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Shinnawi S, Khoury M, Cohen-Vaizer M, Cohen JT, Gordin A. Intracranial complications of acute mastoiditis: Surgery not always necessary. Am J Otolaryngol 2024; 45:104299. [PMID: 38657531 DOI: 10.1016/j.amjoto.2024.104299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Acute mastoiditis (AM) can rapidly become life-threatening with various intracranial complications. The standard care includes antibiotics, mastoidectomy, and drainage. Reports show varying preferences for conservative and surgical treatments, with a more conservative approach gaining popularity. In this study we aim to evaluate the presenting symptoms, management and outcomes of patients presenting with intracranial complications secondary to acute mastoiditis. METHODS Retrospective review for all children admitted for acute mastoiditis for 12 years period (January 2010-December 2021). Children who had mastoiditis associated with intracranial complications were included in the study. STROBE guidelines were followed in this study. RESULTS 23 patients were diagnosed with acute mastoiditis with intracranial complications. The mean age was 2.1 years. The most common presenting sign was fever, followed by otalgia. The most common pathogens were Fusobacterium necrophorum and Streptococcus pneumoniae. The most common intracranial complication was sinus vein thrombosis (SVT) affecting 13 patients. Eventually, 10 patients underwent cortical mastoidectomy during 1-6 days upon admission, with an average of 3.2 days. During the follow-up period patients were monitored for clinical progression. Patients who did not show clinical improvement such as persistent fever, worsening symptoms, or the presence of neurological symptoms were treated surgically. The length of stay was an average of 15.5 days overall, with no significantly longer hospital stay in patients who were treated surgically compared to patients who were treated conservatively (17.1 days vs. 14.2 days, P = .26). CONCLUSION Intracranial complications of acute mastoiditis remain a significant challenge. Selected patients with intracranial complications can be treated conservatively with close monitoring, without increasing the risk of immediate or long-term complications. Initial antimicrobial treatment should cover anaerobic bacteria, as it correlates with severe complications.
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Affiliation(s)
- Shadi Shinnawi
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel.
| | - Majd Khoury
- Department of Otolaryngology Head and Neck Surgery, Bnai-Zion Medical Center, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Mauricio Cohen-Vaizer
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Arie Gordin
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
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Kotowski M, Szydlowski J. Otogenic Cerebral Sinus Thrombosis in Children: A Narrative Review. Neurol Ther 2023; 12:1069-1079. [PMID: 37266793 PMCID: PMC10310653 DOI: 10.1007/s40120-023-00499-0] [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: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare entity that remains a diagnostic challenge due to various clinical manifestations and a wide variety of causative agents. Local infections, such as acute (AOM) or chronic otitis media, can play a role in the pathogenesis of CVT. The proximity of the tympanic cavity and temporal bone air cells to the dural venous sinuses predisposes them to secondary thrombosis. The release of inflammatory cytokines and activation of the coagulation pathway in the middle ear space in response to infection may trigger the thrombotic mechanism in venous sinuses of the central nervous system. There is no consensus in the literature concerning the treatment of otogenic cerebral venous sinus thrombosis (CVST). Both the extent of the surgery and the use of anticoagulants are disputable. The aim of the study was to provide a thorough analysis of the literature concerning CVST in patients with AOM and acute mastoiditis (AM). The current surgical and conventional treatment strategies are presented. Special attention has been attached to the predisposing factors, the extent of the surgery, and the role of anticoagulants in the treatment of septic otogenic CVST.
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Affiliation(s)
- Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland.
| | - Jaroslaw Szydlowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland
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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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Poutoglidis A, Tsetsos N, Keramari S, Skoumpas I, Vlachtsis K, Kilmpasanis A, Fyrmpas G. Sigmoid Sinus Thrombosis as a Complication of Acute Otitis Media in a 6-Year-Old Male. EAR, NOSE & THROAT JOURNAL 2023; 102:527-529. [PMID: 33993776 DOI: 10.1177/01455613211015752] [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: 11/15/2022] Open
Abstract
Sigmoid sinus thrombosis (SST) is a potentially life-threatening complication of otitis media which is nowadays rare due to the widespread use of antibiotics. A high index of suspicion is necessary to allow for a timely diagnostic and therapeutic intervention. Intravenous wide-spectrum antibiotics and a cortical mastoidectomy are the mainstay of treatment. There is no consensus regarding the necessity of anticoagulants in pediatric patients. We present a 6-year-old boy who presented with an SST as a result of acute otitis media.
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Affiliation(s)
- Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Stergiani Keramari
- Second Department of Paediatrics, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Ioannis Skoumpas
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Konstantinos Vlachtsis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Adamantios Kilmpasanis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Georgios Fyrmpas
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
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Yosefof E, Hilly O, Sokolov M, Raveh E, Yacobovich J, Ulanovski D. Paediatric otogenic sinus venous thrombosis: the role of Fusobacterium necrophorum. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:388-394. [PMID: 36254655 PMCID: PMC9577686 DOI: 10.14639/0392-100x-n1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/06/2022] [Indexed: 11/07/2022]
Abstract
Objectives Sinus venous thrombosis (SVT) is a rare complication of acute otitis media (AOM) with acute mastoiditis (AM), which during recent years has been associated with Fusobacterium necrophorum (Fn) infection. Our objective was to review clinical, microbiologic, and hematologic features of paediatric otogenic SVT, with a specific focus on the role of Fn. Methods A retrospective database review in a tertiary paediatric hospital between 2000-2019. Results Fifty children aged 6-155 months were treated for AM with SVT. Forty-seven (94%) underwent cortical mastoidectomy. Forty-six children received low-molecular-weight heparin (LMWH). Follow-up imaging revealed recanalisation in 92% of cases. No long-term neurologic or haematologic complications were observed. Since 2014, when anaerobic cultures and PCR were routinely used in our institute, Fn was isolated from 15/21 children with SVT. Their time to recanalisation was longer, and the rate of lupus anticoagulant antibodies (LAC) was higher than in the 6 non-Fn patients. Children positive for LAC also had a longer time to recanalisation. Conclusions Fn is a common pathogen in AM with SVT; its thrombogenic role was demonstrated by a higher prevalence of LAC and a longer time to recanalisation.
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Affiliation(s)
- Eyal Yosefof
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Aviv University, Aviv, Israel,Correspondence Eyal Yosefof Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva 4941492, Israel Tel. +972 3 9376456. Fax +972 3 9376467 E-mail:
| | - Ohad Hilly
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Meirav Sokolov
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel, Pediatric Otorhinolaryngology Unit, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Eyal Raveh
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel, Pediatric Otorhinolaryngology Unit, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Joanne Yacobovich
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel, Pediatric Hematology Unit, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - David Ulanovski
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel, Pediatric Otorhinolaryngology Unit, Schneider Children’s Medical Center, Petach Tikva, Israel
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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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Sánchez van Kammen M, Male C, Connor P, Monagle P, Coutinho JM, Lensing AWA. Anticoagulant Treatment for Pediatric Infection-Related Cerebral Venous Thrombosis. Pediatr Neurol 2022; 128:20-24. [PMID: 35032886 DOI: 10.1016/j.pediatrneurol.2021.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to describe the clinical presentation, risk of bleeding and recurrent thrombosis, and perioperative anticoagulant management of children with cerebral venous thrombosis (CVT) and an associated head or neck infection. METHODS In this subgroup analysis of the EINSTEIN-Jr study, we included children with CVT and an associated head or neck infection who received therapeutic anticoagulants with either low-molecular-weight heparin (with or without subsequent vitamin K antagonists) or rivaroxaban for a period of 3 months. Analyses are descriptive. RESULTS Of 74 included children, 59 (80%) had otomastoiditis, 21 (28%) a central nervous system infection, 18 (24%) sinusitis, and 9 (12%) another upper respiratory tract infection; 29 (39%) had infection of multiple regions of the head or neck. All 74 children received antibiotics and therapeutic anticoagulants; 41 (55%) underwent surgery, of whom 34 were diagnosed with CVT preoperatively. Anticoagulation was started before surgery in 12 children and interrupted 0-1 days prior to surgery. Anticoagulation was (re)started in all 34 children at a median of 1 day (interquartile range: 0-1) postoperatively, in therapeutic doses in 94%. Overall, one child (1%, 95% confidence interval: 0-7) had recurrent thrombosis, and one (1%, 95% confidence interval: 0-7) had major bleeding; neither was associated with surgery. At 3 months, no children had died, 3 (4%) had persistent focal neurologic deficits, and 2 (3%) had impaired vision. CONCLUSIONS Children with CVT and an associated head or neck infection administered therapeutic anticoagulants generally had low risks of bleeding and thrombotic complications, including those who had surgical interventions with delay or interruption of anticoagulation.
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Affiliation(s)
| | - Christoph Male
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Philip Connor
- Department of Paediatric Haematology/Oncology, Noah's Ark Children's Hospital for Wales, Cardiff, United Kingdom
| | - Paul Monagle
- Kids Cancer Centre, Sydney Children's Hospital Randwick, NSW, Department of Clinical Haematology, Royal Children's Hospital, Haematology Research Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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Paediatric otogenic cerebral venous sinus thrombosis: a multidisciplinary approach. The Journal of Laryngology & Otology 2021; 136:3-7. [PMID: 34698003 DOI: 10.1017/s0022215121003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paediatric otogenic cerebral venous sinus thrombosis is a rare, heterogeneous and life-threatening condition, with possible otological, neurological and ophthalmological sequelae. Its course and outcomes can be widely variable. The publications available often consider individual aspects of paediatric otogenic cerebral venous sinus thrombosis management. The condition itself and the nature of the currently available guidance can lead to uncertainties when holistically managing patients with paediatric otogenic cerebral venous sinus thrombosis. OBJECTIVES Clear recommendations for the comprehensive assessment and management of paediatric otogenic cerebral venous sinus thrombosis are presented, along with the literature review upon which they are based. Its clinical and radiological assessment are discussed. CONCLUSION A multidisciplinary approach to assessment and management is recommended, inclusive of infectious diseases, ENT surgery, neurology, ophthalmology and haematology. On balance, anticoagulation is recommended for three months. Follow-up imaging is not recommended in the absence of clinical concern. Follow up by ENT surgery, neurology and ophthalmology departments is recommended.
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Bergsma P, Kunz S, Kienle AL, Brand Y. Case Report: Petrous Apicitis and Otogenic Thrombosis of the Cavernous Sinus in a 10-Year-Old Boy. Front Surg 2021; 8:667817. [PMID: 34268332 PMCID: PMC8275649 DOI: 10.3389/fsurg.2021.667817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Petrous apicitis and cavernous sinus thrombosis are exceedingly rare complications of acute otitis media with only few reported cases in the post-antibiotic era. Especially in children, the appropriate management is a subject of controversy. Case Presentation: We report the case of a 10-year-old boy who presented to the emergency department with left-sided otalgia, otorrhea, and hearing loss, accompanied by somnolence and high spiking fevers. CT and MRI revealed partially obstructed mastoid air cells including a pneumatized petrous apex. Furthermore, thrombosis of the cavernous sinus and vasculitis of the internal carotid artery on the left side were present. The patient was treated with antibiotics for 6 weeks and anticoagulant therapy for 3 months. Follow-up carried out 3 months post-admission showed complete recanalization of the cavernous sinus on MRI and fatigue as the only remaining symptom. Conclusion: A complicated otitis media with petrous apicitis and cavernous sinus thrombosis in a child can in some cases be managed without a surgical intervention.
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Affiliation(s)
- Patrick Bergsma
- Department of Otolaryngology, Cantonal Hospital of Graubunden, Chur, Switzerland
| | - Seraina Kunz
- Department of Otolaryngology, Cantonal Hospital of Graubunden, Chur, Switzerland
| | - Anna-Lena Kienle
- Department Radiology, Cantonal Hospital of Graubunden, Chur, Switzerland
| | - Yves Brand
- Department of Otolaryngology, Cantonal Hospital of Graubunden, Chur, Switzerland.,University Basel, Basel, Switzerland
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Huang YB, Li L, Pan Y, Li QZ, Li H. Clinical characteristics of otogenic lateral sinus thrombosis in patients under 18 years old compared with that in adult patients. Acta Otolaryngol 2021; 141:237-241. [PMID: 33427005 DOI: 10.1080/00016489.2020.1859134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Otogenic lateral sinus thrombosis (OLST) is a rare complication of otitis media. We do not know whether the disease progress between the pediatric and adult OLST patients is consistent. However, pediatric surgical methods always refer to the adults'. AIMS/OBJECTIVES This study aimed to seek evidence for suitable surgical methods in pediatric patients. MATERIALS AND METHODS The clinical manifestation, laboratory findings, and findings in operation between children and adult groups were compared. RESULTS Ten children and 17 adults OLST patients were included. Most pediatric patients had no history of chronic otitis media or cholesteatoma (p<.001). The ratios of otorrhea, tympanic perforation and sclerotic type mastoid in CT scan were significantly lower in the children group (p<.05). The mean air conduction hearing threshold in the children and adolescent group (31.25 ± 21.27 dB) was significantly lower than that of the adult group (77.6 ± 23.66 dB) (p<.001). The diseases in attics (66.7%) and the ossicular chain destruction (33.3%) were not as severe as those in the adult group (p<.05). The eustachian tube closure was found similar in two groups. CONCLUSIONS AND SIGNIFICANCE Conservative surgery is recommended to pediatric OLST to obliterate the diseases and improve middle ear and mastoid drainage, preserving hearing function.
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Affiliation(s)
- Yi-Bo Huang
- Department of Radiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Li Li
- Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Lianyungang City, Lianyungang City, China
| | - Yucheng Pan
- Department of Radiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qing-Zhong Li
- Department of Radiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Huawei Li
- Department of Radiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China
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Acute mastoiditis complicated by cerebral venous sinus thrombosis in children. Int J Pediatr Otorhinolaryngol 2021; 141:110508. [PMID: 33234334 DOI: 10.1016/j.ijporl.2020.110508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 11/24/2022]
Abstract
AIM Diagnosis and management of complicated mastoiditis in childhood are still controversial. We investigated the clinical manifestations, evaluation and management of children with mastoiditis complicated with cerebral venous sinus thrombosis. METHODS Retrospective cohort study that included all children admitted for acute mastoiditis over the last 5 years. Children were divided in two groups based on the presence or not of venous sinus thrombosis. Clinical, laboratory, imaging and management data were retrieved and compared. RESULTS Overall, 20 children with acute mastoiditis were included, of whom 5 had magnetic resonance imaging-confirmed cerebral venous sinus thrombosis and elevated intracranial pressure (ICP). In all complicated cases, neurological signs rather than mastoiditis signs, prevailed. The more prominent neurologic signs observed were lethargy (60%), nuchal rigidity (60%), abducens nerve palsy (60%) and ataxic gait (20%). Treatment consisted of intravenous antibiotics combined with anticoagulation. Surgery was performed in four children (4/5). Complicated cases had prolonged symptoms prior to admission (p 0.002), presented with neurologic signs and symptoms (p < 0.001), underwent more often lumbar puncture (p < 0.001) and brain imaging (p < 0.001), and were treated with prolonged courses of antibiotics and surgery (<0.001), compared to children with uncomplicated mastoiditis. CONCLUSION Neurological signs and symptoms and elevated ICP dominate in children with mastoiditis complicated with thrombosis. Brain imaging is essential for early diagnosis of cerebral venous sinus complications and appropriate management.
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Yuan L, Yuan J, Sun Y, Wang Y. The Anticoagulant Therapy for Otogenic Sigmoid Sinus Thrombophlebitis: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 101:NP379-NP382. [PMID: 33236644 DOI: 10.1177/0145561320976405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sigmoid sinus thrombophlebitis is a severe and potentially fatal intracranial complication of acute otitis media and middle ear cholesteatoma. Early administration of broad-spectrum antibiotics and immediate radical mastoidectomy are the recommended standard treatments; however anticoagulant therapy is always an option worthy of clinical consideration. Here, we report a case of middle ear cholesteatoma complicated with sigmoid sinus thrombophlebitis in a patient who received anticoagulant therapy for 1 year before the operation because of the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Lanlai Yuan
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Jie Yuan
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yanjun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, Hubei, China
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Shlobin NA, LoPresti MA, Beestrum M, Lam S. Treatment of pediatric cerebral venous sinus thromboses: the role of anticoagulation. Childs Nerv Syst 2020; 36:2621-2633. [PMID: 32743709 DOI: 10.1007/s00381-020-04829-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/22/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cerebral venous sinus thromboses (CVST) occur in children with a variety of etiologies. However, no standard treatment paradigm is established. We sought to identify what treatments have been applied, their outcomes, and the role of anticoagulation in pediatric patients with CVST. METHODS A systematic review was conducted exploring all treatments of pediatric CVSTs using PubMed, Embase, Scopus, and Cochrane Library and Cochrane Central Register of Controlled Trials. Studies meeting inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes. RESULTS Of 2946 resultant articles, 51 full-text articles were included. Management of infectious CVST included broad-spectrum antibiotics, surgery, and anticoagulation. Neoplastic and traumatic CVST treatment included anticoagulation. Treatment of CVSTs associated with metabolic abnormalities centered on correction of metabolic derangements, or supplementation where appropriate, and anticoagulation. Autoimmune, congenital, and thrombotic pathway CVSTs were treated with anticoagulation and treatment of the underlying disorder. Unfractionated heparin and low molecular weight heparin were most commonly used and seen to be effective and safe. Uncommonly, endovascular interventions including venous thrombectomy and intravenous injection of thrombolytic therapy were used with varying success. CONCLUSIONS While conservative, medical, thombolytic, endovascular, and surgical treatment all have a role in in the treatment of pediatric CVSTs, anticoagulation is commonly applied and found to be safe and effective in pediatrics. Risks and benefits of anticoagulation must be considered on an individual basis as no randomized trials have established a standard of care. Based on our findings, we propose an approach to CVST treatment and look to future study aimed at more clearly delineating treatment dose, duration, and timing of re-evaluation in these patients.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Anne and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Molly Beestrum
- Department of Library Services, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandi Lam
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Anne and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA.
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Ulanovski D, Shavit SS, Scheuerman O, Sokolov M, Hilly O, Raveh E. Medical and surgical characteristics of fusobacterium necrophorum mastoiditis in children. Int J Pediatr Otorhinolaryngol 2020; 138:110324. [PMID: 32911237 DOI: 10.1016/j.ijporl.2020.110324] [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: 04/29/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate and compare characteristics of Fusobacterium necrophorum mastoiditis (FnM) to characteristics of acute mastoiditis (AM) caused by other bacteria in tertiary children hospital Methods : Children with FnM (N=43) and non FnM (N=88). Assess medical, microbiologic and imaging characteristics, surgical findings and postoperative recovery. RESULTS Children with FnM had a positive history of otitis media, ear discharge and sub-periosteal abscess (p=0.0004, 0.09, 0.0003, respectively) at presentation. Their temperature, WBC and CRP were significantly higher (39.8 vs. 37.9, 19.4K vs. 16.1K, 21 vs. 8.7, p=0.0001). Positive culture was found in 46% of patients; 64% were diagnosed by PCR. CT scan was indicated in 95% and surgical intervention in 93% of children with FnM, compared to 15% and 9.7% of children in the non-FnM group (p=0.0001). Complex post-operative course was frequent for the FnM group: 88% of children had persistent fever, 46% had additional imaging and 14% additional surgical intervention. Children with FnM were treated with IV antibiotics for an average of 22 compared to seven days for non-FnM children (p=0.0001). CONCLUSIONS Fusobacterium should be suspect in a child presenting with AM, a septic appearance, high fever and increased inflammation markers. A regimen of two antibiotics should be empirically started, then proceed to imaging and early surgical intervention. A relatively slow post-operative recovery process should be expected; however, prognosis is good.
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Affiliation(s)
- David Ulanovski
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Stern Shavit
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Meirav Sokolov
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Raveh
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Trapani S, Stivala M, Lasagni D, Rosati A, Indolfi G. Otogenic Lateral Sinovenous Thrombosis in Children: A Case Series from a Single Centre and Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:105184. [PMID: 32912560 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022] Open
Abstract
AIM We aimed to describe otogenic lateral sinovenous thrombosis (OLST), a rare, potentially life-threatening complication of otomastoiditis. METHODS Children diagnosed with OLST in a tertiary-care Hospital from 2014 to 2019 was retrospectively selected. Clinical and radiological features, timing of diagnosis, treatment and outcome are reported. RESULTS Seven children (5 males) were studied. Fever and neurological symptoms (headache, lethargy, diplopia, dizziness and papilledema) were always present. Otalgia and/or otorrhea were found in 6 children; none had signs of mastoiditis. Diagnosis was reached after 7 days (median) from clinical onset. Brain CT-scan was performed in 5 children being diagnostic for 3. Venography-MRI detected OLST and mastoiditis in all cases without parenchymal lesions. Treatment was based on intravenous rehydration, antibiotic and low-molecular weight heparin; acetazolamide was added in 3 children. Mastoidectomy and ventriculoperitoneal-shunting were selectively performed. Patients were discharged after 26 days (median). Follow-up neuroimaging showed sinus recanalization after a median time of 6 months. CONCLUSION A multidisciplinary approach is needed to optimize diagnostic-therapeutic protocols of pediatric OLST.
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Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, Paediatric Unit, Meyer Children's University Hospital, Viale Pieraccini 24, Florence 50139, Italy.
| | - Micol Stivala
- Paediatric Unit, Meyer Children's Hospital, Viale Pieraccini 24, Florence 50139, Italy.
| | - Donatella Lasagni
- Paediatric Unit, Meyer Children's Hospital, Viale Pieraccini 24, Florence 50139, Italy.
| | - Anna Rosati
- Child Neurology Unit, Meyer Children's Hospital, Viale Pieraccini, 24 Florence 50139, Italy.
| | - Giuseppe Indolfi
- Professor NEUROFARBA Department, Meyer Children's Hospital, Viale Pieraccini 24, Florence 50139, Italy.
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16
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Castellazzi ML, di Pietro GM, Gaffuri M, Torretta S, Conte G, Folino F, Aleo S, Bosis S, Marchisio P. Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review. Ital J Pediatr 2020; 46:122. [PMID: 32883359 PMCID: PMC7470606 DOI: 10.1186/s13052-020-00882-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cerebral venous sinus thrombosis in children is a rare but potentially fatal complication of acute mastoiditis, one of the most common pediatric infectious diseases. Due to its subtle clinical presentation, suspicion is essential for a prompt diagnosis and appropriate management. Unfortunately, no standard treatment options are available. To discuss the possible clinical presentation, microbiology, and management, we here report the case of a child with otogenic cerebral venous sinus thrombosis and perform a literature review starting from 2011. Case presentation The child, a 10-months-old male, presented clinical signs of right acute otitis media and mastoiditis. Brain computed tomography scan detected right sigmoid and transverse sinus thrombosis, as well as a subperiosteal abscess. Fusobacterium necrophorum and Haemophilus Influentiae were detected on cultural sampling. A multidisciplinary approach along with a combination of medical and surgical therapy allowed the patient’s full recovery. Conclusion Cerebral venous sinus thrombosis is a rare but severe complication of acute otitis media and mastoiditis. The management of this pathological condition is always challenging and an interdisciplinary approach is frequently required. Current therapeutic options include a combination of medical and surgical therapy. A patient-centered approach should guide timing and treatment management.
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Affiliation(s)
- Massimo Luca Castellazzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Emergency Department, Milan, Italy
| | | | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giorgio Conte
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | | | - Sebastiano Aleo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy.
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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17
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Krishnan M, Walijee H, Jesurasa A, De S, Sinha A, Sharma R, Donne A. Clinical outcomes of intracranial complications secondary to acute mastoiditis: The Alder Hey experience. Int J Pediatr Otorhinolaryngol 2020; 128:109675. [PMID: 31563751 DOI: 10.1016/j.ijporl.2019.109675] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/07/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Acute mastoiditis is the most common intra-temporal complication of acute otitis media. Its management remains a challenge due to potential extracranial and intracranial complications. This study was designed to evaluate the recent experience with acute mastoiditis and its associated intracranial complications at a tertiary paediatric centre. METHODS A retrospective case note review was carried out for patients admitted to Alder Hey Children's Hospital between January 2006 and December 2016 with a diagnosis of acute mastoiditis. Patients were identified using ICD-10 codes H700, H701, H702, H708 and H709. A case note review was performed to identify patients with intracranial complications and data collected. RESULTS 30 patients were identified with intracranial complications of acute mastoiditis, with 18 males and 12 females. The average age was 4 years and 2 months (range 2 months-15 years). The most common presenting complaint was otalgia and vomiting (63%), with only 27% patients presenting with mastoid swelling. 83% of patients were investigated with a combination of CT and MRI scans, 6.7% with CT scans only and 6.7% with MRI scans only. 73% were diagnosed with sinus thrombosis, 40% cerebral abscess and 33% postauricular subperiosteal abscess. 78% of the patients required surgical intervention. 27 of the 30 patients recovered fully with no significant long term sequalae following an average of 50 months follow-up. CONCLUSION Intracranial complications of acute mastoiditis remain a significant challenge. Most patients tend to present without mastoid swelling, necessitating a high index of suspicion in patients with picket fence fever, vomiting, drowsiness, headaches, seizures or cranial nerve involvement. Most cases treated at our institution required acute surgical intervention in addition to adjuvant medical treatment with majority patients recovering fully.
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Affiliation(s)
- Madhan Krishnan
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK.
| | - Hussein Walijee
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Anthony Jesurasa
- Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Su De
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Ajay Sinha
- Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Ravi Sharma
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - Adam Donne
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
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18
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Coudert A, Fanchette J, Regnier G, Delmas J, Truy E, Nicollas R, Akkari M, Couloignier V, Ayari-Khalfallah S. Fusobacterium necrophorum, a major provider of sinus thrombosis in acute mastoiditis: A retrospective multicentre paediatric study. Clin Otolaryngol 2019; 45:182-189. [PMID: 31746543 DOI: 10.1111/coa.13478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/22/2019] [Accepted: 11/09/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate in children the clinical severity and evolution of otogenic lateral sinus thrombosis (OLST) due to Fusobacterium necrophorum compared with other bacterial otogenic thrombosis and propose a specific management flowchart for Fusobacterium OLST. DESIGN A retrospective multicentre cohort study. SETTINGS Four French ENT paediatric departments. PARTICIPANTS A total of 260 under 18 years old admitted for acute mastoiditis were included. Initial imaging was reviewed to focus on complicated mastoiditis and 52 OLST were identified. Children were then divided into two groups according to bacteriological results: 28 in the "OLST Fusobacterium group" and 24 in the "OLST other bacteria group". RESULTS There was a significant association between F necrophorum and OLST (P < .001). When compared to the OLST other bacteria group, children in the OLST Fusobacterium group were significantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation: higher CRP (113 mg/L vs 175.7 mg/L, P = .02) and larger subperiosteal abscess (14 mm vs 21 mm, P < .01). Medical management was also more intensive in the OLST Fusobacterium group than in the OLST other bacteria group: increased number of conservative surgeries (66.7% vs 92.9%, P = .03) and longer hospital stay (13.7 days vs 19.8 days, P = .02). At the end of follow-up, the clinical course was good in both groups without any neurological sequelae. CONCLUSIONS Thrombotic complications are very frequent in case of Fusobacterium mastoiditis and clinicians should be aware of the initial severity of the clinical presentation. Under appropriate management, the clinical course of Fusobacterium OLST is as good as that of other bacterial otogenic thrombosis.
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Affiliation(s)
- Aurélie Coudert
- Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France
| | - Julia Fanchette
- Service d'ORL Pédiatrique, Hôpital Necker, Centre Hospitalier et Universitaire, Paris, France
| | - Gaëlle Regnier
- Service d'ORL Pédiatrique, Hôpital Gui de Chauliac, Centre Hospitalier et Universitaire, Montpellier, France
| | - Justine Delmas
- Service d'ORL Pédiatrique, Hôpital de la Timone, Centre Hospitalier et Universitaire, Marseille, France
| | - Eric Truy
- Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France
| | - Richard Nicollas
- Service d'ORL Pédiatrique, Hôpital de la Timone, Centre Hospitalier et Universitaire, Marseille, France
| | - Mohamed Akkari
- Service d'ORL Pédiatrique, Hôpital Gui de Chauliac, Centre Hospitalier et Universitaire, Montpellier, France
| | - Vincent Couloignier
- Service d'ORL Pédiatrique, Hôpital Necker, Centre Hospitalier et Universitaire, Paris, France
| | - Sonia Ayari-Khalfallah
- Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France
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19
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Otogenic lateral sinus thrombosis in children: proposal of an experience-based treatment flowchart. Eur Arch Otorhinolaryngol 2018; 275:1971-1977. [PMID: 29948264 DOI: 10.1007/s00405-018-5033-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/05/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE To describe the prevalent clinical, laboratory, and radiological features of otogenic lateral sinus thrombosis (OLST) in children; to identify clinical predictors of outcome; to propose a management algorithm derived from experience. METHODS A retrospective review was conducted of the clinical records of patients with OLST, treated in a single tertiary care referral center for pediatric disease from 2006 to 2017. The inclusion criteria were pediatric age (0-16 years) and OLST diagnosis confirmed by a pre- and post-contrast CT or venography-MRI scan. Primary outcome measures were early (1-2 months) and late (6 months) sinus recanalization assessed by means of neuroimaging. RESULTS Twenty-five patients (8 females and 17 males; mean age = 6 ± 3 years) were included. A genetic abnormality associated with thrombophilia was found in 24 (96%) patients. At diagnosis, anticoagulant treatment with low-molecular-weight heparin (LMWH) was started in all subjects, while surgical treatment (mastoidectomy and tympanostomy tube insertion) was performed in 16/25 (64%) patients. Follow-up neuroimaging showed lateral sinus recanalization in 12/25 (48%) patients after 1-2 months and in 17/25 (68%) after 6 months. At multivariate logistic regression analysis, no significant predictors of the early and late neuroradiological outcome were found. CONCLUSIONS All children with OLST should be screened for thrombophilia to decide on treatment duration and to assess the need for future antithrombotic prophylaxis. Immediately after diagnosis, anticoagulant treatment with LMWH should be started according to the international guidelines. Instead, our experience suggests that surgical treatment should not be indicated in all patients, but decided on a case-to-case basis.
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20
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Abstract
PURPOSE OF REVIEW The aim of this study is to discuss the symptoms, diagnosis, and management of the neurologic complications of acute and chronic otitis media. RECENT FINDINGS Antibiotic therapy has greatly reduced the frequency of complications of otitis media. However, it is of vital importance to remain aware of the possible development of neurologic complications. There is a trend toward less severe presenting symptoms including otorrhea, headache, nausea, and fever, with altered mental status and focal neurologic deficits presenting later. In order to reduce morbidity, early deployment of a multidisciplinary approach with prompt imaging and laboratory studies is imperative to guide appropriate management. Complications of acute and chronic otitis media may present with neurologic signs and symptoms. It is important to recognize the possible otitic origin of such complications to ensure proper management and to decrease overall morbidity and mortality.
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Affiliation(s)
- Michael J Hutz
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA.
| | - Dennis M Moore
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
- Division of Otolaryngology - Head and Neck Surgery, Hines VA Medical Center, Hines, IL, USA
| | - Andrew J Hotaling
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
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21
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Scherer A, Jea A. Pediatric Otogenic Sigmoid Sinus Thrombosis: Case Report and Literature Reappraisal. Glob Pediatr Health 2017; 4:2333794X17738837. [PMID: 29147674 PMCID: PMC5672986 DOI: 10.1177/2333794x17738837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to review our experience with a single case of mastoiditis associated with sigmoid sinus thrombosis and increased intracranial pressure, and to review the experience of others through prior publications. We reviewed a case of a 6-year-old boy with an acute otitis media and mastoiditis, with associated ipsilateral sigmoid sinus and contralateral distal transverse sinus thrombosis. Based on the literature and our own experience, we conclude that most children with dural sinus thrombosis from acute otitis media and mastoiditis, in the setting of increased intracranial pressure, attain a good neurological outcome with a conservative neurosurgical approach. The mainstay of treatment seems to be appropriate antibiotic coverage and anticoagulation. Surgeries such as external ventricular drain, serial lumbar punctures, intracranial pressure monitor, and endovascular thrombectomy are reserved for patients with neurological deterioration despite maximal medical treatment.
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Affiliation(s)
- Andrea Scherer
- Riley Hospital for Children, Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA.,Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | - Andrew Jea
- Riley Hospital for Children, Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA.,Goodman Campbell Brain and Spine, Indianapolis, IN, USA
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22
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Schilder AGM, Marom T, Bhutta MF, Casselbrant ML, Coates H, Gisselsson-Solén M, Hall AJ, Marchisio P, Ruohola A, Venekamp RP, Mandel EM. Panel 7: Otitis Media: Treatment and Complications. Otolaryngol Head Neck Surg 2017; 156:S88-S105. [PMID: 28372534 DOI: 10.1177/0194599816633697] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
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Affiliation(s)
- Anne G M Schilder
- 1 evidENT, Ear Institute, University College London, London, United Kingdom.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tal Marom
- 3 Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Mahmood F Bhutta
- 4 Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Margaretha L Casselbrant
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harvey Coates
- 6 Department of Otolaryngology, School of Paediatrics and Child Health, The University of Western Australia, Nedlands, WA, Australia
| | - Marie Gisselsson-Solén
- 7 Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Amanda J Hall
- 8 University Hospitals Bristol NHS Foundation Trust and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Paola Marchisio
- 9 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aino Ruohola
- 10 Department of Pediatrics, University of Turku, Turku, Finland
| | - Roderick P Venekamp
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen M Mandel
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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23
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Wong BYW, Hickman S, Richards M, Jassar P, Wilson T. Management of paediatric otogenic cerebral venous sinus thrombosis: a systematic review. Clin Otolaryngol 2016; 40:704-14. [PMID: 26769686 DOI: 10.1111/coa.12504] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Otogenic paediatric cerebral venous sinus thrombosis (CVST) is rare but has potential clinical sequelae. Its management has long been debated mainly concerning the role of surgery and the use of anticoagulant therapy. OBJECTIVE OF REVIEW To review the current literature and examine the medical and surgical management of paediatric otogenic CVST and its clinical and radiological outcome. TYPE OF REVIEW Systematic review. SEARCH STRATEGY The electronic databases (MEDLINE, EMBASE, Cochrane) were searched from inception to November 2014 using text words 'cerebral venous sinus thrombosis OR cerebral venous thrombosis OR lateral sinus thrombosis OR sigmoid sinus thrombosis' AND 'otogenic OR mastoiditis OR otitis media' AND 'children OR paediatric OR pediatric'. EVALUATION METHOD Inclusion criteria were applied by two reviewers and data extraction was carried out. The type of otological surgery (conservative versus extensive) and the use of anticoagulants with their clinical and radiological outcomes were tabulated. RESULTS Thirty-six studies (15 case reports and 21 case series) were included with a total of 190 patients. A total of 92.1% of patients underwent otological surgery, and 69.5% had conservative surgery and 30.5% extensive otological surgery. Anticoagulants were used in 59%. A total of 79.2% of patients were reported to have had a good clinical outcome. Within this group, 56% had conservative surgery and anticoagulants. Follow-up scans were documented in 61.6% of patients and complete recanalisation was observed in 51%. Complete recanalisation was observed in 47% of those who had been anticoagulated and 55% of those who received no anticoagulation. CONCLUSIONS Conservative otological surgery with the combination of anticoagulation was the most common treatment modality found in the group of patients with good clinical outcome. However, given the current low level of evidence, a multicentre collaborative study is needed to help establish the optimum surgical approach and the role of anticoagulation in managing paediatric otogenic CVST.
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Affiliation(s)
- B Y W Wong
- Department of ENT, Pinderfields General Hospital, Wakefield, UK
| | - S Hickman
- Department of ENT, Pinderfields General Hospital, Wakefield, UK
| | - M Richards
- Department of Paediatric Haematology, Leeds Children Hospital, Leeds, UK
| | - P Jassar
- Department of ENT, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - T Wilson
- Department of ENT, Leeds General Infirmary, Leeds, UK
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24
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Roche JP, Hansen MR. The role of anticoagulation in the management of pediatric temporal bone septic thrombophlebitis. Laryngoscope 2015; 126:1027-8. [PMID: 26666669 DOI: 10.1002/lary.25755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Joseph P Roche
- Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Carver College of Medicine, Iowa City, Iowa, U.S.A.,Department of Neurosurgery, The University of Iowa Carver College of Medicine, Iowa City, Iowa, U.S.A
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