Microbial Spectrum of Cholesteatomatous Otitis Media and Its Correlation With Cholesteatoma Staging: A Cross-Sectional Analytical Study.

BACKGROUND: Cholesteatomatous chronic otitis media is a locally destructive condition in which persistent bacterial and fungal infection is thought to cause chronic inflammation and osteolytic activity, driving cholesteatoma progression; however, whether the microbial profile correlates with disease severity remains unclear. OBJECTIVE: This study aims to characterize the microbiological profile of cholesteatomatous otitis media and evaluate its relationship with cholesteatoma stage as defined by the European Academy of Otology and Neurotology/Japan Otological Society (EAONO/JOS) staging system. METHODS: In this hospital-based prospective cross-sectional analytical study conducted over 18 months at a tertiary care institute in Central India, 72 patients undergoing tympanomastoid surgery for chronic otitis media with cholesteatoma were enrolled. Cholesteatoma tissue obtained intraoperatively was submitted for aerobic culture, anaerobic culture, and fungal evaluation (KOH mount and culture). Disease stage was assigned using combined radiological and intraoperative findings per the EAONO/JOS (2017) system. Associations between microbiological findings and stage were assessed using Fisher's exact test and Spearman's rank correlation, with p<0.05 considered significant. RESULTS: Mean age was 25.36 ± 11.56 years (range 6-55), with a near-equal gender distribution: 35 males (48.6%) and 37 females (51.4%). Stage II disease was most common in 40 cases (55.6%), followed by Stage III in 26 cases (36.1%). Aerobic bacterial growth was identified in 61 patients (84.7%), fungal elements in 21 (29.2%), and anaerobic bacteria in 2 (2.8%). No statistically significant association was found between disease stage and aerobic (p=0.407), anaerobic (p=0.440), or fungal (p=0.349) growth. Spearman's correlation showed only weak, non-significant relationships between stage and aerobic bacteria (ρ=0.12, p=0.31), anaerobic bacteria (ρ=-0.10, p=0.42), and fungal positivity (ρ=-0.17, p=0.14). CONCLUSION: The microbial profile in cholesteatomatous otitis media was not significantly associated with disease stage; rather, anatomical severity is driven more by the host inflammatory response, biofilm formation, and the intrinsic osteolytic behaviour of cholesteatoma than by the specific organisms isolated. Microbiological culture remains valuable for guiding antimicrobial therapy but should not be used as a marker of disease severity.