The SF-36, VHI, and VOS provide an important complement to traditional endpoints in the analysis of patients with UVCP.

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Objectives: To evaluate a noninvasive method of bacterial identification via fluorescence spectroscopy in the setting of acute otitis media in a chinchilla model. Study Design: Prospective. Methods: For each chinchilla, transbullar inoculation with Streptococcus pneumoniae, Haemophilus influenzae, or Staphylococcus aureus was performed bilaterally and clinical infection was determined by otoscopy. An optical fiber coupled to a spectrofluorometer allowed for the delivery of an excitation wavelength to the inflamed tympanic membrane and the acquisition of the resulting emission signal. Sequential emission spectra obtained over a range of excitation wavelengths were assembled by a computer algorithm, and a single, three-dimensional plot was created for each test ear. Similarly, plots from the healthy external auditory canal (EAC) were also recorded. Twelve animals were used to establish a library of four reference plots representing the three bacteria and the EAC. Of the 24 ears available for study, 10 were excluded from analysis because of lack of clinical infection or presence of tympanic membrane perforation with purulent drainage. From four additional animals, four samples from ears infected with the above bacteria and three samples of the EAC served as unknowns. The unknown plots were analyzed by an investigator blinded to their identity. Results: Using a multiple correlation of the unknown to the reference plots, seven of seven samples were correctly identified. Conclusions: We were able to establish a prototype method for the noninvasive identification of a limited library of pathogens in a chinchilla model of acute otitis media. Key Words: Acute otitis media, fluorescence, noninvasive diagnosis, chinchilla.Laryngoscope , 110:1119-1123, 2000 . INTRODUCTIONAppropriate man agement of acute otitis media (AOM) requires an under standing of bact eria and their propensity to alter sensitivities to antimicrobial th era py. Important vari ables to consider include the prevalence, n atural history, and r esistance patterns of common pathogens ca using AOM within each community. 1 The presence of resistant bacteri a should be su spected in the setting of persistent clinical infec tion despite an initial CO\.ll"Se of treatment. Currently the most common pa thogens that limit the efficacy of first-line ther apy include mul tidr ugr esistant Streptococcus pneumoniae a nd {3-lactamase-producing strains of Haemophilus influenzae and Moraxella catarrhalis. With this in mind , physici ans may tailor th eir n ext treatment selection to best counter known mech anisms of antibiotic resistance. Examples include incr easing the dose of amoxicillin to heighten the concentration of drug in the middle ear fluid or selecting a second-line antibiotic with better activity against {3-lactamase-producing species and penicillin-resista nt S pneumoniae.At present, bacterial identifica tion in the setting of AOM can be accomplished using needl e aspiration of the middle ear fluid via tympanocentesis. Di sadvantages of this procedure inc...