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Samuel O, Saliba W, Stein N, Shiner Y, Cohen-Kerem R. Emerging Clinical Features of Acute Mastoiditis in Israel: A Registry Based Cohort. Pediatr Infect Dis J 2024; 43:620-625. [PMID: 38564738 DOI: 10.1097/inf.0000000000004325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND OBJECTIVES Acute mastoiditis (AM) is a severe infection in the young population, with possible life-threatening complications. This study aimed to characterize AM presentation, symptoms and signs, complications, and management, over a period of 10 years. METHODS This large-scale population-based cohort studied "Clalit Health Care" records, to include patients <18 years diagnosed with AM, hospitalized between the years 2008-2018. After validation, we investigated clinical symptoms and signs, pneumococcal vaccination status, complications, laboratory and microbiological parameters, imaging, antibiotic treatment and surgical interventions. RESULTS AM was diagnosed in 1189 patients, mean age of 2.71 years and 591 (49.71%) were female. Most presented with protrusion of pinna (83.1%), retro auricular redness (73.5%) and fever (71.8%). Patients <2 years of age had more symptoms (3.8 ± 1.4, opposed to 3.6 ± 1.5, P = 0.006) and showed higher white blood cell count and C-reactive protein values. Local and intracranial complications occurred in 233 (20.8%) and 75 (6.5%) patients, respectively. Complications were associated with increased white blood cell count and C-reactive protein and related to bacterial type, specifically Fusobacterium necrophorum ( P < 0.0001), for which 50% had an intracranial complication. Between the years 2008-2018, Streptococcus pneumoniae -positive cultures decreased (30.9% to 10.3%, P > 0.0001) as opposed to group-A Streptococcus (10.9% to 30.9%, P = 0.002). CONCLUSIONS This study shows a difference in AM appearance in the <2 years population and the association between white blood cell count, C-reactive protein and microbiology results with the occurrence of a complication. This may play a role in the management process, such as imaging and intervention needs. Although performed during the pneumococcal vaccine era, the disease microbiology was shown to change significantly throughout the study.
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Affiliation(s)
- Orit Samuel
- From the Department of Otolaryngology-Head and Neck Surgery, Carmel Medical Center
- The Bruce Rappaport Faculty of Medicine, the Technion
- Unit of Otoneurology, Lin Medical Center, Haifa, Israel
- University of Melbourne, Melbourne, Australia
| | - Walid Saliba
- The Bruce Rappaport Faculty of Medicine, the Technion
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Yotam Shiner
- From the Department of Otolaryngology-Head and Neck Surgery, Carmel Medical Center
- The Bruce Rappaport Faculty of Medicine, the Technion
| | - Raanan Cohen-Kerem
- From the Department of Otolaryngology-Head and Neck Surgery, Carmel Medical Center
- The Bruce Rappaport Faculty of Medicine, the Technion
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
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Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Acute mastoiditis. Am J Emerg Med 2024; 79:63-69. [PMID: 38368849 DOI: 10.1016/j.ajem.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures. CONCLUSIONS An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Edwards S, Kumar S, Lee S, Pali BL, Marek RL, Dutta A. Epidemiology and variability in management of acute mastoiditis in children. Am J Otolaryngol 2022; 43:103520. [PMID: 35724628 DOI: 10.1016/j.amjoto.2022.103520] [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: 04/19/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND To evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship. METHODS We conducted a retrospective observational study of children aged >6 months to ≤18 years of age admitted to a tertiary care hospital with AM over an 8-year period (2011-2019). Electronic medical records were reviewed to collect data. RESULTS A total of 129 patients met inclusion criteria for AM during this time period. Eighty-one (63 %) were males with 110 (81 %) White and 67 (52 %) non-Hispanic. The median age at presentation was 6.4 years (3-10.1 years). Ear protrusion was associated with reduced odds of having AM with intracranial extension (ICE) (OR 0.307, 95 % CI = 0.107-0.883) whereas presence of headaches and/or neck pain increased the odds of having AM with ICE (OR = 3.96, 95%CI 1.29-12.1). The most common etiologies were Streptococcus pyogenes (n = 23, 19.2 %), Pseudomonas aeruginosa (n = 20, 17 %), and Streptococcus pneumoniae (n = 15, 12.5 %). Empiric antibiotic selection and duration of therapy was highly variable. The most common empiric antibiotic used was intravenous vancomycin with a third generation cephalosporin (n = 45, 34.8 %). Majority completed course (n = 92; 73 %) with an oral antibiotic. Shorter (≤10 and ≤14 days) versus longer courses (>10 and >14 days) did not affect readmission rates for AM without ICE. CONCLUSION There is high variability of treatment of AM in children. Broad spectrum antibiotics, especially vancomycin were used most frequently despite low rates of Methicillin Resistant Staphylococcus aureus. The use of antibiotic stewardship is essential for judicious antibiotic use.
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Affiliation(s)
- Stephen Edwards
- Baylor College of Medicine Department of Pediatrics, United States of America; Texas Children's Hospital, United States of America; Section of Hospital Medicine, United States of America
| | - Shelley Kumar
- Baylor College of Medicine Department of Pediatrics, United States of America; Texas Children's Hospital, United States of America; Center of Research, Innovation, and Scholarship for Medical Education, United States of America
| | - Soyoon Lee
- Texas Children's Hospital, United States of America
| | - Beth L Pali
- Texas Children's Hospital, United States of America
| | - Rachel L Marek
- Baylor College of Medicine Department of Pediatrics, United States of America; Texas Children's Hospital, United States of America; Section of Hospital Medicine, United States of America
| | - Ankhi Dutta
- Baylor College of Medicine Department of Pediatrics, United States of America; Texas Children's Hospital, United States of America; Section of Infectious Diseases, United States of America.
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Management of Acute Complicated Mastoiditis: A Systematic Review and Meta-analysis. Pediatr Infect Dis J 2022; 41:297-301. [PMID: 35175990 DOI: 10.1097/inf.0000000000003452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of our study was to evaluate the efficacy of treatment options for the most frequently reported complications of acute mastoiditis in the English literature. PubMed, EMBASE, and The Cochrane Library were searched from database inception through March 29, 2019. METHODS Two independent reviewers (M.R.K., K.S.) evaluated search results for study inclusion. References cited in publications meeting inclusion criteria were reviewed. Twenty-three included studies were published from 1998 through 2018. Treatment efficacy was determined by comparing the change in number of complication subtypes in each treatment subgroup (medical, conservative, or surgical) from admission to discharge (range: 5-30 days) or postdischarge follow-up (range: 1-27.5 months) with a random effects model. RESULTS Among 733 identified articles, 23 met inclusion criteria. Of the 883 included patients, 203 were managed medically (23%), 300 conservatively (34%) and 380 surgically (43%). Conservative patients had more extracranial complications (ECC, P = 0.04) and intratemporal complications (IT, P = 0.04) at follow-up compared with medical patients. Medical patients had more total number of complications (TNC, P = 0.03), ECC (P = 0.02), and IT (P = 0.01) at discharge compared with surgical patients. Conservative patients had more of all complications except intracranial/extracranial abscess and "other" at discharge and follow-up compared with surgical patients. CONCLUSIONS There were larger reductions in TNC, ECC, and IT at discharge and follow-up among surgical patients compared with medical and conservative patients. There were greater reductions in TNC, ECC, IT, intracranial complications, subperiosteal abscess and lateral sinus thrombosis at discharge and follow-up among surgical patients compared with conservative patients.
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Management of infective complications of otitis media in resource-constrained settings. Curr Opin Otolaryngol Head Neck Surg 2021; 28:174-181. [PMID: 32332206 DOI: 10.1097/moo.0000000000000627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Complications of otitis media are a cause of significant morbidity and mortality, compounded in resource-constrained settings in which human and physical resources to manage disease are suboptimal. Here, we examine the current best evidence to devise a protocol for management, in particular exploring the opportunity for conservative or nonspecialist management. RECENT FINDINGS Reviews of the literature suggest that intratemporal and extracranial infections can be managed with antibiotics in the first instance, with aspiration or incision and drainage of abscess. Failure to respond necessitates mastoidectomy, which need not be extensive, and can be performed with hammer and gouge. Suspected or possible intracranial extension requires referral for computed tomography (CT) imaging. Intracranial infection can in some instances be managed with antibiotics, but large or persistent intracranial abscess, or the presence of cholesteatoma requires management in a centre for specialist surgery. SUMMARY Many complications of otitis media could be managed by nonspecialists in appropriately equipped local or regional health facilities, and supported by appropriate training. However, regional centres with CT imaging and specialist surgery are required for assessment and treatment of cases that are suspected of having complex or advanced disease, or that fail to respond to initial treatment. Those involved in planning healthcare provision should look to develop infrastructure to support such management.
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Sapir A, Ziv O, Leibovitz E, Kordeluk S, Rinott E, El-Saied S, Greenberg D, Kaplan DM. Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis in children in southern Israel: A 12-year retrospective comparative study (2005-2016). Int J Pediatr Otorhinolaryngol 2021; 140:110485. [PMID: 33168224 DOI: 10.1016/j.ijporl.2020.110485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To define the trends in acute mastoiditis (AM) incidence, microbiology, complications and management in children, before and after the 13-valent pneumococcal conjugate vaccine (PVC13) introduction. METHODS Medical records of all AM patients <15 years of age diagnosed during 2005-2016 were reviewed. The study years were divided into three periods: pre-vaccination (2005-2008), interim (2009-2011) and post-PCV13 vaccination (2012-2016). RESULTS 238 patients (53.4% males) were enrolled, 81, 56 and 101 in the 3 time periods, respectively. Overall, 177/238 (75.2%) of children were <5 years of age. Mean AM incidence in the whole population was 10.32/100,000, with no changes during the study years. Ninety-three (45.6%) of 204 evaluable patients had positive middle ear fluid/mastoid cultures; S. pneumoniae (SP) was isolated in 47/93 (50.5%) cases. Mean incidence of SP-AM during the study years was 2.49 cases/100,000. A trend for decrease in mean incidence of SP-AM was recorded between the pre and the post-vaccination periods (3.05/100,000 vs. 1.82/100,000, P = 0.069). Among patients <5 years, SP-AM rates decreased from pre to post-vaccination period (19/50, 38% vs. 15/73, 20.6%, P = 0.034). No changes were reported in percentages of culture negative-AM and of AM complications in the post-PCV13 period compared with the pre-vaccine period. A significant decrease in distribution of PCV13 serotypes was recorded (17/19, 89.5% vs. 8/12, 66.6% and vs. 7/16, 43.75% during the 3 study periods, P = 0.015) accompanied by a complementary increase in non-vaccine serotypes. CONCLUSIONS The introduction of PCV13 was accompanied by a significant decrease in SP-AM cases among children <5 years of age. PCV13 serotypes decreased significantly as etiologic agents of SP-AM while non-vaccine serotypes and culture negative-AM became more common in the postvaccination period.
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Affiliation(s)
- Aviad Sapir
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Oren Ziv
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Eugene Leibovitz
- Pediatric Infectious Disease Unit, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel.
| | - Sophia Kordeluk
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Ehud Rinott
- Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
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Jung M, Mlynski R, Weiss NM. [Medical examination: Preparation for ENT specialisation : Part 51]. HNO 2020; 68:949-954. [PMID: 33021686 DOI: 10.1007/s00106-020-00943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Jung
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - R Mlynski
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - N M Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland.
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Olzowy B, Al-Nawas B, Havel M, Karbach J, Müller R. Calculated parenteral initial treatment of bacterial infections: Infections in the ear, nose, throat and mouth and jaw area. GMS INFECTIOUS DISEASES 2020; 8:Doc14. [PMID: 32373439 PMCID: PMC7186809 DOI: 10.3205/id000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the sixth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter deals with the antibacterial treatment of more severe infections of the ear, the nose, the throat and the maxillofacial region, including odontogenic and salivary gland infections.
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Affiliation(s)
| | - Bilal Al-Nawas
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Miriam Havel
- Klinik und Poliklinik für HNO-Heilkunde, Klinikum der Universität München, Munich, Germany
| | - Julia Karbach
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Rainer Müller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus Dresden, Germany
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Acute Mastoiditis Associated with Pseudomonas Aeruginosa in the Pediatric Population of the Umbria Region, Italy. Pathogens 2019; 8:pathogens8040180. [PMID: 31600897 PMCID: PMC6963525 DOI: 10.3390/pathogens8040180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 11/17/2022] Open
Abstract
Acute mastoiditis (AM) is the most common complication of acute otitis media (AOM) and is one of the most severe acute bacterial diseases in infants and children. In some geographic areas, the incidence of AM is increasing, and the causative role of some bacterial pathogens could be greater than previously thought. In this paper, the results of a study that evaluated the epidemiology and microbial etiology of paediatric AM in Umbria, which is a region of central Italy, are reported. This is a retrospective study of patients aged 0-14 years with AM admitted to the pediatric wards of the hospitals of Umbria, Italy, between June 1 and September 30 in four consecutive years (2015-2018). A total of 108 children were enrolled. The prevalence of AM in males during the four years of analysis was significantly higher than that in females at 63% (95% confidence intervals [CI]: 0.54-0.72). The most frequently affected age groups were 5-9 years (45.4%) and 10-14 years (31.5%), with statistically significant differences in comparison with children aged <1 year (5.6%, 95% CI: 0.01-0.10) and 1-4 years (17.6%, 95% CI: 0.10-0.25). In most cases (64, 59.3%), AM was associated with spontaneous tympanic membrane perforation (STP). The culture of the middle ear fluid revealed the presence of Pseudomonas aeruginosa in 56 cases (51.6%). The mean incidence rates of pediatric AM in Umbria during the study increased significantly with time, as it was 18.18/100,000 children/year in 2015-2016 and 29.24/100,000 children/year in 2017-2018 (CI difference: +2.5 - +19.9, p < 0.05). The incidence rates of Pseudomonas aeruginosa detection in pediatric AM associated with STP significantly increased with time. The incidence was 6.06/100,000 children/year in 2015-2016 and 18.61/100,000 children/year in 2017-2018 (CI difference: +6.1 - +19.0, p < 0.001). This study demonstrated the high and increasing incidence of AM in the Umbria region during the summer months and the frequent detection of P. aeruginosa as an etiologic agent of the disease in the presence of STP. Confirmation of these results with a larger study population, in different settings, and throughout the whole year is needed to define the first-line approach of AM with STP in pediatrics.
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Stern Shavit S, Raveh E, Levi L, Sokolov M, Ulanovski D. Surgical intervention for acute mastoiditis: 10 years experience in a tertiary children hospital. Eur Arch Otorhinolaryngol 2019; 276:3051-3056. [DOI: 10.1007/s00405-019-05606-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/16/2019] [Indexed: 01/20/2023]
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Management of Acute Mastoiditis With Immediate Needle Aspiration for Subperiosteal Abscess. Otol Neurotol 2019; 40:e612-e618. [DOI: 10.1097/mao.0000000000002231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Recent reports have reported an increase in the incidence of acute mastoiditis because of Fusobacterium necrophorum. However, the crude incidence and the specific clinical and laboratory characteristics of F. necrophorum mastoiditis in children have not been described. Our aim was to describe these features to identify high-risk patients. METHODS The electronic medical records of all children with acute mastoiditis at a tertiary medical center between July 2011 and December 2015 were analyzed. Using a stepwise logistic regression to identify independent risk factors for F. necrophorum, we formulated a predictive model. RESULTS F. necrophorum was identified in 13% (19/149) of mastoiditis cases with an identifiable agent. Its incidence increased 7-fold from 2.8% in 2012 to 20.4% in 2015 (P = 0.02). F. necrophorum infection had unique clinical, laboratory and prognostic features. The vast majority had complications and underwent surgical intervention. The predictive model used 4 parameters to define high-risk patients for F. necrophorum infection at admission: females, winter/spring season, prior antibiotic treatment and a C-reactive protein value >20 mg/dL (area under receiver operating characteristic curve 0.929). CONCLUSIONS Clinicians should be aware of the increasing incidence of F. necrophorum mastoiditis and consider anaerobic cultures and specific anaerobic coverage in high-risk patients.
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Anne S, Schwartz S, Ishman SL, Cohen M, Hopkins B. Medical Versus Surgical Treatment of Pediatric Acute Mastoiditis: A Systematic Review. Laryngoscope 2018; 129:754-760. [DOI: 10.1002/lary.27462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Samantha Anne
- Department of Otolaryngology-Head and Neck Surgery; Cleveland Clinic; Cleveland Ohio
| | - Seth Schwartz
- Department of Otolaryngology-Head and Neck Surgery; Virginia Mason Medical Center; Seattle Washington
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Division of Pulmonary Medicine; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
| | - Michael Cohen
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Brandon Hopkins
- Department of Otolaryngology-Head and Neck Surgery; Cleveland Clinic; Cleveland Ohio
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Schilder AGM, Marom T, Bhutta MF, Casselbrant ML, Coates H, Gisselsson-Solén M, Hall AJ, Marchisio P, Ruohola A, Venekamp RP, Mandel EM. Panel 7: Otitis Media: Treatment and Complications. Otolaryngol Head Neck Surg 2017; 156:S88-S105. [PMID: 28372534 DOI: 10.1177/0194599816633697] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
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Affiliation(s)
- Anne G M Schilder
- 1 evidENT, Ear Institute, University College London, London, United Kingdom.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tal Marom
- 3 Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Mahmood F Bhutta
- 4 Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Margaretha L Casselbrant
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harvey Coates
- 6 Department of Otolaryngology, School of Paediatrics and Child Health, The University of Western Australia, Nedlands, WA, Australia
| | - Marie Gisselsson-Solén
- 7 Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Amanda J Hall
- 8 University Hospitals Bristol NHS Foundation Trust and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Paola Marchisio
- 9 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aino Ruohola
- 10 Department of Pediatrics, University of Turku, Turku, Finland
| | - Roderick P Venekamp
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen M Mandel
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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The Role of Bacteriologic Studies in Predicting Recurrent Mastoiditis in 456 Patients. Otol Neurotol 2016; 37:1059-62. [DOI: 10.1097/mao.0000000000001133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stergiopoulou T, Walsh TJ. Fusobacterium necrophorum otitis and mastoiditis in infants and young toddlers. Eur J Clin Microbiol Infect Dis 2016; 35:735-40. [PMID: 26951264 DOI: 10.1007/s10096-016-2612-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/15/2016] [Indexed: 01/22/2023]
Abstract
There is an increased recovery of Fusobacterium necrophorum from cases of otitis media and mastoiditis in the pediatric population. These infections may be highly severe, causing local osteomyelitis, bacteremia, and Lemierre's syndrome. The severity and difficulties in providing optimal treatment for these infections may be especially difficult in this age group due to immunological immaturity and delayed presentation. In this review of literature, we present and analyze the clinical presentation, management, and outcome of otic infections caused by F. necrophorum in infants and young toddlers less than 2 years old. Search in Pubmed was conducted for reported cases in the English literature for the time period of the last 50 years. Twelve well-described cases were retrieved with F. necrophorum otitis and mastoiditis and complications reported in all cases. Treatment included both intravenously with antimicrobial agents (beta lactams plus metronidazole) and mastoidectomy. Lemierre's syndrome and Lemierre's syndrome variants developed in 60 % of the patients. Dissemination of the infection as distal osteomyelitis and septic shock were also reported. The outcome was favorable in all the cases. Otitis and mastoiditis infections in children less then 2 years old are invasive infections, and severe complications can occur.
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Affiliation(s)
- T Stergiopoulou
- CHU Liege, Department of Pediatrics, Notre Dame des Bruyeres, rue de Gaillarmont 600, B. 4032, Liege, Belgium.
| | - T J Walsh
- Transplantation-Oncology Infectious Diseases Program, and Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center, New York, NY, USA
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Severe Acute Mastoiditis Admission is Not Related to Delayed Antibiotic Treatment for Antecedent Acute Otitis Media. Pediatr Infect Dis J 2016; 35:162-5. [PMID: 26461229 DOI: 10.1097/inf.0000000000000951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed antibiotic treatment for acute otitis media (AOM) is recommended for children >6 months with nonsevere illness, no risk factors for complications or history of recurrent AOM. This study evaluates relationship between delayed antibiotic treatment for antecedent AOM and severity of subsequent acute mastoiditis admission. METHODS A prospective observational study of children aged 0-14 years admitted with acute mastoiditis to 8 hospitals between 2007 and 2012 calculates rates of severe acute mastoiditis admission [defined by ≥1 of the following: complication (mastoid subperiosteal abscess, brain abscess and sagittal vein thrombosis), need for surgical procedure and duration of admission >6 days].Severe acute mastoiditis admissions in children with antecedent AOM treated with immediate antibiotics were compared with those with delayed antibiotic treatment. RESULTS Antecedent AOM was diagnosed in 216 of 512 acute mastoiditis admissions (42.1%), of whom 159 (73%) immediately received antibiotics, and 57 (27%) had delayed antibiotic treatment. Higher rate of recurrent AOM was noted in the immediate compared with delayed antibiotic treatment group (29% vs. 8.7%, P = 0.0021). Complication rates were 19.5% versus 10.5% (P = 0.12), rates of surgical procedures required, 30% versus 10% (P = 0.0033); admission rates >6 days, 37% versus 29% (P = 0.28) for immediate antibiotic therapy and delayed antibiotic treatment. On logistic regression analysis, immediately treated AOM patients had increased need for surgery for acute mastoiditis with adjustment for history of recurrent AOM (relative risk: 3.2, 95% confidence interval: 1.4-7.0). CONCLUSIONS Delayed antibiotic treatment for antecedent AOM is not associated with an increase in severity parameters in subsequent acute mastoiditis admission.
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18
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Fusobacterial head and neck infections in children. Int J Pediatr Otorhinolaryngol 2015; 79:953-8. [PMID: 25980688 DOI: 10.1016/j.ijporl.2015.04.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/28/2015] [Accepted: 04/29/2015] [Indexed: 11/20/2022]
Abstract
Fusobacterium species are increasingly recognized as a cause of head and neck infections in children. These infections include acute and chronic otitis, sinusitis, mastoiditis, and tonsillitis; peritonsillar and retropharyngeal abscesses; Lemierre syndrome; post-anginal cervical lymphadenitis; and periodontitis. They can also be involved in brain abscess and bacteremia associated with head and neck infections. This review describes the clinical spectrum of head and neck fusobacterial infection in children and their management.
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Kordeluk S, Kraus M, Leibovitz E. Challenges in the Management of Acute Mastoiditis in Children. Curr Infect Dis Rep 2015; 17:479. [DOI: 10.1007/s11908-015-0479-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Antibiothérapie des infections ORL sévères du nourrisson et de l’enfant : Mastoïdites aiguës. Arch Pediatr 2013; 20 Suppl 3:e10-3. [DOI: 10.1016/s0929-693x(13)71421-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Abstract
Fusobacteria are members of the oral and gastrointestinal flora and are important potential pathogens in children. They are increasingly recognized as a cause of infections in children. These include infections of the head and neck (Lemierre syndrome, acute and chronic mastoiditis, chronic otitis and sinusitis, tonsillitis, peritonsillar and retropharyngeal abscesses, postanginal cervical lymphadenitis, periodontitis), brain, lungs, abdomen, pelvis, bones, joints, and blood. This review describes the clinical spectrum of fusobacterial infection in children and their management.
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22
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Mastoiditis in adults: a 19-year retrospective study. Eur Arch Otorhinolaryngol 2013; 271:925-31. [DOI: 10.1007/s00405-013-2454-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/15/2013] [Indexed: 10/27/2022]
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23
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Marchisio P, Bianchini S, Baggi E, Fattizzo M, Galeone C, Torretta S, Principi N, Esposito S. A retrospective evaluation of microbiology of acute otitis media complicated by spontaneous otorrhea in children living in Milan, Italy. Infection 2012; 41:629-35. [PMID: 23212462 DOI: 10.1007/s15010-012-0371-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the microbiology of acute otitis media (AOM) with otorrhea due to spontaneous tympanic membrane perforation (STMP) in children living in Milan, Italy. METHODS We evaluated middle ear fluid (MEF) specimens taken from children affected by AOM associated with STMP and otorrhea between January 2001 and December 2011. The fluid was collected by means of direct swab sampling, sent for culture, and processed within 4 h. RESULTS A total of 705 specimens were obtained from 458 children (233 boys; mean age ± SD 28.3 ± 19.9 months), and were positive for bacteria in 487 cases (69.1 %). The most frequently cultured infectious agent in single-pathogen cultures was Haemophilus. influenzae (51.0 %), followed by Streptococcus pneumoniae (19.4 %), Streptococcus pyogenes (17.4 %), and Staphylococcus aureus (10.7 %). After adjusting for the sub-period of data collection, age, gender, and previous full heptavalent pneumococcal conjugate vaccine (PCV-7) schedule, it was found that the prevalence of H. influenzae slightly increased in 2008-2010, and the prevalence of S. pneumoniae significantly decreased over time (p = 0.02). CONCLUSIONS AOM with STMP is a particular form of AOM in which S. pyogenes plays a significant causative role although, as in uncomplicated cases, H. influenzae and S. pneumoniae retain their etiological importance. The frequency of the detection of S. aureus in MEF deserves further study because this pathogen can give rise to severe clinical problems. Finally, although the use of PCV-7 was relatively efficacious, the benefit of pneumococcal vaccination would be increased by vaccines including a larger number of serotypes.
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Affiliation(s)
- P Marchisio
- Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
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Bilateral acute mastoiditis and subperiosteal abscesses in a child managed by simultaneous bilateral mastoid surgery. The Journal of Laryngology & Otology 2012; 126:825-9. [DOI: 10.1017/s002221511200117x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report a case of bilateral acute mastoiditis and subperiosteal abscesses successfully managed with simultaneous surgery.Method:A case report and literature review are presented.Results:A two-year-old boy presented with fever, otalgia, otorrhoea and bilateral protruding ears. He was treated for 72 hours with intravenous antibiotics but failed to improve. Computed tomography confirmed bilateral mastoid abscesses with destruction of the mastoid cortex. Bilateral drainage of the subperiosteal abscesses and bilateral cortical mastoidectomies were carried out. Post-operatively, he recovered well, and free field audiometry showed a normal hearing threshold of 20 dB across all test frequencies.Conclusion:This is only the second reported case of bilateral mastoiditis and subperiosteal abscesses. This case illustrates the use of bilateral cortical mastoidectomy in the successful management of this condition following failed antibiotic therapy, and highlights important management considerations.
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