الفهرس 
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Abstract
Chronic suppurative otitis media (CSOM) is a persistent, and potentially dangerous disease because of its various fatal complications. It is still a significant health problem in developing countries. It is the common cause of conductive deafness which may lead to delayed development of speech and language in children.
Change in the bacteriological scenario with indiscriminate use of antimicrobial agents has been associated with the emergence of multiple drug resistant strains. Information regarding the common pathogens and their antibiotic sensitivities is essential for the proper choice of antibiotics. Hence the present study is undertaken to know the bacteriological flora of CSOM and their antibiogram.
Sixsty clinically diagnosed cases of CSOM of all age groups ranging from 1 to 25 years and both the sexes attending in ENT wards from the three Al-Azhar university hospitals were studied. Another group of 20 healthy subjects were also studied as a control with the same range ages of the patients.
Also, group of water samples were taken under aseptic conditions from three different swimming pools coded as: Club 1, Club 2 and Club 3 .
Two swabs were taken from each patient, one from ear and other from throat.The bacterial isolates were cultured on different media: nutrient agar, blood agar, choclate agar and MacConkey’s agar. HPC, MPN and membrane filter technique were done for the water samples.
The isolates were identified by Gram stain and standard biochemical reactions. Antimicrobial and antifungal susceptibility testing were done by disc diffusion method. SDS-PAGE was also done for the most common isolates from ear and water.
A random selection of 60 CSOM cases were studied, of which 31 were males and 29 were females. Majority of the patients were in the age groups of 21-25years and 11-15 years.
Bacterial isolates from discharging ears showed predominance of P. aeruginosa (23.4%), followed by S. aureus (20.3%), Proteus vulgaris (14%), S. epidermidis (12.5%), E. coli (11%), Klebsiella spp. (9.4%) and C. diphtheroids (9.4%). While the most common organisms isolated from throat were Micrococcus spp. (29.9%), Candida albicans (24.7%), C. diphtheroids (16.9%), S. epidermidis (15.6%) and S. aureus (13%).
The most prevalent microorganisms in the water of swimming pools were Micrococcus spp. (100%), S. aureus, P. aeruginosa, S. epidermidis, C. diphtheroids and B. anthracoid were observed (66.7%), E. coli and Klebsiella spp. (33.3%), while fungal isolates showed predominance of Candida albicans followed by Aspergillus niger, Penicillium spp., Aspergillus flavus and Fusarium spp.
Antibiotics like ciprofloxacin followed by amikacin and ofloxacin were found to be most effective against all bacterial isolates. While ketoconazole followed by nystatin were found to be most effective against C. albicans.
According to the investigation of the protein profile by the SDS-PAGE technique, the results of this study clarified the possibility to the presence of different types of proteins induced in both S. aureus and P. aeruginosa isolated from chronic otitis media such as proteases and lipases enzymes induced in S. aureus and elastase, phospholipase C and leukocidin induced in P. aeruginosa. These proteins showed high similarity with the proteins induced in the same organisms isolated from water, 85% for S. aureus and 88% for P. aeruginosa, also these proteins revealed their importance in the pathogenicity of the two organisms.