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陈 敏, 刘 薇, 杨 扬, 郝 津, 邵 剑, 李 蓓, 郑 军, 张 杰. [Surgical methods of cerebrospinal fluid otorhinorrhea due to inner ear malformation in children]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:788-792. [PMID: 36217660 PMCID: PMC10128563 DOI: 10.13201/j.issn.2096-7993.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Indexed: 06/16/2023]
Abstract
Objective:To discuss the application of two surgical methods, trans-mastoid approach and trans-canal endoscopic approach, in the treatment of CerebroSpinal Fluid(CSF) otorhinorrhea due to inner ear malformation(IEM) in children. Methods:Children with CSF otorhinorrhea due to IEM, from July 2015 to Jan 2021, in ENT department, Beijing Children's Hospital were retrospectively analyzed, and the clinical data, surgical methods, complications, recurrence and follow-up were recorded. Results:30 children with CSF otorhinorrhea due to IEM were included. Half of them had a history of otorhinorrhea, and 53.3% of them were diagnosed as cerebrospinal fluid(CSF) otorrhea at the first onset Unilateral and bilateral IEM were 22 cases and 8 cases respectively. All unilateral IEM children had secondary infections such as meningitis or/and pneumonia, and 9.1% had cochlear implantation(CI) due to deafness after meningitis. 87.5% bilateral IEM children had CI due to profound/severe hearing loss. 96.7% CSF otorhinorrhea were unilateral, there was no relationship between CSF otorhinorrhea and the malformation side or the time of CI surgery. Trans-mastoid approach was used in 14 cases, usually involving CI or other operations; and endoscopic approach in 16 cases. The age of trans-mastoid group was younger than that of endoscopic group. No recurrence and complications occured in the trans-mastoid group. In the endoscopic group, 2 cases recurred; 3 cases had complications(2 with temporary facial paralysis and 1 with labyrinth and intracranial pneumatosis). Except one case lost, the others were followed up for 1.2-6.7 years, and no recurrence of pneumonia, meningitis and CSF otorhinorrhea happened. Conclusion:Unilateral IEM usually leads to meningitis or/and pneumonia, and bilateral IEM requires CI. Both trans-mastoid and trans-canal endoscopic approach were effective for CSF otorrhea repair. Trans-mastoid approach is suitable for those who need mastoid exploration, CI or combined with other operations. Trans-canal endoscopic approach was choosed when fistula was confined to the tympanum and ear canal diameter was wide enough.
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Affiliation(s)
- 敏 陈
- 首都医科大学北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 薇 刘
- 首都医科大学北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 扬 杨
- 首都医科大学北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 津生 郝
- 首都医科大学北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 剑波 邵
- 首都医科大学北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 蓓 李
- 首都医科大学北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 军 郑
- 首都医科大学北京同仁医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University
| | - 杰 张
- 首都医科大学北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
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Manara R, Avato I, Uberti A, Trevisi P, Bovo R, Martini A, Brotto D, Berettini S, Canzi P, Ciorba A, Cristofari E, Cuda D, Della Volpe A, Frau GN, Genovese E, Marsella P, Murri A, Sorrentino F, Vincenti V, Zanetti D. Bulging of the Oval Window in Common Cavity Deformity: A Possible Predictor of Meningitis. Otol Neurotol 2022; 43:101-104. [PMID: 34699400 DOI: 10.1097/mao.0000000000003394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prevalence-rate of oval window bulging in the common cavity and its association with bacterial meningitis. PATIENTS CT and clinical files of 29 children with preliminary diagnosis of common cavity deformity were collected from 13 Italian centers. INTERVENTION A retrospective case review study was conducted with a centralized evaluation of the temporal bone CT imaging was performed at Azienda Ospedale - Università Padova, Padova, Italy. MAIN OUTCOME MEASURE Diagnosis of common cavity was reviewed; in addition, a fluid protrusion into the middle-ear cavity through the oval window at CT imaging was considered as oval window bulging. Its association with the history of bacterial meningitis was investigated. RESULTS Common cavity deformity was confirmed in 14/29 children (mean-age 11.4 ± 3.8; age-range 5-20; nine females) referred with this diagnosis. In 7/14 patients, the common cavity deformity was bilateral (i.e., 21 common cavities). Oval window bulging was found in 3/19 common cavities (concomitant middle-ear effusive otitis hampered the evaluation in two cases), while the internal acoustic meatus fundus was defective in 10/21 cases. History of bacterial meningitis was found in three children (21%) and two of them had oval window bulging at CT. In the case unrelated to oval window bulging, meningitis occurred late at the age of 12 during acute otitis contralateral to common cavity deformity (ipsilaterally to incomplete partition type 1). CONCLUSION Patients harboring common cavity deformity have a high risk of meningitis in their first years of life. Oval window bulging seems to be associated with a higher risk of meningitis. This information might be important for appropriate surgical planning.
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Affiliation(s)
- Renzo Manara
- Neuroradiology Unit, Department of Neurosciences, University of Padova, Padova
| | - Irene Avato
- Experimental Medicine, University of Pavia, Pavia, Italy
| | - Andrea Uberti
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Patrizia Trevisi
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Roberto Bovo
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Alessandro Martini
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Davide Brotto
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | | | - Pietro Canzi
- Department of Otorhinolaryngology, University of Pavia, Pavia
| | - Andrea Ciorba
- ENT Department, University Hospital of Ferrara, Ferrara
| | | | | | | | | | - Elisabetta Genovese
- Department of Diagnostic, Clinical and Public Health, University of Modena and Reggio Emilia, Modena
| | - Pasquale Marsella
- Audiology and Otosurgery Unit, "Bambino Gesù" Pediatric Hospital, Rome
- University of Parma
| | | | - Flavia Sorrentino
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Vincenzo Vincenti
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Parma; and Unit of Surgical Pathology, University of Parma, Parma
| | - Diego Zanetti
- Audiology Unit, Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Predisposing conditions for bacterial meningitis in children: what radiologists need to know. Jpn J Radiol 2021; 40:1-18. [PMID: 34432172 PMCID: PMC8732808 DOI: 10.1007/s11604-021-01191-9] [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] [Received: 07/07/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
A variety of underlying diseases can predispose infants and children to bacterial meningitis (BM). For the diagnosis, treatment, and prevention of its recurrence, radiologists should be familiar with its predisposing conditions so that they can suggest the appropriate imaging approach. Predisposing conditions of BM can be broadly classified into two categories: infection spread from the adjacent tissue to the cerebrospinal fluid (CSF) space and immunodeficiency. Diseases in the former category are further divided according to regardless of whether there is a structural defect between the CSF space and the adjacent tissue. When a structural defect is suspected in a patient with BM, computed tomography (CT) of the head and magnetic resonance (MR) imaging are first-line imaging examinations. Radionuclide cisternography should be implemented as a second-line step to identify the CSF leak site. In patients with suspected parameningeal infection without any structural defect, such as sinusitis or otitis media/mastoiditis, CT or MR images can identify not only the disease itself but also the associated intracranial complications. The purpose of this article is to discuss the diagnostic approach and imaging findings associated with the variety of conditions predisposing patients to recurrent BM, focusing on the role of radiology in their management.
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Chen TM, Chen HY, Hu B, Hu HL, Guo X, Guo LY, Li SY, Liu G. Characteristics of Pediatric Recurrent Bacterial Meningitis in Beijing Children's Hospital, 2006-2019. J Pediatric Infect Dis Soc 2021; 10:635-640. [PMID: 33491083 DOI: 10.1093/jpids/piaa176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/01/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Few data on recurrent bacterial meningitis (RBM) in children are available. Here, we estimated the frequency of RBM in children and investigated the predisposing conditions, etiology, and clinical characteristics of RBM in children. METHODS Cases of RBM in the Beijing Children's Hospital medical record database between January 2006 and December 2019 were collected. RESULTS In total, 1905 children with bacterial meningitis (BM) were documented in the Beijing Children's Hospital medical record database. A total of 43 patients had RBM. The rate of RBM in children was 2.3% (43/1905). Forty (93.0%) patients had predisposing conditions, including 15 (34.9%) cases of inner ear malformations, 5 (11.6%) cases of dermal sinus tracts, 9 (20.9%) cases of head injury, 5 (11.6%) cases of congenital cranial meningocele, 3 (7.0%) cases of congenital skull base defects, 3 (7.0%) cases of immunodeficiency, and other 3 (7.0%) cases of unknown reason. Among all the 121 BM episodes, a total of 64 episodes were etiologically confirmed BM and the other 57 episodes were probable BM. Streptococcus pneumoniae (n = 52) was accounted for 81.3% of confirmed BM episodes. Thirty-four of the 37 patients with congenital or acquired anatomical defects were available to follow up after surgeries, and all of them had no BM after surgeries. Three patients with antibody deficiencies got intravenous immunoglobulin therapy and they did not suffer BM anymore. CONCLUSIONS RBM is rare in children. The majority of children with RBM had predisposing conditions including congenital/acquired anatomical defects and immunodeficiency. Interventions should be implemented to solve the underlying conditions to avoid RBM.
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Affiliation(s)
- Tian-Ming Chen
- Department of Infectious Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - He-Ying Chen
- Department of Infectious Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Bing Hu
- Department of Infectious Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hui-Li Hu
- Department of Infectious Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xin Guo
- Department of Infectious Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Ling-Yun Guo
- Department of Infectious Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shao-Ying Li
- Department of Infectious Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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Orzan E, Pizzamiglio G, Gregori M, Marchi R, Torelli L, Muzzi E. Correlation of cochlear aperture stenosis with cochlear nerve deficiency in congenital unilateral hearing loss and prognostic relevance for cochlear implantation. Sci Rep 2021; 11:3338. [PMID: 33558599 PMCID: PMC7870947 DOI: 10.1038/s41598-021-82818-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
The use of neonatal hearing screening has enabled the identification of congenital unilateral sensorineural hearing loss (USNHL) immediately after birth, and today there are several intervention options available to minimize potential adverse effects of this disease, including cochlear implantation. This study aims to analyze the characteristics of the inner ear of a homogeneous group of congenital non-syndromic USNHL to highlight the features of the inner ear, which can help in clinical, surgical, and rehabilitative decision-making. A retrospective chart review was carried out at a tertiary referral center. Systematic diagnostic work-up and rigorous inclusion-exclusion criteria were applied to 126 children with unilateral hearing impairment, leading to a selection of 39 strictly congenital and non-syndromic USNHL cases, undergoing computed tomography (CT) and magnetic resonance (MR) imaging studies. The frequency and type of malformations of the inner ear in USNHL and unaffected contralateral ears were assessed, with an in-depth analysis of the deficiency of the cochlear nerve (CND), the internal auditory canal (IAC) and the cochlear aperture (CA). Inner ear anomalies were found in 18 out of 39 (46%) of the USNHL patients. In 1 subject, the anomalies were bilateral, and the CND resulted in the predominant identified defect (78% of our abnormal case series), frequently associated with CA stenosis. Only 3 out of 14 children with CND presented stenosis of the IAC. CND and CA stenosis (and to a much lesser extent IAC stenosis) are a frequent association within congenital and non-syndromic USNHL that could represent a distinct pathological entity affecting otherwise healthy infants. In the context of a diagnostic work-up, the evaluation with CT and MRI measurements should take place in a shared decision-making setting with thorough counseling. Both imaging techniques have proven useful in differentiating the cases that will most likely benefit from the cochlear implant, from those with potentially poor implant performance.
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Affiliation(s)
- Eva Orzan
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Pizzamiglio
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
| | - Massimo Gregori
- Radiology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Raffaella Marchi
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Lucio Torelli
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Enrico Muzzi
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Sennaroglu L, Bajin MD. Management of stapes footplate fistula in inner ear malformations. Int J Pediatr Otorhinolaryngol 2021; 140:110525. [PMID: 33264678 DOI: 10.1016/j.ijporl.2020.110525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Certain inner ear malformations have stapes footplate fistula which may cause meningitis during otitis media. This may result in fatality. It is the responsibility of the otolaryngologist to diagnose and treat the condition to prevent further attacks of meningitis. MATERIALS AND METHODS Surgical findings of the 17 patients who have inner ear malformations with oval window fistula were retrospectively analyzed. Inner ear malformations were classified according to Sennaroglu classification. Different stages of stapes footplate fistula are classified. FINDINGS Seventeen patients had spontaneous stapes footplate fistula at the oval window. No patient had spontaneous leakage at the round window site. Proper sealing of the leakage area with fascia in a dumbbell fashion is mandatory. Keeping the stapes in place and lumbar drainage are the two most important factors in the successful management of fistula. Particularly important is the simultaneous fistula repair and cochlear implantation where combined postauricular-transcanal approach provides the best method. Vaccination is important but not sufficient to prevent meningitis in inner ear malformations unless repair of the fistula is performed. CONCLUSION If the patient has a history of meningitis in the presence of inner ear malformation, particular attention should be given to oval window area to look for an opacity, cyst or a leaking lesion at the stapes footplate. Immediate surgical exploration and repair of the leak is mandatory to prevent further attacks of meningitis. Surgeon should not leave the operation without fully controlling the leak.
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Affiliation(s)
- Levent Sennaroglu
- Department of Otolaryngology, Hacettepe University Medical Faculty, Turkey.
| | - Munir Demir Bajin
- Department of Otolaryngology, Hacettepe University Medical Faculty, Turkey
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Deng W, Liu J, Pang F, Zhang X. Diagnosis and management of pediatric cerebrospinal fluid leakage secondary to inner ear malformations: A report of 13 cases. Int J Pediatr Otorhinolaryngol 2020; 135:110049. [PMID: 32497907 DOI: 10.1016/j.ijporl.2020.110049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Inner ear malformations (IEM) with cerebrospinal fluid (CSF) leakage in children is a rare condition, nevertheless, it may lead to meningitis. Early diagnosis and treatment are crucial. The aims of the study were to summarize the clinical characteristic of pediatric CSF leakage secondary to IEM, and to recommend transcanal endoscopic ear surgery (TEES) as an effective surgical technique for the treatment of CSF leakage with IEM in children. METHODS This was a retrospective study. Thirteen children and fourteen ear surgery were included. Demographics, detail history, laboratory data, Audio test, and imageological examination results were recorded. All the pediatric patients underwent TEES. RESULTS Most (92.31%) of the children presented with a history of rhinorrhea. 69.23% (9/13) of the children had suffered from meningitis, and the other had presented with respiratory tract infections. The follow-up duration ranged from 0.75 years to 5.29 years. Transcanal endoscopic repair of CSF leakage secondary to IEM was the first surgery with a success rate of 92.86% (13 out of 14 cases). A fistula could be found in the stapes footplate in all pediatric patients. CONCLUSION Even if there has been no history of meningitis, the diagnosis of CSF leakage in children suffering from unilateral rhinorrhea and recurrent respiratory tract infection is considered. Auditory brainstem response (ABR) and Temporal bone computed tomography (CT) examinations are suggested to identify IEM. The TEES procedure is recommended in our study as the first choice that repairs CSF leakage secondary to IEM.
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Affiliation(s)
- Wenmin Deng
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Jie Liu
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Feng Pang
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Xiangmin Zhang
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
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Zwierz A, Masna K, Burduk P. Recurrent Meningitis in Congenital Inner Ear Malformation. EAR, NOSE & THROAT JOURNAL 2020; 100:38S-41S. [PMID: 32320299 DOI: 10.1177/0145561320920399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous cerebrospinal fluid otorrhea is very rare. Because of nonspecific symptoms, it is usually diagnosed when complications such as meningitis occur. Cerebrospinal fluid leak may be caused by cochlea malformation, which permits nonphysiological communication between subarachnoid space and tympanomastoid cavity. Nearly 20% of congenital sensorineural hearing loss is connected with inner ear bone malformation. We present a case of 40-year-old man suffering since early childhood from recurrent meningitis and right ear deafness, caused by congenital internal ear malformation. For many years, patient with sensorineural hearing loss had not undergone diagnostic radiology; computed tomography scans of the temporal bone had not been performed. Developing meningitis in early childhood was regarded as the reason for deafness.
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Affiliation(s)
- Aleksander Zwierz
- Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Faculty of Health Sciences, 49604Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland.,Department of Phoniatry and Audiology, Faculty of Health Sciences, 49604Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
| | - Krystyna Masna
- Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Faculty of Health Sciences, 49604Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Faculty of Health Sciences, 49604Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
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Abstract
BACKGROUND Pneumococcal meningitis (PM) is a serious disease that can rarely recur at a later time after the initial episode. METHODS A retrospective multicenter case-control study was conducted with data for children 18 years of age or younger obtained from the National Observatory of Bacterial Meningitis in Children between January 2001 and September 2015. Cases were all patients with RPM. Each case was matched with 2 randomized controls with a single PM episode in the year of the first episode of PM in the case and born the same year. Case and control data were compared. RESULTS Among the 1634 PM episodes in children 18 years of age or younger, 24 (1.5%) children had RPM. RPM cases were significantly less frequent than single PM cases in winter (27% vs. 48%; P=0.03) and showed significantly less concomitant ear, nose and throat infections when considering the first episode (30% vs. 56%, P = 0.04) and all episodes (28% vs. 56%, P < 0.01). Cerebrospinal fluid leakage was frequent in RPM cases versus controls (83% vs. 10%, P < 0.01), including 25% discovered after the third PM episode. Immune deficiency was absent in cases and present in 15% of controls. Cases and controls did not differ in death rate or neurologic outcome. CONCLUSIONS RPM is rare in children. Cerebrospinal fluid leakage must be considered.
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Muzzi E, Gregori M, Orzan E. Inner Ear Malformations and Unilateral Sensorineural Hearing Loss-the Elephant in the Room. JAMA Otolaryngol Head Neck Surg 2019; 145:874-875. [PMID: 31343671 DOI: 10.1001/jamaoto.2019.1761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Enrico Muzzi
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo," Trieste, Italy
| | - Massimo Gregori
- Pediatric Radiology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo," Trieste, Italy
| | - Eva Orzan
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo," Trieste, Italy
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Ropers FG, Pham ENB, Rotteveel LJC. Inner Ear Malformations and Unilateral Sensorineural Hearing Loss—the Elephant in the Room—Reply. JAMA Otolaryngol Head Neck Surg 2019; 145:875. [DOI: 10.1001/jamaoto.2019.1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fabienne G. Ropers
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Eveline N. B. Pham
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
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Risk factors for complications in cochlear implant surgery. Eur Arch Otorhinolaryngol 2018; 275:895-903. [PMID: 29429025 DOI: 10.1007/s00405-018-4901-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/05/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE The objective of this study was to achieve uniform reporting of complications and failures in cochlear implantation, to analyze complications and failures and to identify risk factors for complications in a series of over 1300 cochlear implantations. METHODS In a retrospective chart review and observational study, data from all cochlear implantations from 1987 to 2015 were entered in a custom-made database. Complications were classified using the contracted form of the Clavien-Dindo system and risk factors were identified by statistical analysis. RESULTS A complication rate of 18.4% and a device failure rate of 2.9% were found. There was a higher rate of hematoma in patients with a clotting disorder and when a subtotal petrosectomy was performed, a higher rate of wound infections in patients who were not vaccinated against Streptococcus pneumoniae and a higher rate of meningitis in patients with an inner ear malformation. CONCLUSIONS The use of a strict definition of a medical complication and device failure-in combination with the Clavien-Dindo classification system-enables uniform and objective registration of adverse events and prevents any tendency to downgrade complications. Complication and failure rates in this series are comparable to those reported in the literature. These results stress the need for pneumococcal vaccination, which may prevent general wound infections, but is especially important for patients with inner ear malformation, who have an increased risk of (postoperative) meningitis.
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