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Ziv O, Sapir A, Leibovitz E, Kordeluk S, Kaplan DM, El-Saied S. Post-operative clinical course in children undergoing mastoidectomy due to complicated acute mastoiditis. Eur Arch Otorhinolaryngol 2021; 279:3891-3897. [PMID: 34714371 DOI: 10.1007/s00405-021-07149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment. METHODS A retrospective chart review of children diagnosed with CAM who underwent mastoid surgery during 2012-2019 in a tertiary care university hospital. 33 patients, divided into 2 groups: 17 patients with sub-periosteal abscess (SPA) alone-single complication group (SCG) and 16 patients with SPA and additional complications: sigmoid sinus thrombosis (SST), peri-sinus fluid/abscess, epidural/subdural abscess, and acute meningitis-multiple complications group (MCG). RESULTS 33 patients belong to the SCG 17(51%) and 16(49%) belonged to the MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P = 0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P = 0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings; a total of 18 positive cultures were reported. Fusobacterium necrophorum counted for 8/18(44.5%) of all positive cultures, 7/9(77.8%) in the MCG vs. 1/9(11.1%) in the SCG, P = 0.004. Streptococcus pneumoniae was reported only in SCG (5/9, 55.5%, vs. 0/9, P = 0.008). CONCLUSION Post-mastoidectomy fever due to CAM is not unusual and seems to be a benign condition for the first 5-6 days, following surgery. MCG patients are more prone to develop POF. F. necrophorum is more likely to be associated with MCG, and S. pneumoniae is common in SCG patients.
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Affiliation(s)
- Oren Ziv
- Department of Otolaryngology-Head and Neck Surgery, Ben-Gurion University, Beer-Sheva, Israel.,ENT Department, Soroka University Medical Center, 151, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Aviad Sapir
- Department of Otolaryngology-Head and Neck Surgery, Ben-Gurion University, Beer-Sheva, Israel. .,ENT Department, Soroka University Medical Center, 151, Beer Sheva, Israel. .,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
| | - Eugene Leibovitz
- Pediatric Infectious Disease Unit, Ben-Gurion University, Beer-Sheva, Israel.,ENT Department, Soroka University Medical Center, 151, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Sofia Kordeluk
- Department of Otolaryngology-Head and Neck Surgery, Ben-Gurion University, Beer-Sheva, Israel.,ENT Department, Soroka University Medical Center, 151, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Ben-Gurion University, Beer-Sheva, Israel.,ENT Department, Soroka University Medical Center, 151, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology-Head and Neck Surgery, Ben-Gurion University, Beer-Sheva, Israel.,ENT Department, Soroka University Medical Center, 151, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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Huang YB, Li L, Pan Y, Li QZ, Li H. Clinical characteristics of otogenic lateral sinus thrombosis in patients under 18 years old compared with that in adult patients. Acta Otolaryngol 2021; 141:237-241. [PMID: 33427005 DOI: 10.1080/00016489.2020.1859134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Otogenic lateral sinus thrombosis (OLST) is a rare complication of otitis media. We do not know whether the disease progress between the pediatric and adult OLST patients is consistent. However, pediatric surgical methods always refer to the adults'. AIMS/OBJECTIVES This study aimed to seek evidence for suitable surgical methods in pediatric patients. MATERIALS AND METHODS The clinical manifestation, laboratory findings, and findings in operation between children and adult groups were compared. RESULTS Ten children and 17 adults OLST patients were included. Most pediatric patients had no history of chronic otitis media or cholesteatoma (p<.001). The ratios of otorrhea, tympanic perforation and sclerotic type mastoid in CT scan were significantly lower in the children group (p<.05). The mean air conduction hearing threshold in the children and adolescent group (31.25 ± 21.27 dB) was significantly lower than that of the adult group (77.6 ± 23.66 dB) (p<.001). The diseases in attics (66.7%) and the ossicular chain destruction (33.3%) were not as severe as those in the adult group (p<.05). The eustachian tube closure was found similar in two groups. CONCLUSIONS AND SIGNIFICANCE Conservative surgery is recommended to pediatric OLST to obliterate the diseases and improve middle ear and mastoid drainage, preserving hearing function.
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Affiliation(s)
- Yi-Bo Huang
- Department of Radiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Li Li
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Lianyungang City, Lianyungang City, China
| | - Yucheng Pan
- Department of Radiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qing-Zhong Li
- Department of Radiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Huawei Li
- Department of Radiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
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Yuan L, Yuan J, Sun Y, Wang Y. The Anticoagulant Therapy for Otogenic Sigmoid Sinus Thrombophlebitis: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 101:NP379-NP382. [PMID: 33236644 DOI: 10.1177/0145561320976405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sigmoid sinus thrombophlebitis is a severe and potentially fatal intracranial complication of acute otitis media and middle ear cholesteatoma. Early administration of broad-spectrum antibiotics and immediate radical mastoidectomy are the recommended standard treatments; however anticoagulant therapy is always an option worthy of clinical consideration. Here, we report a case of middle ear cholesteatoma complicated with sigmoid sinus thrombophlebitis in a patient who received anticoagulant therapy for 1 year before the operation because of the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Lanlai Yuan
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Jie Yuan
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yanjun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, Hubei, China
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Kaufmann MR, Camilon PR, Levi JR, Devaiah AK. Predicting Anticoagulation Need for Otogenic Intracranial Sinus Thrombosis: A Machine Learning Approach. J Neurol Surg B Skull Base 2020; 82:233-243. [PMID: 33777638 DOI: 10.1055/s-0040-1713105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/15/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The role of anticoagulation (AC) in the management of otogenic cerebral venous sinus thrombosis (OCVST) remains controversial. Our study aims to better define when AC is used in OCVST. Methods MEDLINE, EMBASE, and The Cochrane Library were searched from inception to February 14, 2019 for English and English-translated articles. References cited in publications meeting search criteria were searched. Titles and abstracts were screened and identified in the literature search, assessing baseline risk of bias on extracted data with the methodological index for nonrandomized studies (MINORS) scale. Random effects meta-regression followed by random forest machine learning analysis across 16 moderator variables between AC and nonanticoagulated (NAC) cohorts was conducted. Results A total of 92% of treated patients were free of neurologic symptoms at the last follow-up (mean 29.64 months). Four percent of AC and 14% of NAC patients remained symptomatic (mean 18.72 and 47.10 months). 3.5% of AC patients experienced postoperative wound hematomas. AC and NAC recanalization rates were 81% (34/42) and 63% (five-eights), respectively. OCVST was correlated with cholesteatoma and intracranial abscess. Among the analyzed covariates, intracranial abscess was most predictive of AC and cholesteatoma was most predictive of NAC. Comorbid intracranial abscess and cholesteatoma were predictive of AC. Conclusion The present study is the first to utilize machine learning algorithms in approaching OCVST. Our findings support the therapeutic use of AC in the management of OCVST when complicated by thrombophilia, intracranial abscess, and cholesteatoma. Patients with intracranial abscess and cholesteatoma may benefit from AC and surgery. Patients with cholesteatoma can be managed with NAC and surgery.
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Affiliation(s)
- Matthew R Kaufmann
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - Philip Ryan Camilon
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States
| | - Anand K Devaiah
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States.,Department of Neurological Surgery and Ophthalmology, Boston, Massachusetts, United States.,Institute for Health System Innovation and Policy, Boston University, Boston, Massachusetts, United States
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Otitis Media Complicated by Lateral Sinus Thrombosis and Citelli's Abscess. Otol Neurotol 2020; 41:e1272-e1275. [PMID: 32810021 DOI: 10.1097/mao.0000000000002806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Mastoiditis is the most common intra-temporal complication of acute otitis media. Despite potentially lethal sequelae, optimal management remains poorly defined. METHOD A retrospective case review was conducted of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017. RESULTS Fifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0-27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred. CONCLUSION A detailed contemporary description of paediatric mastoiditis presentation and management is presented. The findings broadly mirror those published by other UK centres, but suggest a higher rate of identified disease complications and surgical interventions.
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Radiology of acute mastoiditis and its complications: a pictorial review and interpretation checklist. The Journal of Laryngology & Otology 2019; 133:856-861. [PMID: 31475649 DOI: 10.1017/s0022215119001609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mastoiditis is an otological emergency, and cross-sectional imaging has a role in the diagnosis of complications and surgical planning. Advances in imaging technology are becoming increasingly sophisticated and, by the same token, the ability to accurately interpret findings is essential. METHODS This paper reviews common and rare complications of mastoiditis using case-led examples. A radiologist-derived systematic checklist is proposed, to assist the ENT surgeon with interpreting cross-sectional imaging in emergency mastoiditis cases when the opinion of a head and neck radiologist may be difficult to obtain. RESULTS A 16-point checklist (the 'mastoid 16') was used on a case-led basis to review the radiological features of both common and rare complications of mastoiditis; this is complemented with imaging examples. CONCLUSION Acute mastoiditis has a range of serious complications that may be amenable to treatment, once diagnosed using appropriate imaging. The proposed checklist provides a systematic approach to identifying complications of mastoiditis.
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Abstract
Infections of the head and neck are common and appropriately managed by primary care providers in most cases. However, some infections are associated with significant morbidity and require urgent recognition and management by specialty services. These include deep neck space infections originating in the oral cavity, pharynx, and salivary glands, as well as complicated otologic and sinonasal infection. This article provides a review of these conditions, including the pathophysiology, presenting features, and initial management strategy.
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Affiliation(s)
- Marika D Russell
- Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 2233 Post Street, 3rd floor, San Francisco, CA 94115, USA.
| | - Matthew S Russell
- Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 2233 Post Street, 3rd floor, San Francisco, CA 94115, USA
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