The most important micro-organisms responsible for otitis media and mastoiditis are group A hemolytic streptococci, pneumococci and staphylococci. There is, however, a marked difference in incidence of these bacteria between otitis media and mastoiditis, inasmuch as staphylococci are rather frequently encountered in the former condition but only rarely in the latter. The question arises, therefore, whether or not staphylococci are the cause of otitis media without tendency to invade the mastoid cells or whether staphylococci found in otitis media may be nonpathogenic and outgrow on culture the true pathogens. It is generally agreed today that the best in vitro method to determine pathogenicity or nonpathogenicity of staphylococci is the plasma coagulation test. Pigment and hemolysin production, formerly considered to reflect pathogenicity, are not as reliable indicators as the production of coagulase. It was decided, therefore, to carry out a bacteriologic study on cases of otitis media and mastoiditis and to
NETER E, NEUBURGER F, SHORT ML. OTITIS MEDIA AND MASTOIDITIS IN CHILDREN: BACTERIOLOGIC STUDIES WITH SPECIAL REFERENCE TO THE PATHOGENICITY OF STAPHYLOCOCCI. Arch Otolaryngol. 1942;35(4):631–639. doi:10.1001/archotol.1942.00670010636011
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