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Esce AR, Trujillo SA, Hawley KA. Clarifying the Diagnosis and Management of Acute Uncomplicated Pediatric Mastoiditis. Ann Otol Rhinol Laryngol 2024:34894241261272. [PMID: 38874209 DOI: 10.1177/00034894241261272] [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: 06/15/2024]
Abstract
INTRODUCTION Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis. This study sought to clarify the diagnostic criteria and management of uncomplicated acute mastoiditis. METHODS All cases of acute pediatric mastoiditis were identified from a single institution over a 16-year period and reviewed for demographic and clinical data. Two different definitions of uncomplicated mastoiditis were compared; the traditional one that excluded patients with intracranial complications or subperiosteal abscess (SPA) and the proposed definition that also excluded patients with any evidence of bony erosion including coalescence, not just SPA. Univariate and multivariate analysis was conducted. RESULTS Eighty cases were identified. Using the traditional definition of uncomplicated mastoiditis, 46.3% of cases were uncomplicated, compared to 36.2% when using the proposed definition. Truly uncomplicated patients, categorized with the proposed definition, were treated more consistently: no patients underwent mastoidectomy and they were less likely to receive a long term course of antibiotics. On multivariate regression analysis, only categorization with the proposed definition of uncomplicated mastoiditis was independently associated with less long-term antibiotic therapy and non-surgical management. CONCLUSION Uncomplicated acute mastoiditis should be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess. These truly uncomplicated patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics. Further research into treatment pathways is necessary to optimize the management of uncomplicated acute pediatric mastoiditis.
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Affiliation(s)
- Antoinette R Esce
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Samantha A Trujillo
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Karen A Hawley
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of New Mexico, Albuquerque, NM, USA
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Shiner YA, Samuel O, Saliba W, Stein N, Kerem N, Cohen-Kerem R. Risk factors for recurrent acute mastoiditis in pediatric patients: a registry-based cohort study. Eur Arch Otorhinolaryngol 2024; 281:2699-2705. [PMID: 38342819 PMCID: PMC11024039 DOI: 10.1007/s00405-024-08473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/09/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To describe characteristics of pediatric patients with recurrent acute mastoiditis, and to identify risk factors for this condition. STUDY DESIGN A retrospective cohort study. SETTING Data based on electronic medical records of the largest Health Maintenance Organization in Israel. METHODS Children hospitalized due to acute mastoiditis during the years 2008-2018 were identified, and their diagnosis was verified. Patients with recurrent acute mastoiditis were identified and grouped, and their characteristics were outlined and compared to those of the original group to identify risk factors for recurrence. RESULTS During the 11-year period, a total of 1115 cases of children hospitalized due to acute mastoiditis were identified with a weighted incidence rate of 7.8/100,000. Of this group, 57 patients were diagnosed with recurrence following a full clinical recovery. The incidence proportion of recurrent acute mastoiditis was 5.1% (57/1115), male-to-female ratio was 27:30, 73.4% were younger than 24 months, the median period from the first episode was 3.4 months (IQR 2.0;10.0), and 82.5% of the patients (n = 47) had a single recurrence, whereas 18.5% (n = 10) had two recurrences or more. Mastoidectomy and swelling over the mastoid area during the first episode were identified as the main risk factors for recurrent mastoiditis HR = 4.7 [(2.7-8.2), p < 0.001] and HR = 2.55 [(1.4-4.8), p = 0.003], respectively. Mastoidectomy was the only independent significant risk factor for recurrence in a multivariate analysis. CONCLUSIONS Mastoidectomy and swelling over the mastoid area during the first episode of acute mastoiditis were found strongly related independent risk factor for future recurrent episodes of acute mastoiditis.
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Affiliation(s)
- Yotam Aharon Shiner
- Department of Otolaryngology, Head and Neck Surgery, Lady Davis Carmel Medical Center, Haifa, Israel.
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Orit Samuel
- Department of Otolaryngology, Head and Neck Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- 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
| | - Nogah Kerem
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Raanan Cohen-Kerem
- Department of Otolaryngology, Head and Neck Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Häußler SM, Peichl J, Bauknecht C, Spierling K, Olze H, Betz C, Stölzel K. A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases. Otol Neurotol 2024; 45:e241-e247. [PMID: 38238923 DOI: 10.1097/mao.0000000000004089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Acute mastoiditis (AM) is a potentially life-threatening condition primarily affecting children. To date, there are no consistent criteria or valid guidelines for the diagnosis and treatment of pediatric AM. Therefore, this study evaluates the clinical course of AM in terms of clinical signs and treatment. In addition, a novel classification scheme for the disease and a treatment algorithm is being proposed. METHODS Patient records over a 12-year period from a single center were reviewed to identify confirmed cases of AM in children. Data collected included clinical signs, body temperature, and infection parameters during the disease, as well as radiological imaging, antibiotics, and surgical as well as conservative treatment. In addition, a classification of the AM stages was established in accordance with the findings described and practical experience, consisting of four stages (1, mastoidal irritation; 2, mild AM; 3, advanced AM; 4, advanced AM and additional complications) with corresponding treatment recommendations. In the retrospective cohort, those AM cases that were treated alongside the classification were compared with the rest concerning clinical course and outcome. RESULTS A total of 109 patients (mean age, 3.8 ± 3.8 years) were included. The main symptoms at hospital admission were auricular protrusion (n = 73; 67.0%), fever (n = 56; 51.4%) with a mean temperature of 38.3 ± 1.1°C, and otalgia (n = 28; 25.7%). The mean laboratory-tested levels of leukocytes and C-reactive protein at the time of hospital admission were 15.96 ± 8.7/nl and 59.6 ± 54.0 mg/L, respectively. During winter, there was a higher prevalence of AM, with peak hospital admissions in April (n = 22). The most common pathogen was Streptococcus pyogenes (32 cases). Treatment was purely conservative in four cases, whereas the remaining cases underwent surgery (41× grommet insertion, 64× plus mastoidectomy). The outcome was generally good, but in eight patients a second surgical procedure had to be performed as they showed signs of clinical deterioration. A total of 101 patients were treated according to the proposed algorithm, and all of which had a good outcome without the need for further interventions. CONCLUSION Based on clinical experience in a large cohort of pediatric AM patients, a novel diagnostic and treatment algorithm has been developed and successfully tested in a retrospective cohort for AM in children to prevent further complications and to ease its management by pediatricians and otorhinolaryngologists in the emergency setting.
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Affiliation(s)
| | - Jonathan Peichl
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - Christian Bauknecht
- Institute of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, Berlin 10117, Germany
| | - Katja Spierling
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Christian Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Cvorovic L, Dudvarski Z, Relic N, Radivojevic N, Soldatovic I, Arsovic N. Clinical Characteristics and Treatment Experiences of Pediatric Acute Mastoiditis and Its Complications at the University Tertiary Care Center in the 10-Year Prevaccinal Period. EAR, NOSE & THROAT JOURNAL 2023:1455613231212828. [PMID: 37997632 DOI: 10.1177/01455613231212828] [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: 11/25/2023] Open
Abstract
Introduction: We aim to provide an overview of the clinical characteristics and treatment of pediatric acute mastoiditis (AM) and its complications in the prevaccinal pneumococcal period. Materials and methods: Retrospective case series. An analysis of pediatric patients with AM treated at a university tertiary care center from 2008 to 2018 was performed. Results: The research included 121 children, and 27.3% of them had some form of complication. The mean age at presentation of AM was 3.7 years (range = 0-18 years). The most common extracranial complication of AM was a subperiosteal abscess (n = 25, 75.8%) and the most common intracranial complication was meningoencephalitis (n = 2, 6%). The most common pathogen isolated in the complicated AM was Streptococcus pneumoniae (n = 17, 51.5%). A total of 60% of patients reported antibiotic use before hospital admission, mostly third-generation cephalosporins (37.5%). There was a statistically significant difference between age group and occurrence of complications (P = .001). Females had complications more frequently than males (P = .035). There were no statistically significant differences in levels of inflammatory parameters (C-reactive protein and leukocyte count) between patients with or without complications (P = .373 and P = .124; respectively). All patients with complications of AM were surgically treated. Mortality was 0% and all children completely recovered. Conclusion: Extracranial and intracranial complications of AM required surgical treatment and extended antibiotic therapy. Inflammation parameters did not have a predictive role in identifying children with complications of AM. Further investigations will determine whether the introduction of the mandatory pneumococcal vaccine in our country has led to a reduction in the incidence of AM and its complications.
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Affiliation(s)
- Ljiljana Cvorovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Centre Serbia, Belgrade, Serbia
| | - Zoran Dudvarski
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Centre Serbia, Belgrade, Serbia
| | - Nenad Relic
- Clinic for Otorhinolaryngology, University Clinical Centre Kragujevac, Kragujevac, Serbia
- Department of Otorhinolaryngology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Nemanja Radivojevic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Centre Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute for Biomedical Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nenad Arsovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Centre Serbia, Belgrade, Serbia
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Ahamad A, Yuan C, Chung C, Blair B, Tran A, Tehreem B. Metabolism and gene sequence variation in Turicella otitidis implies its adaptability and pathogenicity in extra-otic infection: a systematic review. BMC Infect Dis 2023; 23:735. [PMID: 37891485 PMCID: PMC10612267 DOI: 10.1186/s12879-023-08721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Turicella otitidis belongs to the Corynebacteriaceae family and is a normal inhabitant of the ear and exists in a commensal relationship with its host. In children, T. otitidis is frequently associated with otitis media. The emergence of Turicella otitidis as a pathogen is concerning, particularly due to the limited availability of data on its pathogenic properties. The objective of this study is to conduct a systematic review of T. otitidis infections occurring in both the ear and other anatomical sites, and to summarize the differences in metabolism and genome sequences between isolates obtained from the ear and blood.
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Affiliation(s)
- Afrinash Ahamad
- Clinical Laboratory Sciences Program, School of Health Profession, Stony Brook University, Stony Brook, NY, USA.
- Department of Neuroscience and Behavior, Stony Brook University, Stony Brook, NY, USA.
- Department of Pathology, Clinical Microbiology, NYU Langone Health, New York, NY, USA.
| | - Cuishan Yuan
- Clinical Laboratory Sciences Program, School of Health Profession, Stony Brook University, Stony Brook, NY, USA
| | - Casey Chung
- Clinical Laboratory Sciences Program, School of Health Profession, Stony Brook University, Stony Brook, NY, USA
| | - Briana Blair
- Clinical Laboratory Sciences Program, School of Health Profession, Stony Brook University, Stony Brook, NY, USA
| | - Amy Tran
- Clinical Laboratory Sciences Program, School of Health Profession, Stony Brook University, Stony Brook, NY, USA
| | - Bushra Tehreem
- Department of Pediatrics- SUNY Down State, Brooklyn, NY, USA
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Guillén-Lozada E, Bartolomé-Benito M, Moreno-Juara Á. Surgical management of mastoiditis with intratemporal and intracranial complications in children. Outcome, complications, and predictive factors. Int J Pediatr Otorhinolaryngol 2023; 171:111611. [PMID: 37352591 DOI: 10.1016/j.ijporl.2023.111611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Intratemporal or intracranial complications of acute mastoiditis are often of significant severity, can be life-threatening, and require prompt and usually aggressive treatment. This study focused on analyzing the outcomes and complications of different surgical techniques used in intracranial and intratemporal complications of acute mastoiditis, the most common complication of acute otitis media. METHODS A retrospective study of pediatric patients with mastoiditis with intratemporal and intracranial complications was designed at the Niño Jesús University Children's Hospital in Madrid, Spain, from 2005 to 2021. RESULTS Of 417 patients with mastoiditis, 112 patients developed intratemporal and intracranial complications, with subperiosteal abscess being the most frequent complication. The most frequently isolated pathogens were Streptococcus pneumoniae, Streptococcus pyogenes, and Fusobacterium necrophorum. The most used surgical technique was myringotomy with placement of transtympanic drainage, in 86.6% of all cases. In patients with intracranial complications, neurosurgical procedures were necessary for 19.2%, with craniotomy with mastoidectomy being the most frequent. Most of the cases evolved favorably, and only 5.4% of the patients required surgical reintervention, being more frequent in intratemporal complications. In terms of complications, we found cases of neutropenia in 3.6%, neurological sequelae in 5.4%, and permanent hearing loss in 2.7%. CONCLUSIONS There was a favorable evolution with a low incidence of reoperation and sequelae within our series. The surgical technique of choice correlated with the severity of the complication. If the mean size of the abscess exceeds 20 mm, incision and drainage, along with myringotomy and tube placement, should be considered as the initial treatment. Closed mastoidectomy should be reserved for deteriorating of clinical evolution or acute mastoiditis with intracranial complications. Intracranial and multiple concomitant complications were associated with a more extended hospital stay, ICU occupancy, neurosurgical intervention, and risk of neurological sequelae and neutropenia. Conversely, intratemporal complications may result in permanent hearing loss.
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Affiliation(s)
- Enrique Guillén-Lozada
- Otorhinolaryngology Department, Niño Jesus University Children's Hospital, Madrid, Spain.
| | | | - Ángel Moreno-Juara
- Otorhinolaryngology Department, Niño Jesus University Children's Hospital, Madrid, Spain
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Engelhardt MI, Phan N, Zavala H, Chinnadurai S, Roby BB. Head and neck venous thrombosis secondary to pediatric otolaryngologic infection. Int J Pediatr Otorhinolaryngol 2023; 168:111513. [PMID: 37003017 DOI: 10.1016/j.ijporl.2023.111513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 02/16/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Head and neck venous thrombosis is a rare but potentially devastating complication of childhood otolaryngologic infections. This study examines the presentation and management of this condition. METHODS A retrospective chart review was performed on all pediatric patients with otolaryngologic infections complicated by cranial and cervical venous thrombosis at a tertiary children's hospital from 2007 to 2018. Patient demographics, presentation, site of infection, thrombosis location, implicated pathogen, length of hospital stay, need for surgery, and anticoagulant regimen were assessed. RESULTS This study included 33 patients (mean age, 7.5 years; age range, 0.8-17 years; 19 [58%] male). The most common infection source was otologic (n = 20), followed by ophthalmic and sinonasal pathology (n = 9), and neck infections (n = 4). The most common site of thrombosis secondary to ear pathology was the sigmoid sinus. The ophthalmic veins were the most common site of thrombosis for ophthalmic/sinonasal infections. Nine CN VI palsies, one CN VII palsy, and one CN III palsy were observed. Twenty-six subjects (79%) required surgical intervention. All those who experienced a nerve palsy required surgery. Length of hospitalization significantly differed with the stay for a neck infection complicated by thrombosis longer compared to otologic and sinonasal infections (F[2,30] = 7.08, p = 0.003). Length of hospital stay was significantly correlated with admission temperature (r = 0.506, p = 0.003) and CRP (r = 0.400, p = 0.03) but not WBC (r = 0.181, p = 0.31). Culture growth predominantly isolated a single causative organism rather than polymicrobial involvement. Forty-eight species were identified, most (n = 41/48, 85%) being Gram-positive bacteria. Alpha-hemolytic Streptococcus was the most common isolate from children with vessel thrombosis secondary to ear infections, with Streptococcus pyogenes predominant in sinonasal infections and Staphylococcus aureus the most common in neck abscesses. There was significant variability in anticoagulation management within the patient population, but no bleeding complications were documented. Most patients had no evidence of underlying thrombophilia (n = 15); for those with positive hypercoagulability screens, the most common positive marker was the presence of lupus inhibitor (n = 6). CONCLUSION Venous thrombosis resulting from adjacent otolaryngologic infection is a serious complication requiring proper recognition and management. The involved vasculature and cranial nerve findings are dependent on the anatomic location of the underlying infection. Cranial neuropathies in the presence of these infections should prompt evaluation for possible thrombosis.
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Affiliation(s)
- Margaret I Engelhardt
- University of Minnesota, Department of Otolaryngology - Head and Neck Surgery, Minneapolis, MN, USA; Children's of Minnesota, Pediatric ENT & Facial Plastic Surgery, Minneapolis, MN, USA.
| | - Noel Phan
- Icahn School of Medicine at Mount Sinai, Department of Otolaryngology - Head and Neck Surgery, New York City, NY, USA
| | - Hanan Zavala
- Children's of Minnesota, Pediatric ENT & Facial Plastic Surgery, Minneapolis, MN, USA
| | - Sivakumar Chinnadurai
- University of Minnesota, Department of Otolaryngology - Head and Neck Surgery, Minneapolis, MN, USA; Children's of Minnesota, Pediatric ENT & Facial Plastic Surgery, Minneapolis, MN, USA
| | - Brianne B Roby
- University of Minnesota, Department of Otolaryngology - Head and Neck Surgery, Minneapolis, MN, USA; Children's of Minnesota, Pediatric ENT & Facial Plastic Surgery, Minneapolis, MN, USA
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Karaaslan A, Cetin C, Ko le MT, Avci H, Akin Y. Acute mastoiditis in children: A tertiary care center experience in 2015-2021. Niger J Clin Pract 2023; 26:347-351. [PMID: 37056111 DOI: 10.4103/njcp.njcp_392_22] [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: 04/15/2023]
Abstract
Background Acute mastoiditis is a suppurative infection of mastoid air cells and is the most common intratemporal complication of otitis media. Aim This study aimed to evaluate the demographic and clinical characteristics and treatment outcomes of children with acute mastoiditis (AM). Patients and Methods We retrospectively reviewed the medical records of hospitalized pediatric patients aged between 1 month and 18 years with a diagnosis of AM between May 2015 and December 2021. Results A total of 28 hospitalized children with AM were enrolled in this study, of whom 22 (78.6%) were males and 6 (21.4%) were females with a mean ± standard deviation age of 93.5 ± 53.2 months (range = 6 months-16.1 years). The most common clinical symptoms were postauricular erythema (n = 17, 60.7%), tenderness (n = 16, 57.1%), swelling (n = 14, 50%), fever (n = 14, 50%), and auricular protrusion (n = 7, 25%). Mastoiditis complications occurred in 10 (35.7%) children. The most common extracranial complication was subperiosteal abscess (n = 8, 28.6%). The erythrocyte sedimentation rate (ESR) and the rate of antibiotic use before hospitalization were higher in patients with complicated mastoiditis (P = 0.006 and P = 0.039, respectively). Surgery was performed in 12 (42.9%) patients. Statistically, more surgical interventions were performed in patients who developed complications (P = 0.003). Conclusion AM continues as an important disease of childhood. Successful results are obtained with systemic antibiotic therapy and additional surgical intervention as necessary. A careful evaluation of patients with a high ESR and those who received antibiotic therapy before hospitalization is appropriate due to the correlation between these factors and the risk of complication development.
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Affiliation(s)
- A Karaaslan
- Department of Pediatric Infectious Diseases, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - C Cetin
- Department of Pediatric Infectious Diseases, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - M T Ko le
- Department of Pediatrics, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - H Avci
- Department of Pediatrics, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Y Akin
- Department of Otolaryngology, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
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Pediatric temporomandibular joint (TMJ) arthritis, an elusive complication of acute mastoiditis. Int J Pediatr Otorhinolaryngol 2022; 158:111163. [PMID: 35500398 DOI: 10.1016/j.ijporl.2022.111163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/29/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Septic arthritis of the Temporomandibular joint (TMJ) is a rare complication of acute middle ear infection. Presentation is elusive and could be easily missed. Often diagnosis is made only with consequential development of TMJ ankylosis. This study intends to characterize patients and course of disease and suggest a diagnostic and therapeutic strategy. METHODS Retrospective review of all children diagnosed with TMJ arthritis and/or TMJ ankylosis secondary to acute middle ear infection, treated in a tertiary pediatric medical center between the years 2005 and 2021. RESULT Seven patients were identified with otogenic TMJ arthritis. Median age at presentation was 1.14 years (IQ range 1.1-1.5). All seven were diagnosed with acute mastoiditis. CT scans demonstrated TMJ related collections in 5/7 and intracranial complications in 3/7. Treatment included cortical mastoidectomy for 5/7. One patient had a concomitant surgical washout of the TMJ. Two patients had drainage only of subperiosteal collections. Six of the seven patients went on to develop TMJ ankylosis that presented within a median of 2.8 years (IQ range 2.6-3.9) after the episode of acute mastoiditis. All six patients presented with trismus and facial growth anomalies, and all but one required surgery to release the ankylosis. CONCLUSION Otogenic TMJ arthritis develops mostly in young children with acute mastoiditis and intratemproal and/or intracranial suppuration. Imaging is helpful in making the diagnosis, with TMJ related collections on CT being the most common finding. TMJ ankylosis can develop within a few years and present with trismus and abnormal facial growth. Cortical mastoidectomy does not seem to prevent ankylosis. It remains unclear whether focused treatment to the TMJ or physiotherapy could be beneficial in that.
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Chu S, A F, R F. Intracranial Complication as a Manifestation of Clinical Onset in a Child With Insidious Ear Infection. Cureus 2022; 14:e26152. [PMID: 35891838 PMCID: PMC9302454 DOI: 10.7759/cureus.26152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
Acute mastoiditis is a common consequence of acute otitis media and may lead to intracranial complications. Common clinical presentations include otological complaints (i.e., otorrhea, otalgia, fever). Intracranial complication remains a rare manifestation of middle ear infection. We present the case of a child who presented with non-specific symptoms without any otological complaints. Prompt clinical assessment and imaging revealed an otogenic brain abscess with concurrent mastoiditis. Management of this child required both medical and surgical treatment by a multidisciplinary team.
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Intratemporal and intracranial complications of acute mastoiditis in children. Why do they occur? An analysis of risk factors. Int J Pediatr Otorhinolaryngol 2022; 156:111124. [PMID: 35378485 DOI: 10.1016/j.ijporl.2022.111124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
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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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The management of elevated intracranial pressure and sinus vein thrombosis associated with mastoiditis: the experience of eighteen patients. Childs Nerv Syst 2022; 38:421-428. [PMID: 34713346 DOI: 10.1007/s00381-021-05402-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cerebral sinus vein thrombosis (CSVT) associated with acute mastoiditis is a rare complication of acute otitis media. Elevated intracranial pressure (ICP) frequently occurs secondary to CSVT. The study aims to review the 5 years of experience of four medical centres to treat sigmoid sinus thrombosis and elevated intracranial pressure in children. METHODS Patients with CSVT that developed secondary mastoiditis from 2016 through 2021 were evaluated in four centres from Turkey. Patients diagnosed with a preceding or synchronous mastoiditis and intracranial sinus thrombosis were included in the study. Magnetic resonance imaging (MRI), magnetic resonance venography (MRV), ICP measurements, ophthalmological examinations, thrombophilia studies and treatments for increased ICP have also been recorded. RESULTS The study group comprises 18 children. Twelve patients were diagnosed with right-sided, six patients with left-sided sinus vein thrombosis. All of the patients had ipsilateral mastoiditis. The most common presenting symptoms were fever, ear pain, headache, visual disorders and vomiting. The most encountered neurologic findings were papilledema, strabismus and sixth cranial nerve palsy. ICP was over 20 cm H2O in eleven patients. Anticoagulant treatment, antibiotics, pressure-lowering lumbar puncture and lumboperitoneal shunt were among the treatment modalities. CONCLUSION Elevated ICP can damage the brain and optic nerve irreversibly, without treatment. For treating elevation of ICP associated with cerebral sinus thrombosis, pressure-lowering lumbar puncture (LP), acetazolamide therapy, optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF)-shunting procedures are suggested in case of deteriorated vision.
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Brkic FF, Besser G, Schally M, Schmid EM, Parzefall T, Riss D, Liu DT. Biannual Differences in Interest Peaks for Web Inquiries Into Ear Pain and Ear Drops: Infodemiology Study. J Med Internet Res 2021; 23:e28328. [PMID: 34185016 PMCID: PMC8277359 DOI: 10.2196/28328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background The data retrieved with the online search engine, Google Trends, can summarize internet inquiries into specified search terms. This engine may be used for analyzing inquiry peaks for different medical conditions and symptoms. Objective The aim of this study was to analyze World Wide Web interest peaks for “ear pain,” “ear infection,” and “ear drops.” Methods We used Google Trends to assess the public online interest for search terms “ear pain,” “ear infection,” and “ear drops” in 5 English and non–English-speaking countries from both hemispheres based on time series data. We performed our analysis for the time frame between January 1, 2004, and December 31, 2019. First, we assessed whether our search terms were most relevant to the topics of ear pain, ear infection, and ear drops. We then tested the reliability of Google Trends time series data using the intraclass correlation coefficient. In a second step, we computed univariate time series plots to depict peaks in web-based interest. In the last step, we used the cosinor analysis to test the statistical significance of seasonal interest peaks. Results In the first part of the study, it was revealed that “ear infection,” “ear pain,” and “ear drops” were the most relevant search terms in the noted time frame. Next, the intraclass correlation analysis showed a moderate to excellent reliability for all 5 countries’ 3 primary search terms. The subsequent analysis revealed winter interest peaks for “ear infection” and “ear pain”. On the other hand, the World Wide Web search for “ear drops” peaked annually during the summer months. All peaks were statistically significant as revealed by the cosinor model (all P values <.001). Conclusions It can be concluded that individuals affected by otitis media or externa, possibly the majority, look for medical information online. Therefore, there is a need for accurate and easily accessible information on these conditions in the World Wide Web, particularly on differentiating signs and therapy options. Meeting this need may facilitate timely diagnosis, proper therapy, and eventual circumvention of potentially life-threatening complications.
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Affiliation(s)
- Faris F Brkic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerold Besser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Schally
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Elisabeth M Schmid
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Parzefall
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - David T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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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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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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18
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McLaren J, Cohen MS, El Saleeby CM. How well do we know Gradenigo? A comprehensive literature review and proposal for novel diagnostic categories of Gradenigo's syndrome. Int J Pediatr Otorhinolaryngol 2020; 132:109942. [PMID: 32065876 DOI: 10.1016/j.ijporl.2020.109942] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/08/2023]
Abstract
Gradenigo's Syndrome is a rare complication of otitis media and/or mastoiditis resulting in inflammation of the petrous apex of the temporal bone. Here, we highlight an interesting case from our institution, summarize available pediatric cases from the past fifty years to provide an updated diagnostic categorization for this rare condition with confusing nomenclature, and suggest guidance for diagnosis and management.
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Affiliation(s)
- John McLaren
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michael S Cohen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Chadi M El Saleeby
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Divisions of Hospital Medicine, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA; Divisions of Infectious Disease, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA.
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19
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Link-Gelles R, Toews KA, Schaffner W, Edwards KM, Wright C, Beall B, Barnes B, Jewell B, Harrison LH, Kirley PD, Lorentzson L, Aragon D, Petit S, Bareta J, Spina NL, Cieslak PR, Van Beneden C. Characteristics of Intracranial Group A Streptococcal Infections in US Children, 1997-2014. J Pediatric Infect Dis Soc 2020; 9:30-35. [PMID: 30462264 PMCID: PMC8931553 DOI: 10.1093/jpids/piy108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/24/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few data on intracranial group A Streptococcus (GAS) infection in children are available. Here, we describe the demographic, clinical, and diagnostic characteristics of 91 children with intracranial GAS infection. METHODS Cases of intracranial GAS infection in persons ≤18 years of age reported between 1997 and 2014 were identified by the Centers for Disease Control and Prevention's population- and laboratory-based Active Bacterial Core surveillance (ABCs) system. Medical charts were abstracted using a active, standardized case report form. All available isolates were emm typed. US census data were used to calculate rates. RESULTS ABCs identified 2596 children with invasive GAS infection over an 18-year period; 91 (3.5%) had an intracranial infection. Intracranial infections were most frequent during the winter months and among children aged <1 year. The average annual incidence was 0.07 cases per 100000 children. For 83 patients for whom information for further classification was available, the principal clinical presentations included meningitis (35 [42%]), intracranial infection after otitis media, mastoiditis, or sinusitis (34 [41%]), and ventriculoperitoneal shunt infection (14 [17%]). Seven (8%) of these infections progressed to streptococcal toxic shock syndrome. The overall case fatality rate was 15%. GAS emm types 1 (31% of available isolates) and 12 (13% of available isolates) were most common. CONCLUSIONS Pediatric intracranial (GAS) infections are uncommon but often severe. Risk factors for intracranial GAS infection include the presence of a ventriculoperitoneal shunt and contiguous infections in the middle ear or sinuses.
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Affiliation(s)
- Ruth Link-Gelles
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karrie-Ann Toews
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carolyn Wright
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brenda Barnes
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | | | | | | | - Chris Van Beneden
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Cassano P, Ciprandi G, Passali D. Acute mastoiditis in children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:54-59. [PMID: 32073562 PMCID: PMC7947742 DOI: 10.23750/abm.v91i1-s.9259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/01/2020] [Indexed: 11/23/2022]
Abstract
Acute mastoiditis is the most common complication of acute otitis media. Although rare, the disease is carefully studied by otolaryngologists because it usually affects very young children with severe clinical course and sometimes causes serious complications. Most important risk factors are the young age (often>2 years), high fever, alteration of the laboratory findings (very high values of WBC count, absolute neutrophil count and C-reactive protein), while less important are previous antibiotic therapy or previous middle ear infections. The main pathogen of the acute mastoiditis is Streptococcus pneumoniae, followed by Streptococcus piogenes, Haemophilus influentiae, and Staphylococcus aureus. The finding of Pseudomonas aeruginosa is not uncommon, but often its presence is often considered a contamination or simultaneous infection. The complications can be extracranial (subperiosteal abscess, Bezold's abscess); intratemporal (facial nerve palsy, labyrinthitis) and intracranial (subdural abscess). The complications have often a very serious clinical course and potentially life-threatening. Antibiotic therapy is the main treatment in not complicated forms. Considering the prevalence of Streptococcus pneumoniae, cephalosporins are the antibiotic of choice, but they have to be administrated intravenously in hospitalized patients. Combinations with other antibiotic are suggested when multibacterial flora is present. In complicated forms of acute mastoiditis, the antibiotic treatment can be particularly important, in combination with other specific drugs (i.e. anticoagulants and/or corticosteroids). Surgical treatments, such as incision of abscesses, mastoidectomy, and neurosurgical procedures, are sometimes performed in combination with medical therapy in very severe complications. Data from our experience are briefly reported.
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21
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Mierzwiński J, Tyra J, Haber K, Drela M, Paczkowski D, Puricelli MD, Sinkiewicz A. Therapeutic approach to pediatric acute mastoiditis – an update. Braz J Otorhinolaryngol 2019; 85:724-732. [PMID: 30056031 PMCID: PMC9443014 DOI: 10.1016/j.bjorl.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/16/2018] [Accepted: 06/14/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction Acute mastoiditis remains the most common complication of acute otitis media. It may rarely appear also in cochlear implant patients. However, the treatment recommendations for this disease are not precisely defined or employed, and in the current literature the differences regarding both the diagnosis and management are relatively substantial. Objective The aim of this study was to determine a standard and safe procedure to be applied in case of pediatric acute mastoiditis. Methods A retrospective chart review of 73 patients with 83 episodes of acute mastoiditis hospitalized at our tertiary-care center between 2001 and 2016 was conducted. Bacteriology, methods of treatment, hospital course, complications, and otologic history were analyzed. Based on our experience and literature data, a protocol was established in order to standardize management of pediatric acute mastoiditis. Results All the patients treated for acute mastoiditis were submitted to an intravenous antibiotic regimen. In the analyzed group pharmacological treatment only was applied in 11% of children, in 12% myringotomy/tympanostomy was added, and in the vast majority of patients (77%) mastoidectomy was performed. In our study recurrent mastoiditis was noted in 8% of the patients. We also experienced acute mastoiditis in a cochlear implant child, and in this case, a minimal surgical procedure, in order to protect the device, was recommended. Conclusions The main points of the management protocol are: initiate a broad-spectrum intravenous antibiotic treatment; mastoidectomy should be performed if the infection fails to be controlled after 48 h of administering intravenous antibiotic therapy. We believe that early mastoidectomy prevents serious complications, and our initial observation is that by performing broad mastoidectomy with posterior attic and facial recess exposure, recurrence of acute mastoiditis can be prevented.
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Affiliation(s)
- Józef Mierzwiński
- Children's Hospital of Bydgoszcz, Pediatric Cochlear Implant Center, Department of Otolaryngology, Audiology and Phoniatrics, Bydgoszcz, Poland.
| | - Justyna Tyra
- Children's Hospital of Bydgoszcz, Pediatric Cochlear Implant Center, Department of Otolaryngology, Audiology and Phoniatrics, Bydgoszcz, Poland
| | - Karolina Haber
- Children's Hospital of Bydgoszcz, Pediatric Cochlear Implant Center, Department of Otolaryngology, Audiology and Phoniatrics, Bydgoszcz, Poland
| | - Maria Drela
- Children's Hospital of Bydgoszcz, Pediatric Cochlear Implant Center, Department of Otolaryngology, Audiology and Phoniatrics, Bydgoszcz, Poland
| | - Dariusz Paczkowski
- Children's Hospital of Bydgoszcz, Pediatric Cochlear Implant Center, Department of Otolaryngology, Audiology and Phoniatrics, Bydgoszcz, Poland
| | | | - Anna Sinkiewicz
- Nicolaus Copernicus University Hospital of Bydgoszcz, Department of Health Sciences, Department of Phoniatrics and Audiology, Bydgoszcz, Poland
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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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Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis. J Thromb Haemost 2018; 16:1918-1931. [PMID: 29923367 DOI: 10.1111/jth.14210] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Indexed: 01/25/2023]
Abstract
The cerebral venous system is an unusual site of thrombosis, with a particularly high incidence in young adults. This incidence has increased in past decades because of the improvement of neuroradiological techniques. Risk factors for cerebral venous sinus thrombosis overlap with those of other venous thromboembolism sites; however, some are specific for this particular anatomical district. Prognosis is favorable in most cases if diagnosis is made rapidly and treatment is promptly initiated, even if acute complications or chronic invalidity still occur in a quarter of patients. The mainstay of treatment is anticoagulation, which is necessary in order to block clot propagation and obtain recanalization. Intracranial bleeding does not contraindicate anticoagulation. Endovascular procedures are reserved for patients with a particularly severe presentation or rapidly declining neurological symptoms despite appropriate anticoagulation, although data from clinical trials are lacking. Specifically, this review addresses the epidemiology, clinical presentation and course, risk factors, and treatment of cerebral venous sinus thrombosis, with a special focus on the pediatric population.
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Affiliation(s)
- M Capecchi
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - M Abbattista
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
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Pediatric recurrent acute mastoiditis: Risk factors and insights into pathogenesis. Int J Pediatr Otorhinolaryngol 2018; 111:142-148. [PMID: 29958598 DOI: 10.1016/j.ijporl.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Recurrent acute mastoiditis is repeatedly reported in the literature, but data to understand the pathogenesis, update treatment recommendations and inform future trials are sparse due to the infrequency of the disease. METHODS A retrospective chart review from 2001 to 2016 was conducted including 73 children treated for acute mastoiditis. A follow-up survey was attempted for each patient. Bacteriology, method of treatment, hospital course, complications, and otologic history were analyzed. A chi-squared test, Fisher's exact test and Mann-Whitney U test compared recurrent acute mastoiditis to single acute mastoiditis cases. Additionally, a comprehensive PubMed search and review of world literature addressing recurrent pediatric acute mastoiditis was performed for comparative purposes. RESULTS Among 73 children with acute mastoiditis, six (8%) experienced recurrent acute mastoiditis. Streptococcus pneumoniae was the only bacteria isolated in this group. History of recurrent acute otitis media (>4 per year) prior to the first episode of acute mastoiditis was identified in 24% with single episode of acute mastoiditis and 83% with recurrent mastoiditis (p < 0.05). Fewer intracranial/intratemporal complications were identified among recurrent mastoiditis patients (p < 0.05). In a group of patients treated with more extensive surgical communication during mastoidectomy for primary acute mastoiditis (wide mastoidectomy with broad attic exposure and posterior tympanotomy) no recurrence was observed. CONCLUSION We identify multiple risk factors associated with recurrence and provide early data supporting anatomic predisposition to the development of recurrent acute mastoiditis. More aggressive opening between the mastoid cavity and middle ear may prevent recurrent acute mastoiditis episodes.
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25
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Balsamo C, Biagi C, Mancini M, Corsini I, Bergamaschi R, Lanari M. Acute mastoiditis in an Italian pediatric tertiary medical center: a 15 - year retrospective study. Ital J Pediatr 2018; 44:71. [PMID: 29914542 PMCID: PMC6006960 DOI: 10.1186/s13052-018-0511-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 06/08/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute mastoiditis is the main suppurative complication of acute otitis media. Its incidence ranges from 1.2 to 4.2/100.000 children/year and a rise has been reported in the last years. There are controversial data regarding risk factors for mastoiditis and its complications. AIM OF THE STUDY to evaluate demographics and clinical characteristics of children with acute mastoiditis and to identify possible risk factors for complications. METHODS We retrospectively reviewed medical charts of all the children aged 1 month-14 years admitted to our Paediatric Emergency Department from January 2002 to December 2016. RESULTS One hundred forty-seven cases (97 males and 50 females) were included in the analysis, mean age was 4.8 ± 3.6 years and 28.2% of the patients were younger than 2 years. We found an increasing number of mastoiditis per year during the last 3 years of the study. Children younger than 2 years were less treated with antibiotics for acute otitis media or treated for a shorter period (p < 0.05), while they were treated at higher antibiotic's dosage for mastoiditis (p < 0.01). Older children presented more frequently with symptoms such as earache or retroauricular pain (p < 0.0001, p < 0.001). We didn't identify any risk factor for mastoiditis complications in our study. CONCLUSIONS Despite the introduction of pneumococcal vaccines, the incidence of acute mastoiditis in our population has not been reduced during the last years. We have to face all the reasons why this condition is still relevant, such as antibiotic resistance, new pathogens involved and a possible role played by the implementations of therapeutic acute otitis media guidelines restricting the use of antibiotics in this disease. A particular attention should be given to younger children where signs and symptoms may be less pronounced, therefore acute otitis media or mastoiditis may be misunderstood and appropriate treatment delayed.
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Affiliation(s)
- Claudia Balsamo
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Carlotta Biagi
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Margherita Mancini
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Ilaria Corsini
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Rosalba Bergamaschi
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
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Tawfik KO, Ishman SL, Tabangin ME, Altaye M, Meinzen‐Derr J, Choo DI. Pediatric acute mastoiditis in the era of pneumococcal vaccination. Laryngoscope 2017; 128:1480-1485. [DOI: 10.1002/lary.26968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/17/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Kareem O. Tawfik
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOhioU.S.A
| | - Stacey L. Ishman
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOhioU.S.A
- Division of Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOhioU.S.A
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical CenterCincinnati Ohio U.S.A
| | - Meredith E. Tabangin
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnati Ohio U.S.A
| | - Mekibib Altaye
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnati Ohio U.S.A
| | - Jareen Meinzen‐Derr
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOhioU.S.A
- Division of Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOhioU.S.A
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnati Ohio U.S.A
| | - Daniel I. Choo
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOhioU.S.A
- Division of Otolaryngology–Head and Neck SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOhioU.S.A
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Burgess A, Celerier C, Breton S, Van den Abbeele T, Kadlub N, Leboulanger N, Garabedian N, Couloigner V. Otogenic Temporomandibular Arthritis in Children. JAMA Otolaryngol Head Neck Surg 2017; 143:466-471. [PMID: 28253398 DOI: 10.1001/jamaoto.2016.3977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Septic arthritis of the temporomandibular joint (SATMJ) is a very rare but potentially severe complication of pediatric middle ear infections because it presents risks of TMJ ankylosis. Objective To describe the clinical, radiological, biological, and microbiological characteristics and evolution of SATMJ complicating middle ear infections (otogenic SATMJ) in children. Design, Setting, and Participants This multicenter retrospective study included all children younger than 18 years referred between January 1, 2005, and December 31, 2015, for otogenic SATMJ or for TMJ ankylosis that occurred a few months to a few years after an acute mastoiditis. Nine children were included in the study. Review of the children's medical charts was conducted from February 1, 2016, to April 1, 2016. Main Outcomes and Measures Patients' demographic characteristics and symptoms; radiological, biological, and bacteriological findings, including reanalysis of initial imaging; and treatment and outcome of SATMJ. Results Of the 9 children, 6 were boys and 3 were girls; the mean age was 2.1 years (range, 6 months to 4.7 years). In 7 cases (78%), the primary middle ear infection was acute mastoiditis. Clinically, 5 children (55%) had preauricular swelling and only 1 (11%) had trismus. Associated thrombophlebitis of the lateral sinus or intracranial collections was present in 7 cases (78%). An initial computed tomographic scan was performed for all but 1 patient, and second-line analysis detected clear signs of TMJ inflammation in all 8 children who had a computed tomographic scan. However, SATMJ was diagnosed in only 3 cases at the time of the initial middle ear infection, leading to the recommendation of TMJ physical therapy for several months. The most frequently involved bacteria was Fusobacterium necrophorum, which was found in 4 cases. Long-term ankylosis was identified in 6 cases (67%), and 5 of these children required surgical treatment. Conclusions and Relevance Clinicians and radiologists must thoroughly look for signs of SATMJ in children with acute mastoiditis to detect this complication, which can lead to disabling and hard-to-treat TMJ ankylosis.
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Affiliation(s)
- Alice Burgess
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charlotte Celerier
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvain Breton
- Radiology Department, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | | | - Natacha Kadlub
- Maxillofacial Surgery Department, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Nicolas Leboulanger
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Noël Garabedian
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Couloigner
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children. Curr Allergy Asthma Rep 2017; 16:72. [PMID: 27613655 DOI: 10.1007/s11882-016-0654-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.
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Tawfik KO, Ishman SL, Altaye M, Meinzen-Derr J, Choo DI. Pediatric Acute Otitis Media in the Era of Pneumococcal Vaccination. Otolaryngol Head Neck Surg 2017; 156:938-945. [DOI: 10.1177/0194599817699599] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives (1) Describe longitudinal trends in annual prevalence of hospital admission for pediatric acute otitis media (AOM) and complications of AOM (CAOM) since introduction of pneumococcal vaccination in 2000 and (2) describe the longitudinal trend of prevalence of hospital admission for pneumococcal meningitis in children with AOM-related diagnoses in the postvaccination era. Study Design Retrospective analysis of Kids’ Inpatient Database from 2000 to 2012. Setting Community, nonrehabilitation hospitals. Subjects and Methods To determine annual prevalence of admission for AOM/CAOM, nationally weighted frequencies of children aged <21 years with acute suppurative otitis media, acute mastoiditis, suppurative labyrinthitis, and/or acute petrositis were collected. The frequency of coexisting pneumococcal meningitis diagnoses among these patients was also collected. Trend analysis of prevalences of admission for AOM/CAOM and for pneumococcal meningitis occurring in the setting of AOM/CAOM from 2000 to 2012 was performed. Results Between 2000 and 2012, annual prevalence of admission for AOM/CAOM decreased from 3.956 to 2.618 per 100,000 persons ( P < .0001) (relative risk reduction 34%). Declines in admission prevalence were most pronounced in children <1 year of age (from 22.647 to 8.715 per 100,000 persons between 2000 and 2012, P < .0001) and 1 to 2 years of age (from 13.652 to 5.554 per 100,000 persons between 2000 and 2012, P < .0001). For all ages, the admission prevalence for pneumococcal meningitis and concomitant AOM/CAOM decreased (from 1.760 to 0.717 per 1,000,000 persons, P < .0001) over the study period. Conclusions The prevalence of hospital admission for pediatric AOM/CAOM has declined since the advent of pneumococcal vaccination. Admission rates for pneumococcal meningitis with AOM/CAOM have similarly declined.
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Affiliation(s)
- Kareem O. Tawfik
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey L. Ishman
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Divisions of Otolaryngology–Head & Neck Surgery and Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jareen Meinzen-Derr
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Otolaryngology–Head & Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel I. Choo
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Otolaryngology–Head & Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Prospective evaluation of the aetiology of acute otitis media with spontaneous tympanic membrane perforation. Clin Microbiol Infect 2017; 23:486.e1-486.e6. [PMID: 28110050 DOI: 10.1016/j.cmi.2017.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/07/2017] [Accepted: 01/12/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the aetiological role of the main bacterial pathogens associated with acute otitis media (AOM) in children with AOM and spontaneous tympanic membrane perforation (STMP). METHODS Between 1 May 2015 and 30 April 2016, 177 children, aged 6 months to 7 years, with AOM complicated by STMP within 12 h were prospectively enrolled. Middle ear fluid (MEF) was tested by real-time PCR for Streptococcus pneumoniae, non-typeable Haemophilus influenzae, Streptococcus pyogenes, Moraxella catarrhalis and Staphylococcus aureus. RESULTS Among the 177 children with AOM and STMP, 92/100 (92.0%) of those with recurrent AOM and 13/77 (16.9%) without recurrent AOM had recurrent STMP (p <0.001). A single pathogen was identified in 70 (39.5%) MEF samples, whereas two, three and four bacteria were detected in 54 (30.5%), 20 (11.3%), and 7 (4.0%) cases, respectively. Non-typeable H. influenzae was the most common and was identified in 90 children (50.8%), followed by M. catarrhalis (62 cases, 35.0%) and S. pneumoniae (48 cases, 27.1%). Non-typeable H. influenzae was the most frequent pathogen in children with co-infections. Children with co-infections, including non-typeable H. influenzae, had significantly more frequent recurrent AOM (adjusted OR 6.609, 95% CI 1.243-39.096, p 0.029). CONCLUSIONS Recurrent AOM episodes appear to be associated with an increased risk of AOM with STMP. In AOM with STMP, non-typeable H. influenzae is detected at a high frequency, especially in children with recurrent STMP and often in association with other pathogens.
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Garcia C, Salgueiro AB, Luís C, Correia P, Brito MJ. Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics. Int J Pediatr Otorhinolaryngol 2017; 92:32-37. [PMID: 28012530 DOI: 10.1016/j.ijporl.2016.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute mastoiditis (AM) is a suppurative infection of the mastoid air cells, representing the most frequent complication of acute otitis media. AM remains an important entity in children due to its potential complications and sequelae. We aim to describe the cases of AM admitted at our department, identify risk factors potentially associated with complications and analyse the changes in clinical approach of AM over time. METHODS Case review of clinical files of children admitted with acute mastoiditis from June 1996 to May 2013 at a Lisbon metropolitan area hospital. Data was divided into two groups (prior and after May 2005) in order to evaluate changes in AM approach over the years. RESULTS 135 AM episodes were included. The median age was 3.8 years and 42% children were less than 24 months of age. Symptoms at presentation included fever (69%), ear pain (56%) and otorrhea (40%). Complications occurred in 22% patients and were more common in children under 24 months (33% vs 15%, p ≤ 0.01). Leukocyte count was significantly higher in children with complications (16.7 vs 14.5 × 109/μL, p ≤ 0.05) as was C-Reactive Protein value (13 vs 6.3 mg/dL, p ≤ 0.001). There was a significant association between the development of complications and C-Reactive Protein value at admission (OR 1.892; IC95%: 1.018-2.493, p ≤ 0.01). The optimal cut-off value was 7.21 mg/dL. Over time there was a significant increase in middle ear cultures obtained by tympanocentesis during surgery (2% vs 16%, p ≤ 0,01) and also a decrease in the use of broad spectrum antibiotherapy as initial treatment (52% vs 25%,p ≤ 0,001). CONCLUSIONS Children under 24 months, with high leukocyte count or with high C-Reactive Protein value should be monitored closely since complications tend to be more frequent. A CRP value of 7.21 mg/dL at admission seems to be a good cut-off to monitor children for potential complications. Throughout the period analysed more cultures were performed allowing identification of the pathogens and implementation of appropriate antibiotic therapy.
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Affiliation(s)
- Catarina Garcia
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
| | - Ana Bárbara Salgueiro
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
| | - Catarina Luís
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
| | - Paula Correia
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
| | - Maria João Brito
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
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Ghadersohi S, Young NM, Smith-Bronstein V, Hoff S, Billings KR. Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital. Laryngoscope 2016; 127:2321-2327. [PMID: 27796038 DOI: 10.1002/lary.26365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/31/2016] [Accepted: 09/09/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the presentation and management of acute complicated mastoiditis in children. STUDY DESIGN Retrospective case series. METHODS An analysis of pediatric patients with acute complicated mastoiditis treated at an urban, tertiary care children's hospital from 2007 to 2014 was performed. RESULTS Forty-eight patients presented with a total of 67 complications of acute mastoiditis. Mean age at presentation was 4.8 years (range = 0.1-15.3 years). The most common complications were subperiosteal abscess (n = 22, 45.8%), epidural abscess (n = 16, 33.3%), and sigmoid sinus thrombosis (n = 14, 29.2%). The most common pathogens isolated included Streptococcus pneumoniae (n = 14, 29.2%) and group A streptococcus (n = 10, 20.8%). Multidrug resistance was not associated with complication type. Surgical management included myringotomy ± tympanostomy tube placement in 46 (95.8%) patients (the only surgery in 10), drainage of subperiosteal abscess without mastoidectomy in 18 (37.5%) patients, and mastoidectomy in 21 (43.8%) total patients. Patients presenting with intracranial complications were the most likely to undergo a mastoidectomy. Anticoagulation was used in the management of nine of 14 (64.3%) patients presenting with sigmoid sinus thrombosis. Neurosurgical interventions (n = 7, 14.6% patients) were primarily performed to manage increased intracranial pressure. CONCLUSIONS Subperiosteal abscess was the most common complication of acute mastoiditis, and when occurring as the sole complication was successfully managed with antibiotics and surgical intervention that did not include mastoidectomy. Epidural abscess and sigmoid sinus thrombosis were more prevalent than reported in prior series and were managed more aggressively. These patients were more likely to need neurosurgical interventions. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2321-2327, 2017.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Nancy M Young
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Virginia Smith-Bronstein
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Stephen Hoff
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Kathleen R Billings
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
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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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McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, Clark JE, Cooper CM, Curtis N, Goeman E, Hazelton B, Haeusler GM, Khatami A, Newcombe JP, Osowicki J, Palasanthiran P, Starr M, Lai T, Nourse C, Francis JR, Isaacs D, Bryant PA. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. THE LANCET. INFECTIOUS DISEASES 2016; 16:e139-52. [PMID: 27321363 DOI: 10.1016/s1473-3099(16)30024-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. All eligible studies were assessed for quality. 4090 articles were identified and 170 studies were included. Evidence relating antibiotic duration to outcomes in children for some infections was supported by meta-analyses or randomised controlled trials; in other infections data were from retrospective series only. Criteria for intravenous to oral switch commonly included defervescence and clinical improvement with or without improvement in laboratory markers. Evidence suggests that intravenous to oral switch can occur earlier than previously recommended for some infections. We have synthesised recommendations for antibiotic duration and intravenous to oral switch to support clinical decision making and prospective research.
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Affiliation(s)
- Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - David Andresen
- Department of Infectious Diseases, Immunology, and HIV Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; PathWest Laboratory Medicine, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Minyon L Avent
- The University of Queensland, UQ Centre for Clinical Research and School of Public Health, Herston, QLD, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; Menzies School of Health Research, Darwin, NT, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Philip N Britton
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Celia M Cooper
- Department of Microbiology and Infectious Diseases, SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Emma Goeman
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Briony Hazelton
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Gabrielle M Haeusler
- Department of Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Infection and Immunity, Monash Children's Hospital, Clayton, VIC, Australia
| | - Ameneh Khatami
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - James P Newcombe
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - Mike Starr
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tony Lai
- Department of Pharmacy, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Clare Nourse
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - David Isaacs
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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Pneumococcal Mastoiditis in Children Before and After the Introduction of Conjugate Pneumococcal Vaccines. Pediatr Infect Dis J 2016; 35:292-6. [PMID: 26569193 DOI: 10.1097/inf.0000000000000995] [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: 01/06/2023]
Abstract
OBJECTIVES To determine whether serotype distribution and antibiotic resistance of Streptococcus pneumoniae acute mastoiditis (AM) in children have changed in the post pneumococcal conjugate vaccines (PCVs) era. METHODS Medical records of pneumococcal AM cases, in a tertiary pediatric hospital were reviewed from January 1999 to December 2014. S. pneumoniae isolates were serotyped using the quellung reaction and tested for antibiotic susceptibility by E-test and for macrolide resistance genes by polymerase chain reaction. RESULTS Among 334 children with AM, S. pneumoniae was isolated from 89 (26.6%) with median age 22 months (interquartile range: 12-30 months). S. pneumoniae was recovered from ear fluid (58%), mastoid specimens (35.2%) and blood (6.8%). Resistance to penicillin, erythromycin and clindamycin was 12.4%, 49.4% and 18%, respectively. Distribution of pneumococcal serotypes before (1999-2005), after the introduction of PCV7 (2006-2010) and after PCV13 (2011-2014) was found: for the PCV7 serotypes 81%, 25% and 0% (P < 0.0001), for PCV13 additional serotypes 16.3%, 70.8% and 63.6% (P < 0.0001) and for non-PCV serotypes 2.3%, 4.1% and 36.3% (P = 0.0002), respectively. Significant increase was detected for the serotype 19A after PCV7, and this trend was not changed after PCV13 (2.3%, 50% and 50%, respectively; P < 0.0001). A significant proportion of resistant isolates to penicillin (54.5%) and erythromycin (34.8%) was identified as 19A. CONCLUSIONS After the introduction of PCV7, a significant increase of serotype 19A and replacement of PCVs serotypes was identified. After PCV13, the overall proportion of pneumococcal mastoiditis and the incidence of serotype 19A were not significantly declined. A significant proportion of resistant isolates to penicillin and erythromycin is attributed to serotype 19A.
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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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Zanoletti E, Cazzador D, Faccioli C, Sari M, Bovo R, Martini A. Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management. Int J Pediatr Otorhinolaryngol 2015; 79:2398-403. [PMID: 26590005 DOI: 10.1016/j.ijporl.2015.10.059] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/30/2015] [Accepted: 10/31/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Otogenic lateral sinus thrombosis (LST) is a rare intracranial complication of acute otitis media (AOM), which can lead to severe neurological sequelae and death. The aim of this study was to analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations. METHODS At a tertiary Italian hospital, a retrospective review was conducted on the medical records of eight patients diagnosed with otogenic LST over a 3-year period. Four children were males and mean age was 4.7 years. RESULTS All patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy±trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus (p=0.029). CONCLUSION LST is a severe condition occurring even in absence of otological signs, and despite adequate antibiotic therapy for AOM, which should be ruled out and promptly treated. A dominant neurological presentation is associated in our series with anatomical variations of cerebral sinus venous drainage patterns. This should be carefully evaluated and considered in diagnosis, treatment planning and prognosis.
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Affiliation(s)
- Elisabetta Zanoletti
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy.
| | - Diego Cazzador
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Chiara Faccioli
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Marianna Sari
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Roberto Bovo
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Alessandro Martini
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
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Marchisio P, Bianchini S, Villani A, Verri G, Bernardi F, Porta A, Biban P, Caimmi S, Iughetti L, Krzysztofiak A, Garazzino S, Romanin B, Salvini F, Lancella L, Landini S, Galeone C, Esposito S, Principi N. Diagnosis and management of acute mastoiditis in a cohort of Italian children. Expert Rev Anti Infect Ther 2015; 12:1541-8. [PMID: 25382701 DOI: 10.1586/14787210.2014.982093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Italian Society for Pediatric Infectious Diseases created a registry to determine the management of pediatric acute mastoiditis (AM) in Italy. METHODS A cross-sectional survey of paediatricians was conducted to evaluate hospitalization due to AM in Italian pediatric wards between 1 January 2002, and 31 December 2013. RESULTS A total of 913 children (561 males, 61.4%) were included in this study. The annual number of AM cases significantly increased during the study period (30 in 2002 and 98 in 2013) but only among older children (≥ 4 years old; p = 0.02). AM complications occurred in 69 (7.6%) of the children and sequelae were observed in 13 (1.4%) patients. CONCLUSION The annual number of pediatric AM cases admitted to Italian pediatric wards increased in the past few years; this increase was strictly age-related. The risk of severe AM complications appeared relatively low, and most AM cases could be treated conservatively.
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Affiliation(s)
- Paola Marchisio
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
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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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Gisselsson-Solen M. Acute otitis media in children-current treatment and prevention. Curr Infect Dis Rep 2015; 17:476. [PMID: 25896748 DOI: 10.1007/s11908-015-0476-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute otitis media (AOM) is the most common bacterial infection in children and has a very varied clinical spectrum, ranging from spontaneous resolutions to serious complications. The effect of antibiotics in AOM depends on the chosen outcome, but has been shown to reduce pain somewhat, and have a greater beneficial effect in severe cases of AOM. Today, not all episodes of AOM are treated with antibiotics, but most countries have issued guidelines that include an option of watchful waiting in many cases. Prevention of AOM reaches from modification of environmental risk factors to vaccinations and surgery. Conjugate pneumococcal vaccines and influenza vaccines have been shown to somewhat reduce the number of AOM episodes in different groups of children. Grommets, with or without adenoidectomy, are effective at least during the first 6 months after surgery.
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Affiliation(s)
- Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, 22185, Lund, Sweden,
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Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc11. [PMID: 25587371 PMCID: PMC4273172 DOI: 10.3205/cto000114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.
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Affiliation(s)
- Amir Minovi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
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Acute mastoiditis in the pneumococcal conjugate vaccine era. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1189-91. [PMID: 24920600 DOI: 10.1128/cvi.00289-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following the introduction of the 7- and 13-valent pneumococcal conjugate vaccines, we observed an inverse relationship between the increasing rate of immunized children and the proportion of middle ear fluid cultures collected during acute mastoiditis episodes that tested positive for Streptococcus pneumoniae among a subset of children 0 to 6 years old who had initially presented with severe acute otitis media and had bacterial cultures collected during tympanocentesis or from spontaneous otorrhea.
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Marom T, Tan A, Wilkinson GS, Pierson KS, Freeman JL, Chonmaitree T. Trends in otitis media-related health care use in the United States, 2001-2011. JAMA Pediatr 2014; 168:68-75. [PMID: 24276262 PMCID: PMC3947317 DOI: 10.1001/jamapediatrics.2013.3924] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Otitis media (OM) is a leading cause of pediatric health care visits and the most frequent reason children consume antibiotics or undergo surgery. During recent years, several interventions have been introduced aiming to decrease OM burden. OBJECTIVE To study the trend in OM-related health care use in the United States during the pneumococcal conjugate vaccine (PCV) era (2001-2011). DESIGN, SETTING, AND PARTICIPANTS An analysis of an insurance claims database of a large, nationwide managed health care plan was conducted. Enrolled children aged 6 years or younger with OM visits were identified. MAIN OUTCOMES AND MEASURES Annual OM visit rates, OM-related complications, and surgical interventions were analyzed. RESULTS Overall, 7.82 million unique children (5.51 million child-years) contributed 6.21 million primary OM visits; 52% were boys and 48% were younger than 2 years. There was a downward trend in OM visit rates from 2004 to 2011, with a significant drop that coincided with the advent of the 13-valent vaccine (PCV-13) in 2010. The observed OM visit rates in 2010 (1.00/child-year) and 2011 (0.81/child-year) were lower than the projected rates based on the 2005-2009 trend had there been no intervention (P < .001). Recurrent OM (≥3 OM visits within 6-month look-back) rates decreased at 0.003/child-year (95% CI, 0.002-0.004/child-year) in 2001-2009 and at 0.018/child-year (95% CI, 0.008-0.028/child-year) in 2010-2011. In the PCV-13 premarket years, there was a stable rate ratio (RR) between OM visit rates in children younger than 2 years and in those aged 2 to 6 years (RR, 1.38; 95% CI, 1.38-1.39); the RR decreased significantly (P < .001) during the transition year 2010 (RR 1.32; 95% CI, 1.31-1.33) and the postmarket year 2011 (RR 1.01; 95% CI, 1.00-1.02). Tympanic membrane perforation/otorrhea rates gradually increased (from 3721 per 100,000 OM child-years in 2001 to 4542 per 100,000 OM child-years in 2011; P < .001); the increase was significant only in the older children group. Mastoiditis rates substantially decreased (from 61 per 100,000 child-years in 2008 to 37 per 100,000 child-years in 2011; P < .001). Ventilating tube insertion rate decreased by 19% from 2010 to 2011 (P = .03). CONCLUSIONS AND RELEVANCE There was an overall downward trend in OM-related health care use from 2001 to 2011. The significant reduction in OM visit rates in 2010-2011 in children younger than 2 years coincided with the advent of PCV-13. Although tympanic membrane perforation/otorrhea rates steadily increased during that period, mastoiditis and ventilating tube insertion rates decreased in the last years of the study.
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Affiliation(s)
- Tal Marom
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX
| | - Alai Tan
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Gregg S. Wilkinson
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Karen S. Pierson
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Jean L. Freeman
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Tasnee Chonmaitree
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX,Department of Pathology, University of Texas Medical Branch, Galveston, TX
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Vigier S, Nicollas R, Roman S, Barlogis V, Coulibaly B, Triglia JM. [Burkitt's leukemia presenting as atypical acute mastoiditis in a 7-month-old child]. Arch Pediatr 2013; 20:1317-20. [PMID: 24176693 DOI: 10.1016/j.arcped.2013.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/12/2013] [Accepted: 09/03/2013] [Indexed: 11/17/2022]
Abstract
A 7-month-old girl presented with left acute mastoiditis and a white blood cell count of 79,000/mm(3). A surgically obtained bacteriological sample showed Streptococcus pneumoniae. Direct blood examination revealed leukemic blast cells. Histological samples showed leukemic infiltration of the left temporal bone. The final diagnosis was Burkitt's leukemia with left temporal bone leukemic infiltration. The patient received chemotherapy according to the LMB 2001 protocol from the Société française d'oncologie pédiatrique. Clinical, biological, and imaging follow-up 30 months after the end of treatment showed remission with complete recovery in the left temporal bone. Atypical presentation of acute mastoiditis (AM) should prompt investigation into whether there is a rare underlying pathology, such as a hemopathy, histiocytosis, or solid tumor. The first sign of leukemia may be acute middle ear disease. To our knowledge, no other cases of Burkitt's leukemia with temporal bone leukemic infiltration presenting as AM have been reported in a child under 1 year of age.
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Affiliation(s)
- S Vigier
- Service de chirurgie oto-rhino-laryngologique et cervico-faciale pédiatrique, université d'Aix-Marseille 2, hôpital de la Timone, 264, rue St-Pierre, 13385 Marseille cedex 5, France.
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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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Tsai TC, Yu PM, Tang RB, Wang HK, Chang KC. Otorrhea as a sign of medical treatment failure in acute otitis media: two cases with silent mastoiditis complicated with facial palsy. Pediatr Neonatol 2013; 54:335-8. [PMID: 23602239 DOI: 10.1016/j.pedneo.2013.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 03/14/2012] [Accepted: 03/26/2012] [Indexed: 10/26/2022] Open
Abstract
We report two children with otitis media who developed facial palsy despite prompt antibiotic therapy. Brain images revealed silent mastoiditis. Persistent otorrhea may be a cautious sign of medical treatment failure or complication of acute otitis media, including mastoiditis or facial palsy. Delayed identification of coexisting mastoiditis or hesitation over surgical intervention may lead to treatment failure and complications. Adequate intravenous antibiotics and myringotomy provide reasonable and appropriate management to prevent permanent sequelae.
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Affiliation(s)
- Tzu-Chun Tsai
- Department of Pediatrics and Otorhinolaryngology, National Yang-Ming University Hospital, Yilan, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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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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Jung TTK, Alper CM, Hellstrom SO, Hunter LL, Casselbrant ML, Groth A, Kemaloglu YK, Kim SG, Lim D, Nittrouer S, Park KH, Sabo D, Spratley J. Panel 8. Otolaryngol Head Neck Surg 2013; 148:E122-43. [DOI: 10.1177/0194599812467425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Objectives Although serious complications of otitis media (OM) such as brain abscess are rare, sequelae of OM such as tympanic membrane perforation and atelectatic tympanic membrane are quite common. Inner ear sequelae can cause hearing loss and speech and language problems. The objectives of this article are to provide a state-of-the-art review on recent articles on complications and sequelae of OM in different anatomic locations, from the tympanic membrane to intracranial sites, as well as hearing loss and speech and language development. Data Sources Primarily PubMed supplemented by Ovid MEDLINE and the Cochrane Database. Review Methods All types of articles related to OM complications and sequelae published in English between January 2007 and June 2011 were identified. A total of 127 relevant quality articles are summarized and included in this report. Results Key findings are summarized based on the following major anatomic locations and categories: tympanic membrane; cholesteatoma; ossicular problems; mucosal sequelae; inner ear sequelae; speech and language development; extracranial areas, including mastoiditis and facial nerve paralysis; intracranial complications; and future research goals. New information and insights were gained to prevent complications and sequelae. Conclusion and Implications for Practice Over the past 4 years, progress has been made in advancing the knowledge on the complications and sequelae of OM, which can be used to prevent and treat them effectively. Areas of potential future research have been identified and outlined.
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Affiliation(s)
- Timothy T. K. Jung
- Department of Otolaryngology, Loma Linda University, Loma Linda, California, USA
| | - Cuneyt M. Alper
- Division of Pediatric Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sten O. Hellstrom
- Department of Audiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa L. Hunter
- Division of Audiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Anita Groth
- Department of Otolaryngology, University of Lund, Lund, Sweden
| | | | - Sang Gyoon Kim
- Department of Otolaryngology, Loma Linda University, Loma Linda, California, USA
| | - David Lim
- House Ear Institute, Los Angeles, California, USA
| | - Susan Nittrouer
- Division of Audiology, Ohio State University, Columbus, Ohio, USA
| | - Kee Hyun Park
- Department of Otolaryngology, Ajou University, Suwon, Korea
| | - Diane Sabo
- Division of Audiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jorge Spratley
- Department of Otolaryngology, University of Porto, Porto, Portugal
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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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Groth A, Enoksson F, Stalfors J, Stenfeldt K, Hultcrantz M, Hermansson A. Recurrent acute mastoiditis - a retrospective national study in Sweden. Acta Otolaryngol 2012; 132:1275-81. [PMID: 22938013 DOI: 10.3109/00016489.2012.709321] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Recurrences were seen in 5% of all patients with acute mastoiditis (AM). Mastoidectomy had been performed in the majority of the patients with recurrences at their first episode of AM. Compared with the group with a single episode of AM, the recurrent group exhibited more subperiosteal and ear canal abscesses, although they were not more severely ill. It appears from this study that previous mastoidectomy itself could predispose patients to recurrent AM (rAM), perhaps due to easier access to the mastoid cavity and/or due to a reduction in mucosal lining. OBJECTIVE To retrospectively study the incidence and characteristics of rAM in Sweden. METHODS Data from patients with rAM were reviewed and compared with data from patients with a single episode of AM during 1993-2007 in 33 ear, nose and throat departments in Sweden. RESULTS Of 798 cases fulfilling the criteria for AM, 36 patients (5%) had experienced one or more recurrences, of which 4 patients (11%) had concurrent cholesteatoma. More than 50% of the patients had their first episode of AM before the age of 2 years. There was a highly significant difference between the two groups concerning the frequency of mastoidectomies and subperiosteal/retroauricular abscesses. However, other clinical characteristics, including severe complications, did not differ significantly. The majority of recurrences were treated conservatively with myringotomy and intravenous antibiotics, and also with aspiration/incision if a subperiosteal/retroauricular abscess was present.
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Affiliation(s)
- Anita Groth
- Strama Skåne, Grynmalaregatan 1, Lund, Sweden.
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