Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl Risk of otitis media with effusion (OME) in children by Pseudomonas aeruginosa Amir Emami a,* , Neda Pirbonyeh b,c , Afagh Moattari c , Abdollah Bazargani c , Mohammad Motamedifar c a Department of Microbiology, Burn & Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran b Department of Microbiology, Burn & Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Shiraz, Iran c Bacteriology & Virology Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran ARTICLE INFO Keywords: Otitis media Pediatrics Bacteria Viruses Middle ear fluid Pseudomonas aeruginosa ABSTRACT Objective: Two third of children in the world experience otitis media with effusion (OME) at least once in their life. According to the importance of knowing OME reason in pediatrics, beside introduced probable bacterial and viral causal agents, Pseudomonas aeruginosa was evaluated either. Methods: In this study, 42 middle ear fluid (MEF) samples were collected from pediatrics who confirmed OME by an ears, nose and throat (ENT) specialist. Samples were cultured on bacteriological media for bacterial growth and were either extracted for total DNA and RNA to be tested for introduced bacterial and viral agents with simple and Reverse Transcriptase PCR method within specific primers. Results: Total results from culture and molecular methods showed that the most prevalent infections were Pseudomonas aeruginosa and streptococcus pneumonia with 33.33% and 14.29% respectively. In total, 66.67% of patients were infected with bacteria, 11.9% with test viruses while in 21.42% of patients no infectious agents were detected. Influenza type A was the only virus was detected. Conclusion: Pseudomonas aeruginosa was the most prevalent agent while mostly detected in patients who were referred from the tropical and humid region. According to these results, it is highly recommended to know the pattern of OME infection in each area separately for more successful treatment. 1. Introduction One of the most common childhood infections with important so- cietal and individual consequences is Otitis Media (OM) [1]. Acute otitis media (AOM) is an infection abrupt onset that usually presents with pain in ear and irritability specifically in infants but otitis media with effusion (OME) Symptoms usually involve hearing loss or aural fullness but typically do not involve pain or fever [2]. In children, hearing loss is generally mild and is often detected only with an audiogram. Serous otitis media is a specific type of otitis media with effusion caused by transudate formation as a result of a rapid decrease in middle ear pressure relative to the atmospheric pressure. The fluid, in this case, is watery and clear. These diseases are in the group of middle ear inflammatory disease which defined as otitis media [3]. According to the anatomy of the Eustachian tube (ET) in children, they are more prone to have a higher predisposition for an ear infection than adults which permits easier access of organism through the nasopharynx [1,4,5]. OME is considered to be a multifactorial disease, which clini- cally appears on different levels, caused by predisposing factors. Now it has been showed that several factors are an important role in the OME disease which the most is dysfunction in ET, failures or insufficiencies in the aeration of the mastoid cells, allergies, immunity, and poly- microbial infections [6,7]. In general, there are most criteria for OME while acute onset of some symptoms such as irritability and earache, signs of tympanic membrane inflammation, usually involve hearing loss or aural fullness but typically do not involve pain or fever and presence of middle ear fluid (MEF) are the most important criteria shows the developing the disease [8]. Bacterial and viral upper respiratory tract infection (URI) are the most agents have been shown to precede OM. Bacterial and viral URI agents mostly lead to ET inflammation which results in its dysfunction and beside that negative middle ear pressure permitting secretions containing the infecting pathogenic bacteria and viruses that colonize the nasopharynx to enter the middle ear. Viruses alter the ET function via decreased mucociliary action which besides https://doi.org/10.1016/j.ijporl.2019.06.017 Received 17 January 2019; Received in revised form 22 May 2019; Accepted 16 June 2019 * Corresponding author. Burn & wound healing research center, Microbiology department, Amir-Al-Momenin Burn Hospital, Sadra Blv., Shiraz, Fars, Iran. E-mail addresses: emami_a@sums.ac.ir, emami.microbia@gmail.com (A. Emami), p.pirbonyeh@yahoo.com (N. Pirbonyeh), moattaria@yahoo.com (A. Moattari), bazargania@gmail.com (A. Bazargani), motamedm@yahoo.com (M. Motamedifar). International Journal of Pediatric Otorhinolaryngology 125 (2019) 6–10 Available online 19 June 2019 0165-5876/ © 2019 Elsevier B.V. All rights reserved. T