively. Streptococcus spp was the main organism found in 6 cases (20.0%) in preoperative external ear canal  and in 7 cases (23.3%) in postoperative dressing smear cultures, followed by Pseudomonas aeruginosa in 5 cases (16.7%) and 4 cases (13.3%), Diphteroid bacilli in 4 cases (13.3%) and 2 cases (6.7%), Coagulase staphylococcus in 4 cases (13.3%) and 2 cases (6.7%), also, Klebsiella spp was found in 2 cases (6.7%) and 2 cases (6.7%) for preoperative external ear canal  and postoperative dressing smear cultures, respectively. Regarding type and number of bacteria growing in blood culture immediately after surgery, the results showed that Streptococcus spp was presented in 11 cases (58.0%). Both Coagulase (-) staphylococcus and Bacillus spp with spores were found in 4 cases (21.0%). Conclusion: The risk of bacteremia should be considered in the preoperative period for the patients undergoing mastoidectomy. Postoperative use of antibiotics prevents several undesired complications and increases the success rate of the surgical procedure.