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Tymofieiev OO, Ushko NO, Fesenko II, Tymofieiev OO, Yarifa MO, Cherniak OS. Suppurative mastoid lymphadenitis mimicking mastoiditis: a case report. J Korean Assoc Oral Maxillofac Surg 2021; 47:398-402. [PMID: 34713816 PMCID: PMC8564086 DOI: 10.5125/jkaoms.2021.47.5.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
Mastoid lymph node inflammation is a rare entity. Pathological conditions in the vicinity of the mastoid processes can be challenging for maxillofacial head-neck surgeons to address. We report a case of suppurative mastoid lymphadenitis in an 18-year-old Caucasian male. To our knowledge, there are no publications that highlight the clinical, ultrasonographic, intra-, and postoperative data for any pathologic process that presented as mastoiditis.
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Affiliation(s)
- Oleksii O Tymofieiev
- Department of Maxillofacial Surgery, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Natalia O Ushko
- Department of Maxillofacial Surgery, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Ievgen I Fesenko
- Center of Maxillofacial Surgery, Kyiv Regional Clinical Hospital, Kyiv, Ukraine
| | - Olexander O Tymofieiev
- Department of Dentistry, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Maria O Yarifa
- Department of Oral and Maxillofacial Surgery, Private Higher Educational Establishment "Kyiv Medical University", Kyiv, Ukraine
| | - Olha S Cherniak
- Department of Ultrasound, Regional Diagnostic Center, Kyiv Regional Clinical Hospital, Kyiv, Ukraine
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Paediatric otogenic cerebral venous sinus thrombosis: a multidisciplinary approach. The Journal of Laryngology & Otology 2021; 136:3-7. [PMID: 34698003 DOI: 10.1017/s0022215121003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paediatric otogenic cerebral venous sinus thrombosis is a rare, heterogeneous and life-threatening condition, with possible otological, neurological and ophthalmological sequelae. Its course and outcomes can be widely variable. The publications available often consider individual aspects of paediatric otogenic cerebral venous sinus thrombosis management. The condition itself and the nature of the currently available guidance can lead to uncertainties when holistically managing patients with paediatric otogenic cerebral venous sinus thrombosis. OBJECTIVES Clear recommendations for the comprehensive assessment and management of paediatric otogenic cerebral venous sinus thrombosis are presented, along with the literature review upon which they are based. Its clinical and radiological assessment are discussed. CONCLUSION A multidisciplinary approach to assessment and management is recommended, inclusive of infectious diseases, ENT surgery, neurology, ophthalmology and haematology. On balance, anticoagulation is recommended for three months. Follow-up imaging is not recommended in the absence of clinical concern. Follow up by ENT surgery, neurology and ophthalmology departments is recommended.
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Krishnan M, Walijee H, Jesurasa A, De S, Sinha A, Sharma R, Donne A. Clinical outcomes of intracranial complications secondary to acute mastoiditis: The Alder Hey experience. Int J Pediatr Otorhinolaryngol 2020; 128:109675. [PMID: 31563751 DOI: 10.1016/j.ijporl.2019.109675] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/07/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Acute mastoiditis is the most common intra-temporal complication of acute otitis media. Its management remains a challenge due to potential extracranial and intracranial complications. This study was designed to evaluate the recent experience with acute mastoiditis and its associated intracranial complications at a tertiary paediatric centre. METHODS A retrospective case note review was carried out for patients admitted to Alder Hey Children's Hospital between January 2006 and December 2016 with a diagnosis of acute mastoiditis. Patients were identified using ICD-10 codes H700, H701, H702, H708 and H709. A case note review was performed to identify patients with intracranial complications and data collected. RESULTS 30 patients were identified with intracranial complications of acute mastoiditis, with 18 males and 12 females. The average age was 4 years and 2 months (range 2 months-15 years). The most common presenting complaint was otalgia and vomiting (63%), with only 27% patients presenting with mastoid swelling. 83% of patients were investigated with a combination of CT and MRI scans, 6.7% with CT scans only and 6.7% with MRI scans only. 73% were diagnosed with sinus thrombosis, 40% cerebral abscess and 33% postauricular subperiosteal abscess. 78% of the patients required surgical intervention. 27 of the 30 patients recovered fully with no significant long term sequalae following an average of 50 months follow-up. CONCLUSION Intracranial complications of acute mastoiditis remain a significant challenge. Most patients tend to present without mastoid swelling, necessitating a high index of suspicion in patients with picket fence fever, vomiting, drowsiness, headaches, seizures or cranial nerve involvement. Most cases treated at our institution required acute surgical intervention in addition to adjuvant medical treatment with majority patients recovering fully.
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Affiliation(s)
- Madhan Krishnan
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK.
| | - Hussein Walijee
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Anthony Jesurasa
- Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Su De
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Ajay Sinha
- Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Ravi Sharma
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Adam Donne
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
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Clinical Challenges in the Diagnosis and Treatment of Temporal Bone Osteomyelitis. Case Rep Otolaryngol 2017; 2017:4097973. [PMID: 28487802 PMCID: PMC5401737 DOI: 10.1155/2017/4097973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/21/2017] [Accepted: 03/26/2017] [Indexed: 11/30/2022] Open
Abstract
Temporal bone osteomyelitis is a serious life-threatening condition—a quick and proper diagnosis is needed to start treatment and reduce morbidity and mortality. Changing trends of the disease make a differential diagnosis difficult. To emphasize the importance of a clinical suspicion of this dangerous condition, our experience with three difficult cases is presented. The diagnosis was based on clinical symptoms, otoscopic findings, and findings on computed tomography or magnetic resonance imaging. Neoplasm and granulomatous inflammation were excluded by multiple biopsies. The disease can develop in nondiabetic patients. The disorder might be related to the initial inflammatory process in the middle ear with further direct spreading of infection through defects in the bony walls to deep temporal bone structures. Imaging should be performed early to detect osteolytic lesions of the skull base. Surgery was used for the presence of bone sequestra and infratemporal abscess.
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Prognostic effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis. The Journal of Laryngology & Otology 2016; 131:S12-S17. [PMID: 27748206 DOI: 10.1017/s0022215116009063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis. DESIGN Retrospective study. METHOD Eighty-eight children with acute mastoiditis, from 2003 to 2012, were studied to investigate the effect of antibiotic therapy on short and long-term sequelae. RESULTS The median period of antibiotic therapy immediately following hospital discharge was 10 days (range, 5-49 days; standard deviation = 7.46). There were no sequelae within the fortnight following antibiotic therapy completion, but 14 of 40 patients had significant sequelae thereafter, including recurrent otorrhoea, acute otitis media and ventilation tube insertion requirement. Complication rates were significantly higher among patients who had pre-admission antibiotic therapy (52 per cent), compared to patients previously untreated (27 per cent). CONCLUSION Paediatric acute mastoiditis patients treated with antibiotic therapy prior to admission are at higher risk for complication development. The advised time period for oral antibiotic therapy following hospital discharge remains as 10 days in all cases of uncomplicated acute mastoiditis.
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Opacification of the middle ear and mastoid: imaging findings and clues to differential diagnosis. Clin Radiol 2015; 70:e1-e13. [DOI: 10.1016/j.crad.2014.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
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Prasad SC, Prasad KC, Kumar A, Thada ND, Rao P, Chalasani S. Osteomyelitis of the temporal bone: terminology, diagnosis, and management. J Neurol Surg B Skull Base 2014; 75:324-31. [PMID: 25302143 DOI: 10.1055/s-0034-1372468] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022] Open
Abstract
Objectives To review the terminology, clinical features, and management of temporal bone osteomyelitis. Design and Setting Prospective study in a tertiary care center from 2001 to 2008. Participants Twenty patients visiting the outpatient department diagnosed with osteomyelitis of the temporal bone. Main Outcome Measures The age, sex, clinical features, cultured organisms, surgical interventions, and classification were analyzed. Results Of the 20 cases, 2 (10%) were diagnosed as acute otitis media. Eighteen (90%) had chronic otitis media. Nineteen (95%) were classified as medial temporal bone osteomyelitis and one (5%) as lateral temporal osteomyelitis. The most common clinical features were ear discharge (100%), pain (83%), and granulations (100%). Facial nerve palsy was seen in seven cases (35%) and parotid involvement in one case. Ten patients (56%) had diabetes mellitus. The organisms isolated were Pseudomonas aeruginosa (80%) and Staphylococcus aureus (13.33%). Histopathology revealed chronic inflammation in 20 patients (100%) and osteomyelitic bony changes in 14 (70%). Surgical debridement was the most preferred modality of treatment (87%). Conclusion A new classification of temporal bone osteomyelitis has been proposed. Bacterial cultures must be performed in all patients. Antibiotic therapy is the treatment of choice. Surgical intervention is necessary in the presence of severe pain, complications, refractory cases, or the presence of bony sequestra on radiology.
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Affiliation(s)
- Sampath Chandra Prasad
- Department of Otolaryngology - Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
| | - Kishore Chandra Prasad
- Department of Otolaryngology - Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
| | - Abhijit Kumar
- Department of Otolaryngology - Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
| | - Nikhil Dinaker Thada
- Department of Otolaryngology - Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
| | - Pallavi Rao
- Department of Radiodiagnosis, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
| | - Satyanarayana Chalasani
- Department of Otolaryngology - Head & Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), Mangalore, Karnataka, India
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Novoa E, Podvinec M, Angst R, Gürtler N. Paediatric otogenic lateral sinus thrombosis: therapeutic management, outcome and thrombophilic evaluation. Int J Pediatr Otorhinolaryngol 2013; 77:996-1001. [PMID: 23639339 DOI: 10.1016/j.ijporl.2013.03.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Otogenic lateral sinus thrombosis (LST) in children represents a serious condition with potential long-lasting morbidity. The role of adjunct anticoagulation therapy and the benefit of an analysis of prothrombotic factors are unclear. The aim of the study was to report therapeutic management and outcome, analyze prothrombotic factors in children with otogenic LST treated with mastoidectomy/antibiotics/anticoagulation and to evaluate the results with a review of the literature. METHODS Retrospective chart review of 9 children with otogenic LST (2000-2009) and literature search in PubMed. RESULTS The most frequent sign was fever in 88%, while neurologic findings were seen in 55%. Streptococci was the most common bacteria (55%). Prothrombotic factors were normal in all children. All patients received therapeutic anticoagulation, without experiencing bleeding complications. Eight children made a full recovery, neurologic sequelae persisted in one. The literature review of 115 children identified fever as the most prominent sign, reported the absence of neurologic findings in almost 50% of cases and confirmed the major role of streptococci. Anticoagulation, as adjunct therapy, was given to 38% of patients in the therapeutic range with a trend towards better neurologic outcome. A prothrombotic analysis was reported in 5 studies with positive results in 2. CONCLUSIONS Surgery and antibiotics represent the mainstay of the therapy. Anticoagulation can be safely added in view of the high potential for morbidity and might reduce neurologic sequelae. Bacteria with thrombotic activity seem to be an important aetiology. In contrast, a prothrombotic disposition seems to play a minor role in the development of otogenic LST.
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Affiliation(s)
- Eva Novoa
- Klinik für Hals-Nasen-Ohrenkrankheiten, Hals-Gesichtschirurgie, Kantonsspital Aarau, Switzerland
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del Castillo Martín F, Baquero Artigao F, de la Calle Cabrera T, López Robles M, Ruiz Canela J, Alfayate Miguelez S, Moraga Llop F, Cilleruelo Ortega M, Calvo Rey C. Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda. An Pediatr (Barc) 2012; 77:345.e1-8. [DOI: 10.1016/j.anpedi.2012.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 05/28/2012] [Indexed: 12/01/2022] Open
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Minks DP, Porte M, Jenkins N. Acute mastoiditis--the role of radiology. Clin Radiol 2012; 68:397-405. [PMID: 22980753 DOI: 10.1016/j.crad.2012.07.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 07/21/2012] [Accepted: 07/24/2012] [Indexed: 11/18/2022]
Abstract
Acute mastoiditis is a commonly occurring condition in children and adults, and one that most radiologists will come across at some point during their on-call duties. Acute mastoiditis is usually clinically apparent. However, the complications, especially the intracranial ones, can be more insidious and may have fatal consequences. Therefore, it is imperative that the radiologist is well versed in identifying these. Local spread of infection from the mastoids and middle ear cleft may occur via four routes: bone erosion, thrombophlebitis, periphlebitis, and via the anatomical pathways. The role of radiology is largely to demonstrate the complications of mastoiditis, which can be clinically occult and are often serious; this article will highlight these complications.
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Affiliation(s)
- D P Minks
- Radiology, Leeds Teaching Hospitals Trust, Leeds General Infirmary,Great George Street, Leeds, UK.
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Prasad SC, Prasad KC, Bhandary R, Abhijith K, Sampath P. Osteomyelitis of the temporal bone in identical twin infants. EAR, NOSE & THROAT JOURNAL 2011; 90:E16-21. [PMID: 21674456 DOI: 10.1177/014556131109000611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Osteomyelitis of the skull base almost always occurs in elderly patients with diabetes; however, it may occur in patients with compromised immune function regardless of their age. We present the cases of a pair of immunocompetent, 2-year-old identical twins who experienced osteomyelitis of the temporal bone almost exactly 1 year apart. An incident such as this, in this age group, has never been reported in the literature.
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Affiliation(s)
- Sampath C Prasad
- Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College, Light House Hill Rd., Mangalore, Karnatka, India
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12
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Decesare GE, Deleyiannis FWB, Losee JE. Reconstruction of osteomyelitis defects of the craniofacial skeleton. Semin Plast Surg 2011; 23:119-31. [PMID: 20567734 DOI: 10.1055/s-0029-1214164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteomyelitis of the craniofacial skeleton closely resembles osteomyelitis elsewhere in the body in its pathophysiology and medical management; subsequent reconstruction after debridement remains distinctly challenging. The goals of reconstruction must include the restoration of the complex and readily visible morphology of the cranium and face, as well as the adequate return of vital sensory, expressive, and digestive functions. In this article, the various reconstructive modalities will be discussed including pedicled and nonpedicled flaps with or without an osseous component, nonvascularized bone grafts, alloplastic implants, and bone regeneration using protein therapy. Although reconstruction of craniofacial defects after osteomyelitis commonly proves formidable, the satisfactory return of form and function remains a plausible reconstructive goal.
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Affiliation(s)
- Gary E Decesare
- Division of Pediatric Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Shifting trends: mastoiditis from a surgical to a medical disease. Am J Otolaryngol 2010; 31:467-71. [PMID: 20015791 DOI: 10.1016/j.amjoto.2009.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/31/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study is to review the outcome of pediatric patients suffering from acute mastoiditis treated conservatively and to correlate this to the evolution of our understanding of the shift in which mastoiditis has been transformed from a surgical to a medial disease. METHODS We performed a retrospective review patient files hospitalized in our tertiary-care center between 2005-2008. We examined the data concerning the infection which included: presenting signs/symptoms, prior otologic history, treatment (including both surgical and conservative) prior to hospitalization and during hospitalization, computed tomography (CT), hospital duration, complications and overall outcome. This data was analyzed and compared between different patients who underwent different treatment strategies. RESULTS Fifty-one patients were included in this retrospective review. Initially, forty-nine patients admitted to our hospital were treated conservatively. This treatment included intra-venous antibiotics, myringtomy and if needed subperiosteal abscess incision and drainage. Only 2 patients underwent CT scanning on admission. Further on, during hospitalization 4 additional patients underwent CT scanning due to continued fever or progression of local disease. All four CT scans showed no intra-cerebral complications, and so all continued with conservative treatment. CONCLUSION Most cases of acute mastoidits may be treated with a conservative therapy regime. This regime, in our opinion, should include three branches: the first intravenous antibiotic therapy using a broad spectrum antibiotic. The second is myringotomy and the third branch is incision and drainage of subperiosteal abscess when needed.
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Abdel-Aziz M, El-Hoshy H. Acute mastoiditis: A one year study in the pediatric hospital of Cairo university. BMC EAR, NOSE, AND THROAT DISORDERS 2010; 10:1. [PMID: 20205885 PMCID: PMC2827389 DOI: 10.1186/1472-6815-10-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 01/04/2010] [Indexed: 12/02/2022]
Abstract
Background Acute mastoiditis is a serious complication of acute otitis media especially in the pediatric age group. This study reports the authors' experience in the treatment of children admitted with acute mastoiditis to the Pediatric Hospital of Cairo University throughout the year 2007, also we aimed to evaluate our current management of this serious disease. Methods Nineteen children were included in this study, 11 females and 8 males, their ages ranged from 9 months to 11 years. All children were treated with intravenous antibiotic on initial admission, myringotomy was considered for cases that did not respond to medical treatment for 48 hours, while cortical mastoidectomy (with myringotomy) was reserved for cases that presented initially with subperiosteal abscess with or without post-auricular fistula, cases with intracranial complications and for cases that showed no response to myringotomy (after 48 hours). Follow up of the patients was carried out for at least 1 year. Results Medical management alone was enough in 5 cases (26%); all of them had erythematous tender mastoid on first presentation. Seven cases (37%) needed myringotomy; 2 of them showed no response and they needed cortical mastoidectomy and the other 5 cases responded well except for 1 case that developed post-auricular subperiosteal abscess 2 months later necessitating cortical mastoidectomy with no evidence of recurrence till the end of the follow-up period. Seven cases (37%) presented with subperiosteal abscess and they needed cortical mastoidectomy with myringotomy; they showed no recurrence till the end of the study. Conclusion Conservative management is an effective method in the treatment of non-complicated acute mastoiditis, but myringotomy should be considered if there is no response within 48 hours. Cortical mastoidectomy should be used in conjunction with the medical management in the treatment of complicated cases.
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Affiliation(s)
- Mosaad Abdel-Aziz
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hassan El-Hoshy
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Geva A, Oestreicher-Kedem Y, Fishman G, Landsberg R, DeRowe A. Conservative management of acute mastoiditis in children. Int J Pediatr Otorhinolaryngol 2008; 72:629-34. [PMID: 18304656 DOI: 10.1016/j.ijporl.2008.01.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 01/13/2008] [Accepted: 01/15/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review the current management of acute mastoiditis with critical emphasis on the role of myringotomy. DESIGN A retrospective chart review. SETTING Tertiary-care, university affiliated children's hospital. PATIENTS One hundred and forty-four consecutive children hospitalized for acute mastoiditis between the years 1991 and 2002. INTERVENTIONS All children were treated with parenteral antibiotics (conservative management). Myringotomy was performed at the discretion of the otolaryngologist on-call. MAIN OUTCOME MEASURES Comparing outcomes of children with or without myringotomy regarding hospital stay, complications and the need for surgical interventions. RESULTS Myringotomy was performed in 34.6% of episodes. The children who underwent myringotomy were found to be significantly younger (22.4 compared to 28.8 months, p=0.028) and had more complications (n=17 vs. n=8, p<0.001). Complications overall occurred in 16.3% of episodes. Performing myringotomy had no significant effect on the duration of hospital stay. Children pretreated with antibiotics underwent significantly less myringotomies p=0.027. There were no significant differences between children who underwent myringotomy and those who did not with regard to WBC count, or ESR. CONCLUSIONS These findings suggest that myringotomy may not be required in all cases of acute mastoiditis. Parenteral antibiotics is sufficient in most cases. Criteria for myringotomy may include a younger age. Conservative management resulted in good outcomes in this series.
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Affiliation(s)
- Adi Geva
- Family Medicine Program, Maccabi Health Services, Israel
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Sethi A, Sareen D, Mrig S, Agarwal AK, Khera PS. Acute suppurative otitis media: an unusual cause of orbital apex syndrome. Orbit 2008; 27:462-465. [PMID: 19085305 DOI: 10.1080/01676830802352519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report the case of a 40-year-old female who presented to us with earache and a rapidly progressive painful ophthalmoplegia involving the right eye with right temporal swelling. A clinical and radiological assessment revealed it to be temporal cellulitis with orbital apex syndrome secondary to acute otitis media. In spite of prompt initiation of treatment, the patient died within 30 hr of presentation. The case is discussed in detail with a brief review of medical literature.
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Affiliation(s)
- Ashwani Sethi
- Department of ENT, Maulana Azad Medical College and Associated L. N. Hospital, New Delhi, India
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Cervera J, Villafruela M, del Castillo F, Delgado Rubio A, Rodrigo G. de Liria C, Picazo J. Consenso Nacional sobre otitis media aguda. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74918-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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del Castillo F, Delgado Rubio A, Rodrigo C, de Liria G, Cervera J, Villafruela MA, Picazo JJ. Consenso Nacional sobre otitis media aguda. An Pediatr (Barc) 2007; 66:603-10. [PMID: 17583623 DOI: 10.1157/13107396] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
CONCLUSION All bones of the facial skeleton and spine are susceptible to osteomyelitis due to various predisposing conditions. Current radiological tools are sufficient to provide adequate diagnosis. Treatment can be conservative resection of the diseased bone with adequate clearance in all cases except in cases of osteomyelitis due to osteoradionecrosis (ORN) where resection has to be more radical. OBJECTIVE In today's antibiotic era, osteomyelitis in the head and neck is a rare occurrence. Dealing with osteomyelitis in head and neck bones is not the same as in other bones of the body due to the nature of the bones, complex anatomy of the region, and esthetics. Our purpose was to analyze the behavior of osteomyelitis in the head and neck bones and its management. MATERIALS AND METHODS A total of 84 cases of osteomyelitis in head and neck were reviewed in a 10-year period. Pus for culture, antibiotic sensitivity, and radiology were the main investigations. A medical line of treatment was effective in acute cases. Surgery was opted for in chronic cases. RESULTS Mandible, frontal bone, cervical spine, maxilla, temporal bones, and nasal bones were involved, in descending order of frequency, i.e. the mandible was the most common bone affected. Nine patients were diagnosed as having acute osteomyelitis (11%); 75 were diagnosed as having chronic osteomyelitis (89%). Radiation-induced ORN leading to osteomyelitis was the most common cause of osteomyelitis of the mandible (13 of the 32 cases; 41%). Odontogenic infections and chronic sinusitis each gave rise to osteomyelitis in 3 of 10 cases (30%) of the patients with osteomyelitis of the maxilla. Chronic sinusitis was the main cause of frontal bone osteomyelitis in all 20 cases (100%). Tuberculosis (10 of 15 cases; 67%) and malignancy (5 of 15 cases; 33%) were the main predisposing factors in cervical spine osteomyelitis. Malignant external otitis (MEO) with diabetes mellitus was an underlying factor in all four cases of osteomyelitis of the temporal bone. Of the 18 patients with a diagnosis of ORN, the mandible was found to be the most susceptible bone (13 cases; 72%), followed by the maxilla (four cases; 22%) and cervical spine (1 case). Acute osteomyelitis responded to antibiotics. Sequestrectomy was carried out in all chronic cases but in cases of ORN more radical surgery was performed.
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Affiliation(s)
- Kishore Chandra Prasad
- Department of Otolaryngology - Head & Neck Surgery, Kasturba Medical College, Mangalore, India.
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