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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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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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Shrestha IB, Pokharel M, Dhakal A, Mishra A. Pediatric Acute Mastoiditis: Our Experience in a Tertiary Care Center. Cureus 2021; 13:e15052. [PMID: 34141502 PMCID: PMC8204207 DOI: 10.7759/cureus.15052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Acute mastoiditis (AM) is a common intra-temporal complication of acute otitis media (AOM) and is more commonly seen in children. Occasionally, it presents as the first sign of ear disease. This study aimed to evaluate the clinical course of AM and determine therapeutic options for pediatric patients presenting with AM. Methods This was a prospective, observational study conducted on patients with AM presenting at a tertiary center during one year period. Convenience sampling was employed and 79 pediatric patients (18 years or below) were recruited for the study. Data on the demographic profile of patients, the treatment offered, duration of hospital stay, and outcome were analyzed. Result In our study, 62% were male patients (n = 49) and 38% (n = 30) were females. The mean age of patients was 9.32 ± 5.3 years and a history of AOM was present in 60 (75.9%). On admission, the most common presentation was post-auricular inflammation (100%) followed by otalgia (79.7%), fever (59.5%), aural protrusion (54.4%), and otorrhoea (51.9%). Culture reports were available for 54 (68.4%) patients and 30 (38%) grew organisms. The cultured organisms were Streptococcus pneumonia (20.3%), Pseudomonas aeruginosa (10.1%), Streptococcus pyogenes (3.8%), and Staphylococcus aureus (3.8%). Most patients were managed conservatively (n = 66, 83.5%) whereas surgery was performed in 16.5% (n = 13) patients. The mean hospital stay was 5.58 ± 1.99 days. The need for surgical management was significantly associated with age >5 years (p = 0.006), history of AOM (p = 0.026) and the presence of complications (p = 0.012). Subperiosteal abscess (SA) was present in 21 (26.6%) patients and one had facial palsy. SA along with AM had a mean hospital stay of 8.5 ± 0.77 days compared to 4.94 ± 1.43 days in case of isolated AM (p < 0.001) and the mean age of presentation in SA with AM was 11.97 ± 5.13 years compared to 8.29 ± 5.14 years in case of isolated AM (p = 0.006). All patients recovered and were followed up to three months with no recurrence, complications, or sequelae. Conclusion Most of the cases of acute mastoiditis follow previous AOM episodes. With early recognition and effective treatment, the prognosis is good.
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Affiliation(s)
- Inku B Shrestha
- Department of Ear, Nose and Throat - Head and Neck Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, NPL
| | - Monika Pokharel
- Department of Ear, Nose and Throat - Head and Neck Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, NPL
| | - Ashish Dhakal
- Department of Ear, Nose and Throat - Head and Neck Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, NPL
| | - Aakash Mishra
- Department of Ear, Nose and Throat - Head and Neck Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, NPL
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The National Landscape of Acute Mastoiditis: Analysis of the Nationwide Readmissions Database. Otol Neurotol 2020; 41:1084-1093. [PMID: 32569137 DOI: 10.1097/mao.0000000000002745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine risk factors for readmission, prolonged length of stay, and discharge to a rehabilitation facility in patients with acute mastoiditis. Trends in treatment and complication rates were also examined. STUDY DESIGN Retrospective cohort study. SETTING Nationwide Readmissions Database (2013, 2014). PATIENTS Pediatric and adult patients in the Nationwide Readmissions Database with a primary diagnosis of acute mastoiditis. INTERVENTIONS Medical treatment, surgical intervention. OUTCOME MEASURES Rates of and risk factors for readmission, prolonged length of stay, and discharge to a rehabilitation facility. Procedure and complication rates were also examined. RESULTS Four thousand two hundred ninety-five pediatric and adult admissions for acute mastoiditis were analyzed. The overall rates of readmission, prolonged length of stay, and discharge to a rehabilitation facility were 17.0, 10.4, and 10.2%, respectively. Children 4 to 17 years of age had the highest rates of intracranial complications, and children ≤3 years were most likely to undergo operative intervention. Any procedure was performed in 31.2% of cases, and undergoing myringotomy or mastoidectomy was associated with lower rates of readmission but higher rates of prolonged length of stay. Those with intracranial complications and subperiosteal abscesses had the highest surgical intervention rates. CONCLUSIONS Readmission, prolonged length of stay, and discharge to a rehabilitation facility are common in patients with acute mastoiditis with various sociodemographic and disease-related risk factors. While once a primarily surgical disease, a minority of patients in our cohort underwent procedures. Undergoing a surgical procedure was protective against readmission but a risk factor for prolonged length of stay.
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Fernandez IJ, Crocetta FM, Pelligra I, Burgio L, Demattè M. Clinical features and management of Luc's abscess: Case report and systematic review of the literature. Auris Nasus Larynx 2019; 47:173-180. [PMID: 31812444 DOI: 10.1016/j.anl.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/10/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Luc's abscess is a rare complication of acute otitis media, with a challenging diagnosis and a controversial surgical treatment. The aim of the present study was to review the published literature in order to clarify the clinical features and the surgical management of those patients. METHODS A systematic review of the literature was carried out for published reports or case series in English language, describing a temporo-zygomatic (or Luc's) abscess which complicated an acute or chronic otitis media and/or mastoiditis, confirmed through CT scan or MRI of the petrous bone. The collected clinical and radiological data were merged and critically appraised. RESULTS Eighteen reports of Luc's abscess were included. Adding our case report, a total of 21 cases were included in the analysis. Abscess drainage plus myringotomy alone vs. abscess drainage plus myringotomy and mastoidectomy were the two surgical management approaches described in the literature. Patients undergoing first line mastoidectomy were successfully treated in all cases, while among those undergoing a more conservative approach, one failure required subsequent mastoidectomy. CONCLUSIONS The clinical features of Luc's abscess are rather constant and help in rising the suspicion before the radiological diagnosis. Although cases with associated intra-cranic complications have been reported, the limited existing data do not permit to advocate the mastoidectomy over a more conservative surgical approach. However, the decision to avoid mastoidectomy as the first line surgical treatment should be based on the clinical and radiologic assessment, after an accurate counseling, particularly in the case of a pediatric patient.
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Affiliation(s)
- Ignacio Javier Fernandez
- Otolaryngology Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy.
| | - Francesco Maria Crocetta
- Otolaryngology Head and Neck Surgery Department, University Hospital of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Irene Pelligra
- Otolaryngology Head and Neck Surgery Department, University Hospital of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Luca Burgio
- Otolaryngology Head and Neck Surgery Department, University Hospital of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Marco Demattè
- Otolaryngology Head and Neck Surgery Department, University Hospital of Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Stern Shavit S, Raveh E, Levi L, Sokolov M, Ulanovski D. Surgical intervention for acute mastoiditis: 10 years experience in a tertiary children hospital. Eur Arch Otorhinolaryngol 2019; 276:3051-3056. [DOI: 10.1007/s00405-019-05606-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/16/2019] [Indexed: 01/20/2023]
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Management of Acute Mastoiditis With Immediate Needle Aspiration for Subperiosteal Abscess. Otol Neurotol 2019; 40:e612-e618. [DOI: 10.1097/mao.0000000000002231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Crowson MG, Cheng J. Safety and postoperative adverse events in management of acute mastoiditis in children - 30 Day NSQIP outcomes. Int J Pediatr Otorhinolaryngol 2018; 108:132-136. [PMID: 29605342 DOI: 10.1016/j.ijporl.2018.02.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine preoperative risk factors, postoperative 30-day outcomes and adverse events of acute mastoiditis using a national pediatric surgical database. METHODS We explored our objectives using a cross-sectional analysis of a hospital-based reporting system database. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) pediatric database was used to identify surgical encounters for the treatment of acute mastoiditis from 2012 to 2015. Patient demographics, co-morbidities, laboratory values, surgical details, complications, and outcomes were tabulated. Linear regression was used to determine predictors of prolonged hospital stay based on pre-operative, surgical and outcome variables. RESULTS 113 patients with acute mastoiditis were identified from with mean age of 7.8 years. Mastoidectomy was the most common index procedure performed (44; 34%). Average hospital stay length was 5.2 days. No patients died within 30 days. 4 (3.1%) patients required readmission, and 9 (6.9%) required unplanned subsequent operative procedures. Pre-operative presence of sepsis or systemic inflammatory response syndrome (SIRS; p = 0.03), and unplanned additional procedures were associated with a prolonged hospital stay (p = 0.03), but age, gender, race, and pre-operative morbidities were not (p > 0.05). CONCLUSIONS Contemporary surgical management of acute mastoiditis in children appears to be safe. Mortality is rare and has been potentially eliminated as a complication. Rates of pre-operative systemic infection were very high, despite current antibiotic utilization trends. Opportunities for quality improvement exist to investigate how to decrease rates of preoperative sepsis, limit readmissions, and unplanned re-operations. The role of mastoidectomy appears prominent, as it was used in about two-thirds of cases. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Matthew G Crowson
- Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Jeffrey Cheng
- Pediatric Otolaryngology, Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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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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Do TN, Linabery AM, Patterson RJ, Tu A. Cranial Rhabdomyosarcoma Masquerading as Infectious Mastoiditis: Case Report and Literature Review. Pediatr Neurosurg 2018; 53:317-321. [PMID: 30145587 DOI: 10.1159/000490729] [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: 04/10/2018] [Accepted: 06/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rhabdomyosarcoma originating in the mastoid is rare and may be misdiagnosed as an infectious mastoiditis due to overlapping clinical and imaging features. We aimed to identify distinguishing characteristics to facilitate earlier diagnosis and treatment. METHOD Here we describe a case report and a systematic review of 23 reports describing previous cases of mastoid rhabdomyosarcoma. We compare these patients to a systematic review of patients with infectious mastoiditis and identify distinguishing clinical features. RESULTS A total of 43 patients with rhabdomyosarcoma of the mastoid were identified and compared with patients with mastoiditis. Rhabdomyosarcoma patients were more likely to present with a mass (86%) or cranial nerve dysfunction (83.7%), while mastoiditis patients were more likely to have fever (72.4%), pain (48.2%), and present at a younger age (4.4 vs. 6.1 years). The average lifespan with rhabdomyosarcoma of the mastoid was 7.1 months after diagnosis, with 41.7% of patients alive at the time of report. CONCLUSIONS Based on abstracted and aggregated information, we identified unique features observed more frequently in each of rhabdomyosarcoma and mastoiditis. These predictive features allow for the differentiation of each diagnosis and avoid the delay of proper treatment.
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Affiliation(s)
- Thao N Do
- Children's Minnesota, St. Paul, Minnesota, USA
| | - Amy M Linabery
- Children's Minnesota Research Institute, Minneapolis, Minnesota, USA
| | | | - Albert Tu
- Department of Neurosurgery, Children's Minnesota, St. Paul, Minnesota, USA
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Management of paediatric acute mastoiditis: systematic review. The Journal of Laryngology & Otology 2017; 132:96-104. [DOI: 10.1017/s0022215117001840] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Acute mastoiditis remains the commonest intratemporal complication of otitis media in the paediatric population. There has been a lack of consensus regarding the diagnosis and management of acute mastoiditis, resulting in considerable disparity in conservative and surgical management.Objectives:To review the current literature, proposing recommendations for the management of paediatric acute mastoiditis and appraising the treatment outcomes.Method:A systematic review was conducted using PubMed, Web of Science and Cochrane Library databases.Results:Twenty-one studies were included, with a total of 564 patients. Cure rates of medical treatment, conservative surgery and mastoidectomy were 95.9 per cent, 96.3 per cent and 89.1 per cent, respectively.Conclusion:Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy may be an appropriate first-line management when treating acute mastoiditis.
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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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