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Rubini A, Ronzani G, D’Alessandro E, Marchioni D. Management of Otogenic Meningitis: A Proposal for Practical Guidelines from a Multicenter Experience with a Systematic Review. J Clin Med 2024; 13:5509. [PMID: 39336995 PMCID: PMC11432078 DOI: 10.3390/jcm13185509] [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: 08/09/2024] [Revised: 09/09/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Otogenic meningitis represents the most common and life-threatening complication of infective middle ear diseases. However, no guidelines are available to describe the optimal management strategy and the role of surgical intervention. Methods: A six-year multicenter retrospective study on consecutive patients treated for otogenic meningitis caused by acute otitis and re-exacerbation of chronic otitis at the University Hospital of Verona and Modena was performed, and a systematic review regarding acute otitis media-related meningitis in accordance with the PRISMA 2020 statement was then conducted. Results: From the clinical chart analysis, 16 patients with surgical indications according to our decision-making flow chart were reviewed, with most of them undergoing surgery within 7 days of admission (n = 13, 81%). The systematic review ultimately utilized 24 studies (16 case reports and 8 case series) published between 1990 and 2023, with the overall analysis involving a total of 181 patients. Conclusion: The primary treatment for acute bacterial meningitis relies on antibiotic therapy, with surgical intervention being employed in the event of complications and when the initial treatment is not effective within 48 h. The objective of surgery is to sterilize the tympanic and mastoid cavity, thereby eradicating the suspected infective foci and managing any eventual intracranial complications.
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Affiliation(s)
- Alessia Rubini
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Modena, 41125 Modena, Italy; (A.R.); (E.D.); (D.M.)
| | - Guglielmo Ronzani
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Verona, 37134 Verona, Italy
| | - Edoardo D’Alessandro
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Modena, 41125 Modena, Italy; (A.R.); (E.D.); (D.M.)
| | - Daniele Marchioni
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Modena, 41125 Modena, Italy; (A.R.); (E.D.); (D.M.)
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Ranzenigo M, van Soest TM, Hensen EF, Cinque P, Castagna A, Brouwer MC, van de Beek D. Otitis in Patients With Community-Acquired Bacterial Meningitis: A Nationwide Prospective Cohort Study. Clin Infect Dis 2024; 79:329-335. [PMID: 38655694 PMCID: PMC11327785 DOI: 10.1093/cid/ciae221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Otitis is commonly associated with community-acquired bacterial meningitis, but the role of ear surgery as treatment is debated. In this study, we investigated the impact of otitis and ear surgery on outcome of adults with community-acquired bacterial meningitis. METHODS We analyzed episodes of adults with community-acquired bacterial meningitis from a nationwide prospective cohort study in the Netherlands, between March 2006 and July 2021. RESULTS A total of 2548 episodes of community-acquired bacterial meningitis were evaluated. Otitis was present in 696 episodes (27%). In these patients the primary causative pathogen was Streptococcus pneumoniae (615 of 696 [88%]), followed by Streptococcus pyogenes (5%) and Haemophilus influenzae (4%). In 519 of 632 otitis episodes (82%) an ear-nose-throat specialist was consulted, and surgery was performed in 287 of 519 (55%). The types of surgery performed were myringotomy with ventilation tube insertion in 110 of 287 episodes (38%), mastoidectomy in 103 of 287 (36%), and myringotomy alone in 74 of 287 (26%). Unfavorable outcome occurred in 210 of 696 episodes (30%) and in 65 of 696 episodes was fatal (9%). Otitis was associated with a favorable outcome in a multivariable analysis (odds ratio 0.74; 95% confidence interval [CI] .59-.92; P = .008). There was no association between outcome and ear surgery. CONCLUSIONS Otitis is a common focus of infection in community-acquired bacterial meningitis in adults, with S. pneumoniae being the most common causative pathogen. Presence of otitis is associated with a favorable outcome. Ear surgery's impact on the outcome of otogenic meningitis patients remains uncertain.
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Affiliation(s)
- Martina Ranzenigo
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy
| | - Thijs M van Soest
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head and Neck Surgery, LUMC, Leiden, The Netherlands
| | - Paola Cinque
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
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Gkrinia E, Brotis AG, Vallianou K, Ntziovara AM, Hajiioannou J. Otogenic brain complications: a systematic review and meta-analysis. J Laryngol Otol 2024:1-10. [PMID: 38440882 DOI: 10.1017/s0022215124000343] [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: 03/06/2024]
Abstract
OBJECTIVE This study aimed to form astute deductions regarding the presentation, treatment and mortality of otogenic brain complications. METHODS A systematic literature search of four medical databases (PubMed, Embase, Web of Science and Scopus) was conducted. Studies associated with otogenic brain complications were considered eligible. Fixed- and random-effects model meta-analysis was developed to assess the proportion estimate for each outcome individually. RESULTS Twenty-eight studies, with 1650 patients in total, were included. In 66 per cent of patients there was a known history of chronic otitis media. The most common symptoms were purulent otorrhoea (84 per cent), headache (65 per cent) and otalgia (45 per cent). A brain abscess was observed in 49 per cent of patients, followed by meningitis (34 per cent) and sinus thrombosis (22 per cent). A combination of surgical and conservative therapy was chosen in 84.3 per cent of cases and the mortality rate approached 11.1 per cent. CONCLUSION Otogenic brain complications are a possibly life-threatening condition. Prompt imaging examination may set the final diagnosis and lead to an effective treatment.
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Affiliation(s)
- Eleni Gkrinia
- ENT Department, University Hospital of Larissa, Larissa, Greece
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4
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Xu W, Fang Y, Zhu K. Enterococci facilitate polymicrobial infections. Trends Microbiol 2024; 32:162-177. [PMID: 37550091 DOI: 10.1016/j.tim.2023.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
Enterococci are ubiquitous members of the gut microbiota in human beings and animals and are among the most important nosocomial organisms. Due to their opportunistic pathogenicity, enterococci are referred to as pathobionts and play decisive roles in a diverse array of polymicrobial infections. Enterococci can promote the colonization, pathogenesis, and persistence of various pathogens, compromise the efficacy of drugs, and pose a severe threat to public health. Most current treatments tend to focus on the sole pathogenic bacteria, with insufficient attention to the driving role of enterococci. In this review, we summarize the characteristics of enterococci in infections, the factors facilitating their outgrowth, as well as the sites and types of enterococci-associated polymicrobial infections. We present an overview of the underlying mechanisms of enterococci-mediated pathogenesis in polymicrobial infections. Furthermore, we discuss alternative strategies and potential intervention approaches to restrict such infections, shedding light on the discovery and development of new therapies against polymicrobial infections.
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Affiliation(s)
- Wenjiao Xu
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China; Engineering Research Center of Animal Innovative Drugs and Safety Evaluation, Ministry of Education, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Yuwen Fang
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China; Engineering Research Center of Animal Innovative Drugs and Safety Evaluation, Ministry of Education, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Kui Zhu
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China; Engineering Research Center of Animal Innovative Drugs and Safety Evaluation, Ministry of Education, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China.
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Araújo ALPKD, Cordeiro FP, da Costa Monsanto R, Penido NDO. Audiometric evaluation in different clinical presentations of otitis media. Braz J Otorhinolaryngol 2024; 90:101359. [PMID: 38070239 PMCID: PMC10755540 DOI: 10.1016/j.bjorl.2023.101359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 01/01/2024] Open
Abstract
OBJECTIVES To assess the hearing thresholds in acute otitis media, otitis media with effusion and chronic otitis media (non-suppurative, non-cholesteatomatous suppurative and cholesteatomatous) and to compare the hearing outcomes with non-diseased ears (in bilateral cases) or contralateral healthy ears (in unilateral cases), since hearing loss is the most frequent sequel of otitis media and there is no previous study comparing the audiometric thresholds among the different forms of otitis media. METHODS Cross sectional, controlled study. We performed conventional audiometry (500-8000Hz) and tympanometry in patients with otitis media and healthy individuals (control group). Hearing loss was considered when the hearing thresholds were > 25 dBHL. RESULTS Of the 112 patients diagnosed with otitis media (151 ears), 48 were men (42.86%) and 64 were women (57.14%). The average age was 42.72 years. Of those, 25 (22.32%) were diagnosed as AOM, 15 (13.39%) were diagnosed with OME and the remaining 72 (63.28%) were diagnosed with COM (non-suppurative COM, n=31; suppurative COM, n=18; cholesteatomatous COM, n=23). As compared with controls, all forms of otitis media had significantly higher bone-conduction thresholds (500-4000Hz). Conductive hearing loss was the most frequent type of hearing loss (58.94%). However, the number of patients with mixed hearing loss was also relevant (39.07%). We noted that the presence of sensorioneural component occurred more frequently in 1) Higher frequencies; and 2) In groups of otitis media that were more active or severe in the inflammatory/infective standpoint (AOM, suppurative COM and cholesteatomatous COM). CONCLUSION All types of otitis media, even those with infrequent episodes of inflammation and otorrhea, had worse bone conduction thresholds as compared with nondiseased ears (p<0.01). We observed worse hearing outcomes in ears with recurrent episodes of otorrhea and in ears with AOM, especially in high frequencies.
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Affiliation(s)
| | | | - Rafael da Costa Monsanto
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP), São Paulo, SP, Brazil; Otopathology Laboratory - University of Minnesota, Minneapolis, MN, USA
| | - Norma de Oliveira Penido
- Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP), São Paulo, SP, Brazil
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Fei J, Peng XW, Yang TY, Shen XL, Gao L, Liao N, Li LJ. Experience in the management of sigmoid sinus thrombophlebitis secondary to middle ear cholesteatoma. J Otolaryngol Head Neck Surg 2023; 52:84. [PMID: 38115035 PMCID: PMC10731876 DOI: 10.1186/s40463-023-00681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To discuss the management of sigmoid sinus thrombophlebitis secondary to middle ear cholesteatoma. METHODS We retrospectively analyzed all cases of sigmoid sinus thrombophlebitis caused by middle ear cholesteatoma over a period of 7 years. 7 male and 2 female patients, ranging in age from 9 to 66 years, were diagnosed with sigmoid sinus thrombophlebitis by clinical presentation and radiological examination. By executing a modified mastoidectomy and tympanoplasty (canal wall-down tympanoplasty) to entirely remove the cholesteatoma-like mastoid epithelium, all patients were effectively treated surgically without opening the sigmoid sinus. All patients were treated with broad-spectrum antibiotics, but no anticoagulants were used. RESULTS 9 patients had otogenic symptoms such as ear pus, tympanic membrane perforation, and hearing loss. In the initial stage of the surgery, modified mastoidectomy and tympanoplasty were performed on 8 of the 9 patients. 1 patient with a brain abscess underwent puncturing (drainage of the abscess) to relieve cranial pressure, and 4 months later, a modified mastoidectomy and tympanoplasty were carried out. Following surgery and medication, the clinical symptoms of every patient improved. After the follow-up of 6 months to 7 years, 3 patients were re-examined for MRV and showed partial sigmoid sinus recovery with recanalization. 4 months following middle ear surgery, the extent of a patient's brain abscess lesions was significantly reduced. 1 patient experienced facial paralysis after surgery and recovered in 3 months. None of the patients had a secondary illness, an infection, or an abscess in a distant organ. CONCLUSION The key to a better prognosis is an adequate course of perioperative antibiotic medication coupled with surgical treatment. A stable sigmoid sinus thrombus can remain for a long time after middle ear lesions have been removed, and it is less likely to cause infection and abscesses in the distant organs. The restoration of middle ear ventilation is facilitated by tympanoplasty. It is important to work more closely with multidisciplinary teams such as neurology and neurosurgery when deciding whether to perform lateral sinusotomies to remove thrombus or whether to administer anticoagulation.
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Affiliation(s)
- Jing Fei
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou City, 646000, Sichuan Province, China
| | - Xiao-Wen Peng
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou City, 646000, Sichuan Province, China
| | - Ting-Yu Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou City, 646000, Sichuan Province, China
| | - Xue-Li Shen
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou City, 646000, Sichuan Province, China
| | - Lin Gao
- Department of Health Management Center, the Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Na Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou City, 646000, Sichuan Province, China.
| | - Lei-Ji Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou City, 646000, Sichuan Province, China.
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Kloth C, Beck A, Sollmann N, Beer M, Horger M, Thaiss WM. Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications-Pictorial Review. Tomography 2023; 9:2190-2210. [PMID: 38133074 PMCID: PMC10747582 DOI: 10.3390/tomography9060170] [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: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Radiology and Radiation Therapy Lindau, Friedrichshafener Str. 83, 88131 Lindau (Lake Constance), Germany
| | - Annika Beck
- Institute of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany;
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Wolfgang Maximilian Thaiss
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
- Department of Nuclear Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Hidaka H, Tarasawa K, Fujimori K, Obara T, Fushimi K, Shimamura A, Iwai H. Identification of Risk Factors for Mortality and Prolonged Hospitalization in Patients Treated With Surgical Drainage for Otogenic Intracranial Complications: A Nationwide Study Using a Japanese Inpatient Database. Otol Neurotol 2023; 44:1027-1032. [PMID: 37853770 DOI: 10.1097/mao.0000000000004038] [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: 10/20/2023]
Abstract
OBJECTIVE Data on risk factors for otogenic intracranial complications including cerebral abscess have been limited. Using a nationwide database, the aim was to identify the factors related to mortality and delayed discharge. STUDY DESIGN Retrospective. SETTING Nationwide database using the Diagnostic Procedure Combination database. MAIN OUTCOME MEASURES Data of 145 patients were extracted from a Japanese inpatient database between 2012 and 2020. The main outcome was survival at discharge. In a subgroup analysis of the 137 surviving patients, the second outcome was delayed discharge. RESULTS The mortality rate was 5.5% (8 of 145). Logistic regression analyses identified intracerebral complications (adjusted odds ratio [OR], 3.09) and more than 2-day delay of the first surgery after admission (adjusted OR, 4.68) as risk factors for mortality. Specifically, consciousness level evaluated by the Japan Coma Scale (JCS) was significantly related to prolonged hospitalization or mortality: JCS I (adjusted OR, 3.40) and JCS ≥II (adjusted OR, 25.1). CONCLUSIONS Although otogenic intracranial complications are rare, and their mortality is decreasing because of the progress in imaging and clinical strategies, they remain the most severe complications of suppurative otitis media and/or cholesteatoma. Consciousness level at admission, comorbid diabetes mellitus, and a greater than 2-day delay of surgical intervention were related to prolonged hospitalization or mortality.
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Affiliation(s)
- Hiroshi Hidaka
- Department of Otolaryngology-Head and Neck Surgery, Kansai Medical University, Hirakata
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University School of Medicine
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University School of Medicine
| | | | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Akihiro Shimamura
- Department of Otolaryngology-Head and Neck Surgery, Kansai Medical University, Hirakata
| | - Hiroshi Iwai
- Department of Otolaryngology-Head and Neck Surgery, Kansai Medical University, Hirakata
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Shah UK, Shah BK, Muskan V, Bhusal A, Shah N. Thrombosis of sigmoid sinus, transverse sinus, and internal jugular vein in chronic otitis media in 9-year-old girl: a case report. Ann Med Surg (Lond) 2023; 85:5051-5055. [PMID: 37811032 PMCID: PMC10553046 DOI: 10.1097/ms9.0000000000001155] [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: 03/09/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance Chronic otitis media can lead to dreadful intracranial complications, the most common being meningitis. A concomitant finding of thrombosis in more than one sinus with a cerebral vein is extremely rare. Septic sigmoid sinus thrombosis has an infectious origin and the treatment is debatable between antibiotics and surgery. Case presentation A case of 9-year-old female with prolonged symptoms of right sided ear discharge, fever, right sided neck pain, and vomiting. Examination revealed tachycardia and neck rigidity suggesting meningitis. The child developed shock, generalized seizure, and a persistent high grade fever in the course of hospital stay. Brain imaging revealed sigmoid, transverse, and internal jugular thrombosis. Blood culture grew both gram-positive and gram-negative bacteria, suggesting the infectious origin of the thrombus. The authors treated meningitis with cephalosporin and vancomycin at first, and then additional antibiotics to treat the septic sigmoid sinus thrombosis. Clinical discussion Sigmoid sinus thrombosis is a rare condition caused by infections, thrombophilia, head trauma, some types of cancer, and intravenous drug use. Cerebral vein or sinus thrombosis can lead to raised intracranial pressure and can cause fever, otalgia, headache, vomiting, cranial nerve palsies, papilledema altered mental status and may cause seizures, stupor, and coma. Prompt diagnosis by CT scan or MRI and prompt treatment with antibiotics are crucial. Conclusion Sigmoid sinus thrombosis with involvement of the transverse sinus and internal jugular vein is a rare complication of chronic otitis media, and should be suspected if a recurring fever with features of raised intracranial pressure is present in a child with chronic otitis media.
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Affiliation(s)
- Ujjwal K. Shah
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bipesh K. Shah
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan
| | - Vitasta Muskan
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Amrit Bhusal
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Neha Shah
- Chitwan Medical College, Bharatpur, Nepal
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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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11
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Extensive Cholesteatomas: Presentation, Complications and Management Strategy. Indian J Otolaryngol Head Neck Surg 2022; 74:184-189. [PMID: 36032932 PMCID: PMC9411359 DOI: 10.1007/s12070-020-01948-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022] Open
Abstract
To document the clinical presentation, complications, management strategy and post-operative outcomes of extensive cholesteatomas. Cholesteatoma is a well demarcated cystic lesion derived from an abnormal growth of keratinizing squamous epithelium in the temporal bone. Cholesteatomas commonly involve the middle ear, epitympanum, mastoid antrum and air cells and can remain within these confines for a considerable period. Bony erosion is present confined to ossicular chain and scutum initially, but as the cholesteatoma expands, erosion of the otic capsule, fallopian canal and tegmen can occur. Erosion of the tegmen tymapani or tegmen mastoideum may lead to development of a brain hernia or cerebrospinal fluid leakage. Invasion of jugular bulb, sigmoid sinus, internal carotid artery are noticed in extensive cholesteatoma and are quite challenging and requires expertise. Neurosurgical intervention should be considered along with the otological management in the same sitting in all possible cases. A retrospective review of 12 patients were carried out to assess the clinical presentation, complications, surgical management and postoperative outcomes of extensive cholesteatomas presenting at our centre between January 2017 and December 2019. CT or MRI findings, extent of cholesteatoma intra-operatively along with the status of major neurovascular structures and disease clearance, and the post-operative outcomes including morbidity and mortality were noted. All patients underwent canal wall down mastoidectomy with or without ossiculoplasty. Post operatively all patients were treated with intravenous antibiotics and if required intravenous steroids. Amongst the 12 patients of extensive cholesteatoma (EC), all of them (100%) presented with foul smelling, purulent ear discharge. 9 (75%) patients presented with otalgia. 4 (33.33%) patients had temporal headache. 10 (83.33%) patients complained of hard of hearing. 7 (58.33%) patients gives history of vertigo at the time of presentation. In 8 (66.66%) patients there was tegmen plate erosion noticed in CT scan. In 3 (25%) patients, the disease was invading the sigmoid sinus and in 1 (8.33%) patient jugular bulb was involved. In 3 (25%) cases of EC, blind sac closure was performed. In two patients who developed cerebellar abscess, drainage procedure was performed. 2 (16.66%) patients developed sigmoid sinus thrombosis, 1 (8.33%) patient had petrositis.
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Monsanto RDC, Kasemodel ALP, Tomaz A, Elias TGA, Paparella MM, Penido NDO. Evaluation of vestibular symptoms and postural balance control in patients with chronic otitis media. J Vestib Res 2021; 30:35-45. [PMID: 32083607 DOI: 10.3233/ves-200691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Evidence to support potential links between chronic otitis media (COM) and vestibular impairment/postural balance control issues is lacking. OBJECTIVE To investigate whether COM associates with vestibular symptoms, balance problems, and abnormalities in vestibular function tests. METHODS We selected 126 patients with COM and excluded patients with any identifiable underlying causes for vestibular dysfunction. Fifty-two healthy volunteers were included as controls. All subjects underwent anamnesis, physical examination, posturography, and video-head impulse tests. RESULTS We found a high prevalence of vestibular symptoms (58.4%) among patients with COM, while only 2% of the controls had vestibular symptoms. There was a positive correlation between COM activity with the presence of tinnitus and vestibular symptoms (P < 0.05). Clinical vestibular tests were abnormal in 63% of patients with COM, and those positively associated with presence of vestibular symptoms. Posturography results shown worse postural balance control in patients with COM as compared with controls, especially in the limit of stability (LOS) (Mean LOS, COM = 157.56 cm2; controls = 228.98 cm2; p < 0.001) and worse results in the test with eyes closed while standing on a foam mattress (sway area, COM = 10.91 cm2; controls = 5.90 cm2; p < 0.001) in patients with COM as compared with controls. We did not observe differences in the average vestibuloocular reflex gains in the video-head impulse test between our COM and control groups. CONCLUSIONS Our results show that COM associates with higher prevalence of vestibular symptoms and abnormalities in clinical vestibular function tests, and worse postural control as compared with controls. Among patients with COM, the activity of the middle-ear inflammation seemed to positively associate with the severity of hearing and balance problems.
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Affiliation(s)
- Rafael da Costa Monsanto
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil).,Department of Otolaryngology Head & Neck Surgery, University of Minnesota (Minnesota, MN, USA)
| | - Ana Luiza Papi Kasemodel
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil)
| | - Andreza Tomaz
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil)
| | - Thais Gomes Abrahão Elias
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil)
| | - Michael Mauro Paparella
- Department of Otolaryngology Head & Neck Surgery, University of Minnesota (Minnesota, MN, USA).,Paparella Ear Head & Neck Institute (Minnesota, MN, USA)
| | - Norma de Oliveira Penido
- Department of Otolaryngology, Head & Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) (São Paulo, SP, Brazil)
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Fujita Y, Imataka G, Ohkusu M, Yoshihara S. Cerebral haemorrhagic infarction associated with acute otitis media in a 4-year-old boy. BMJ Case Rep 2021; 14:14/5/e242098. [PMID: 34020990 DOI: 10.1136/bcr-2021-242098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - George Imataka
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Misako Ohkusu
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
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Abuserewa ST, Faris M, Golden T. Aphasia as the Initial Presentation of Acute Otomastoiditis in an Elderly Male. Cureus 2021; 13:e14293. [PMID: 33968507 PMCID: PMC8097664 DOI: 10.7759/cureus.14293] [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] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
Acute otomastoiditis is a potentially life-threatening condition. It is relatively uncommon in elderly patients and is usually seen as a complication of acute otitis media. Limited studies are available on this uncommon disease in the elderly, and thus the clinical course of the disease is not fully understood. Proper use of antibiotics for acute otitis media has markedly decreased the incidence of acute otomastoiditis. We describe a case of a 76-year-old male with acute otomastoiditis complicated by cerebellopontine angle epidural abscess who presented with a chief complaint of sudden onset of global aphasia, which is an unusual presentation for acute otomastoiditis. The patient eventually required medical and surgical intervention. To the best of our knowledge, acute otomastoiditis presenting with sudden onset of global aphasia has not been previously described in the literature. This case illustrates how multidisciplinary team involvement is vital in the management of these uncommon cases.
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Affiliation(s)
- Sherif T Abuserewa
- Department of Internal Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | - Mohamed Faris
- Department of Internal Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | - Thaddeus Golden
- Department of Pulmonary and Critical Care Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
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Management of infective complications of otitis media in resource-constrained settings. Curr Opin Otolaryngol Head Neck Surg 2021; 28:174-181. [PMID: 32332206 DOI: 10.1097/moo.0000000000000627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Complications of otitis media are a cause of significant morbidity and mortality, compounded in resource-constrained settings in which human and physical resources to manage disease are suboptimal. Here, we examine the current best evidence to devise a protocol for management, in particular exploring the opportunity for conservative or nonspecialist management. RECENT FINDINGS Reviews of the literature suggest that intratemporal and extracranial infections can be managed with antibiotics in the first instance, with aspiration or incision and drainage of abscess. Failure to respond necessitates mastoidectomy, which need not be extensive, and can be performed with hammer and gouge. Suspected or possible intracranial extension requires referral for computed tomography (CT) imaging. Intracranial infection can in some instances be managed with antibiotics, but large or persistent intracranial abscess, or the presence of cholesteatoma requires management in a centre for specialist surgery. SUMMARY Many complications of otitis media could be managed by nonspecialists in appropriately equipped local or regional health facilities, and supported by appropriate training. However, regional centres with CT imaging and specialist surgery are required for assessment and treatment of cases that are suspected of having complex or advanced disease, or that fail to respond to initial treatment. Those involved in planning healthcare provision should look to develop infrastructure to support such management.
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Kasemodel ALP, Costa LEM, Monsanto RDC, Tomaz A, Penido NDO. Sensorineural hearing loss in the acute phase of a single episode of acute otitis media. Braz J Otorhinolaryngol 2020; 86:767-773. [PMID: 31324458 PMCID: PMC9422693 DOI: 10.1016/j.bjorl.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/17/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Acute otitis media is a disease with high global prevalence, that can lead to several acute complications and auditory sequelae. Data regarding the auditory evaluation in the acute phase of acute otitis media are scarce. Objective To evaluate the main audiometric changes (air and bone conduction thresholds) in the initial phase of an acute otitis media episode. Methods A case-control study was performed. Patients diagnosed with acute otitis media with less than 7 days of evolution in relation to the complaint onset were selected, and healthy volunteers were selected as controls. The acute otitis media and control groups were submitted to pure tone and vocal audiometry. Results The acute otitis media group included a total of 27 patients (30 ears). Hearing loss was present in 90.0% of the ears with acute otitis media, with conductive loss in 14 (46.67%) and mixed loss in 13 (43.33%). Both the air and bone conduction thresholds obtained with the tonal audiometry in the acute otitis media group were significantly worse than the controls at all tested frequencies (p < 0.05). In patients with acute otitis media, we observed that the thresholds for frequency >1 kHz (bone conduction) and 3 kHz (air conduction) were significantly worse in patients with tinnitus compared to patients without tinnitus. Conclusion During the first 7 days of evolution after the onset of an isolated episode of acute otitis media, we observed significant increases in bone and air thresholds at all frequencies, especially >2 kHz, compared to healthy ears.
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Song Y, Cheng D, Qiu K, Yan X, Ren J, Qiu J, Deng D, Rao Y, Zheng Y, Pang W, Dong Y, Liu Q, Ren Y, Zhao Y. Clinical outcomes of different treatments and risk factors in patients with otogenic brain abscess, a real-world evidence-based retrospective study. Acta Otolaryngol 2020; 140:919-924. [PMID: 32804559 DOI: 10.1080/00016489.2020.1800088] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Otogenic Brain Abscess (OBA) is a life-threatening complication secondary to otitis media, but its appropriate management remains controversial. OBJECTIVES To understand the demographic characteristics, management, and variables that affect the outcomes of patients with OBA based on our experiences over 11 years. MATERIAL AND METHODS Clinical data were collected for 41 patients. Prognostic factors associated with mortality were assessed, and clinical outcomes compared among groups receiving different treatments. RESULTS Among the 41 patients, 19.6% did not undergo surgery, 39.0% were treated with two-stage surgery (otological surgery and neurosurgery) and 41.4% were treated with single-stage surgery (otological surgery or neurosurgery). Overall mortality rate was 32.5%, and mortality was significantly higher in patients with invasion of the petrous apex (odds ratio [OR]: 7.81, 95% confidence interval [95% CI]: 1.26-48.36), and lower in those with appropriate surgical management (single otological surgery, OR: 0.07, 95% CI: 0-0.97; single neurosurgery, OR: 0.13, 95% CI: 0.02-1.0; two-stage surgery, OR: 0.08, 95% CI: 0.01-0.64) or a higher Glasgow Coma Scale (GCS) score at admission (OR: 0.64, 95% CI: 0.44-0.93). CONCLUSIONS AND SIGNIFICANCE Data on invasiveness and pre-surgery GCS greatly aid in predicting the prognosis of OBA patients. Early evaluation will facilitate decision-making by physicians treating OBA patients.
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Affiliation(s)
- Yao Song
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Ke Qiu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Xiaohong Yan
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Jianqing Qiu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Di Deng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yongbo Zheng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Wendu Pang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yijun Dong
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Qiurui Liu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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Liourdi D, Litsardopoulos P, Dimitropoulou D, Fatourou A, Argyriou AA. Pneumococcal Otogenic Meningitis Complicated With Pneumocephalus and Coma State. Cureus 2020; 12:e10917. [PMID: 33194484 PMCID: PMC7657374 DOI: 10.7759/cureus.10917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We herein describe the unusual case of a male patient with pneumococcal otogenic meningitis, which was complicated with non-traumatic pneumocephalus and coma, in the absence of head trauma or a neurosurgical procedure. The initiation of an aggressive, empirical scheme with wide-spectrum antibiotics was achieved to stop the progression of meningitis, pneumocephalus, and their underlying causes in this patient. We propose pathogenetic mechanisms to explain this life-threatening condition.
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Epidural Abscess and Sigmoid Sinus Thrombosis as Intracranial Complications of the Middle Ear Cholesteatoma. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The otogenic intracranial complications are rare manifestations in modern era of antibiotics. An early antibiotic therapy often covers typical clinical signs and symptoms for each complication. A sigmoid sinus thrombosis is often associated with other intracranial complications, as in this case, an epidural abscess. We are presenting a case of 12-year-old girl with the sigmoid sinus thrombosis and epidural abscess as complications of chronic infection to the middle ear with cholesteatoma. In the active phase of chronic inflammation of the middle ear she was treated with the antibiotic therapy that covered early symptoms of intracranial complication development. A humid attic perforation of the tympanic membrane with protrusion of choleastoma and evident signs of bony wall destruction to the external auditory canal was noticed by performing routine otomicroscopy and otoendoscopic examination. Assuming intracranial complication, magnetic resonance imaging (MRI) of the endocranium was undertaken. The MRI showed inflammatory changes of both middle ears with intracranial complications: the right sigmoid sinus thrombosis and epidural abscess of the same side. During the surgery we have noticed an extensive middle ear cholesteatoma with significant destruction of the bony tissue and purulent collection between sigmoid sinus changed with granulation and respective dural segment of the posterior cranial cavity.
Timely diagnosis, multidisciplinary approach with an adequate choice of the antibiotic therapy and surgical technique have a crucial prognostic significance.
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20
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Cavel O, Ungar OJ, Oron Y, Ben Ami R, Dekel M, Handzel O. Outcome of surgery for chronic suppurative otitis media with resistant Pseudomonas aeruginosa. Eur Arch Otorhinolaryngol 2020; 278:959-964. [PMID: 32583180 DOI: 10.1007/s00405-020-06152-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of surgical treatment of active chronic suppurative otitis media (CSOM) with ciprofloxacin-resistant Pseudomonas aeruginosa (P. aeruginosa) that failed comprehensive local and systemic treatment. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Eleven patients with ciprofloxacin-resistant P. aeruginosa CSOM that remained active despite comprehensive local and systemic treatment. All patients were operated by a single surgeon between February 2016 and July 2019 INTERVENTION(S): Tympanoplasty alone was performed in seven cases and accompanied by mastoidectomy in the other four cases. MAIN OUTCOME MEASURE(S) Resolution of infection and tympanic graft take on otoscopy. The secondary outcome measure is hearing. RESULTS Tympanic graft take was successful and the infectious process was resolved in 8 out of the 11 cases, yielding a success rate of 73%. The average follow-up was 20 months. No surgical complications occurred. CONCLUSIONS Tympanoplasty, with or without mastoidectomy, is safe and yields acceptable anatomical and functional success rates when intensive local and systemic treatment fails to stop the purulent discharge.
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Affiliation(s)
- O Cavel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel.
| | - O J Ungar
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - Y Oron
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - R Ben Ami
- Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Dekel
- Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Handzel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
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Foligno S, Loi B, Pezza L, Piastra M, Autilio C, De Luca D. Extrapulmonary Surfactant Therapy: Review of Available Data and Research/Development Issues. J Clin Pharmacol 2020; 60:1561-1572. [PMID: 32578234 DOI: 10.1002/jcph.1675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/21/2020] [Indexed: 11/07/2022]
Abstract
Since the discovery of surfactant, a large amount of knowledge has been accumulated about its biology and pharmacology. Surfactant is the cornerstone of neonatal respiratory critical care, but its proteins and phospholipids are produced in various tissues and organs, with possible roles only partially similar to that played in the alveoli. As surfactant research is focused mainly on its respiratory applications, knowledge about the possible role of surfactant in extrapulmonary disorders has never been summarized. Here we aim to comprehensively review the data about surfactant biology and pharmacology in organs other than the lung, especially focusing in the more promising surfactant extrapulmonary roles. We also review any preclinical or clinical data available about the therapeutic use of surfactant in these contexts. We offer a summary of knowledge and research/development milestones, as possible useful guidance for researchers of multidisciplinary background.
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Affiliation(s)
- Silvia Foligno
- Division of Pediatrics and Neonatal Critical Care, Medical Center, "A. Béclère," South Paris University Hospitals, Assistance Publique-Hopitaux de Paris (APHP), Paris, France
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, Medical Center, "A. Béclère," South Paris University Hospitals, Assistance Publique-Hopitaux de Paris (APHP), Paris, France
| | - Lucilla Pezza
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital "A.Gemelli"-IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital "A.Gemelli"-IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Autilio
- Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut-Hospital "12 de Octubre,", Complutense University, Madrid, Spain
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Medical Center, "A. Béclère," South Paris University Hospitals, Assistance Publique-Hopitaux de Paris (APHP), Paris, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris/Saclay University, Paris, France
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Meyfroidt G, Kurtz P, Sonneville R. Critical care management of infectious meningitis and encephalitis. Intensive Care Med 2020; 46:192-201. [PMID: 31938828 DOI: 10.1007/s00134-019-05901-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/14/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Geert Meyfroidt
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium. .,Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Pedro Kurtz
- Neuro-Critical Care Unit, Instituto Estadual Do Cérebro Paulo Niemeyer and Hospital Copa Star, Rio de Janeiro, Brasil
| | - Romain Sonneville
- Université de Paris, INSERM UMR1148, team 6, 75018, Paris, France.,APHP, Intensive Care Medicine, Hôpital Bichat-Claude Bernard, 75018, Paris, France
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Yoon J, Redmond M. Check the Ear. The Importance of Ear Examinations in Assessment of Intracranial Subdural Empyema. Trop Med Infect Dis 2019; 4:tropicalmed4030120. [PMID: 31540395 PMCID: PMC6789478 DOI: 10.3390/tropicalmed4030120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022] Open
Abstract
Intracranial subdural empyema (ISE) is an uncommon condition previously associated with almost 100% morbidity and mortality. Since the introduction of antibiotics and advancements in diagnosis the complication rates have significantly improved. We report an unusual case of a 32-year-old Aboriginal male diagnosed with ISE. On closer inspection the ISE was found to be a complication of otitis media with a cotton bud lodged in the external acoustic meatus. The report provides a literature review on the relationships of ISE, otitis media and foreign bodies. We conclude that although rare, all patients with suspected ISE should undergo an ear examination as it is at no cost to the patient or health service but may be the difference between life and death.
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Affiliation(s)
- Joseph Yoon
- Department of Neurosurgery, Royal Darwin Hospital, Darwin Northern Territory, Tiwi 0810, Australia.
| | - Michael Redmond
- Department of Neurosurgery, Royal Darwin Hospital, Darwin Northern Territory, Tiwi 0810, Australia.
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Chew YK, Cheong JP, Khir A, Brito-Mutunayagam S, Prepageran N. Complications of Chronic Suppurative Otitis Media: A Left Otogenic Brain Abscess and a right Mastoid Fistula. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556131209101006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yok Kuan Chew
- Department Otorhinolaryngology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Jack Pein Cheong
- Department of Otorhinolaryngology, University of Malaya Faculty of Medicine, Kuala Lumpur
| | - Abdullah Khir
- Department of Otorhinolaryngology, Hospital Pakar Sultanah Fatimah, Muar, Johor
| | | | - Narayanan Prepageran
- Department of Otorhinolaryngology, University of Malaya Faculty of Medicine, Kuala Lumpur
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Preventative and medical treatment of ear disease in remote or resource-constrained environments. The Journal of Laryngology & Otology 2019; 133:59-72. [PMID: 30706843 DOI: 10.1017/s0022215119000057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Important ear problems can affect the outer ear, the middle ear and the inner ear. Globally, the greatest burden of disease is due to ear conditions that are associated with otorrhoea and hearing loss. METHODS This study reviewed the literature on the prevention and treatment of common ear conditions that are most relevant to settings with high rates of ear disease and limited resources. The grading of recommendations assessment, development and evaluation ('GRADE') approach was utilised to assess interventions. RESULTS Accurate diagnosis of ear disease is challenging. Much of the preventable burden of ear disease is associated with otitis media. Nine otitis media interventions for which there is moderate to high certainty of effect were identified. While most interventions only provide modest benefit, the impact of treatment is more substantial in children with acute otitis media with perforation and chronic suppurative otitis media. CONCLUSION Disease prevention through good hygiene practices, breastfeeding, reducing smoke exposure, immunisation and limiting noise exposure is recommended. Children with acute otitis media with perforation, chronic suppurative otitis media, complications of otitis media, and significant hearing loss should be prioritised for medical treatment.
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Iaccarino I, Bozzetti F, Piccioni LO, Falcioni M. A case of external auditory canal osteoma complicated with cholesteatoma, mastoiditis, labyrinthitis and internal auditory canal pachymeningitis. ACTA ACUST UNITED AC 2019; 39:358-362. [PMID: 30745589 PMCID: PMC6843583 DOI: 10.14639/0392-100x-1547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 06/06/2017] [Indexed: 11/23/2022]
Abstract
The association between external auditory canal osteoma and external auditory canal cholesteatoma is rare, with only a few reports in the current literature. Intracranial complications are very rare in the external auditory canal cholesteatoma, especially with direct propagation through the internal auditory canal. A case of 27-year-old male presenting with external auditory canal osteoma with secondary external auditory canal cholesteatoma is described. Progression of the disease created in turn a mastoiditis, labyrinthitis and pachymeningitis confined to the internal auditory canal. The patient was treated by a subtotal petrosectomy, without entering the internal auditory canal. A control MRI after 3 months showed reduction of the internal auditory canal enhancement.
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Affiliation(s)
- I Iaccarino
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - F Bozzetti
- Neuroradiology Department, University Hospital of Parma, Italy
| | - L O Piccioni
- Otorhinolaryngology Department, San Raffaele Scientific Institute, Milan, Italy
| | - M Falcioni
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
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Fenollosa-Romero E, Taeymans O, Nelissen P, Cherubini GB, Busse C. Retrobulbar steatitis and meningitis/empyema secondary to right otitis media, right otitis interna and an inflammatory polyp in a cat. Open Vet J 2018; 8:144-148. [PMID: 29765868 PMCID: PMC5943686 DOI: 10.4314/ovj.v8i2.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/24/2018] [Indexed: 11/24/2022] Open
Abstract
The purpose was to describe a case of retrobulbar steatitis and meningitis in a cat caused by otitis media, otitis interna and an inflammatory polyp in the middle ear. Investigations included ophthalmic and neurological examinations, haematology and biochemistry, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and aerobic, anaerobic bacterial and fungal culture of material from the middle ear. A 6-year-old female neutered domestic-short-haired cat presented with right-sided exophthalmos and resistance to retropulsion. Anisocoria, reduced corneal sensation and oculocephalic movements and low Schirmer tear test (STT1) were found. An MRI revealed the right external ear canal and tympanic bulla to be fluid filled with presence of a thickened contrast-enhancing mucosa. Contrast enhancement extended into the calvarium, as marked thickening and contrast enhancement of the pachymeninges, and further rostrally through the right orbital fissure into the orbit. The retrobulbar tissues were swollen, resulting in mild exophthalmos. Enrichment culture of material from the middle ear revealed Klebsiella pneumonia susceptible to marbofloxacin. The cat underwent a total ear canal ablation with removal of the cartilaginous cuff at the external auditory meatus and local debridement and curettage. A polypoid structure was removed from the middle ear. No bulla osteotomy was performed. Horner’s syndrome was present immediately following surgery. The cat received a course of systemic dexamethasone (1mg/cat SID/3 weeks) tapered off and marbofloxacin (2mg/kg SID/2 weeks). Follow up at 120 days showed no recurrence of the symptoms. The Horner’s syndrome and low STT1 had resolved and returned to normal values respectively. This case highlights the importance of MRI in the investigation of retrobulbar diseases. MRI is a useful tool for the evaluation of the extent of the lesion and the appearance of adjacent structures in which additional potentially life-threatening abnormalities, such as meningitis, can be seen.
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Affiliation(s)
- Elena Fenollosa-Romero
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire CB8 0UH, UK
| | - Olivier Taeymans
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire CB8 0UH, UK
| | - Pieter Nelissen
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire CB8 0UH, UK
| | - Giunio B Cherubini
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire CB8 0UH, UK
| | - Claudia Busse
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire CB8 0UH, UK
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Duarte MJ, Kozin ED, Barshak MB, Reinshagen K, Knoll RM, Abdullah KG, Welling DB, Jung DH. Otogenic brain abscesses: A systematic review. Laryngoscope Investig Otolaryngol 2018; 3:198-208. [PMID: 30062135 PMCID: PMC6057212 DOI: 10.1002/lio2.150] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/28/2017] [Accepted: 01/30/2018] [Indexed: 11/09/2022] Open
Abstract
Objective Otogenic brain abscesses are one of the most significant life-threatening complications of otologic infections. Given their low prevalence, otogenic brain abscesses require a high index of suspicion for diagnosis. In this systematic review, we aim to provide an analysis of otogenic brain abscesses and describe common clinical signs and symptoms, bacteriology, location, treatment options, morbidity, and mortality. Data Sources PubMed, Cochrane CENTRAL database, Google Scholar, and Scopus. Methods A systematic review of literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. Variables assessed included clinical signs and symptoms, bacteriology, location, treatment, morbidity, and mortality. Results Twenty-nine studies met inclusion and exclusion criteria, corresponding to a total of 1307 otogenic abscess cases for review. Fifty-five percent of abscesses were found in the temporal lobe and 28% in the cerebellum. Most patients (88.3%) had a history of suppurative chronic otitis media. The most common symptoms were headache, altered mental status, papilledema, and meningeal irritation. Fever, nausea, and vomiting affected about 40% of patients. The most commonly cultured bacterial species was Proteus mirabilis. In addition to antibiotics, most otogenic brain abscesses were treated by burr hole aspiration. Average mortality following advent of computed tomography was 8.11%. Conclusion Although rare, otogenic brain abscesses may occur as a complication of suppurative otitis media and require a high index of suspicion. Appropriate imaging studies and multidisciplinary expertise are crucial in the diagnosis and management. Level of Evidence 4.
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Affiliation(s)
- Maria J Duarte
- Department of Otolaryngology, Harvard Medical School Boston Massachusetts U.S.A.,Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School Boston Massachusetts U.S.A.,Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Miriam B Barshak
- Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A.,Massachusetts General Hospital Boston Massachusetts U.S.A.,Department of Infectious Diseases, Massachusetts General Hospital Boston Massachusetts U.S.A
| | - Katherine Reinshagen
- Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A.,Department of Radiology, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Renata M Knoll
- Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Kalil G Abdullah
- Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia Pennsylvania U.S.A
| | - D Bradley Welling
- Department of Otolaryngology, Harvard Medical School Boston Massachusetts U.S.A.,Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - David H Jung
- Department of Otolaryngology, Harvard Medical School Boston Massachusetts U.S.A.,Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
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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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Early signs and symptoms of intracranial complications of otitis media in pediatric and adult patients: A different presentation? Int J Pediatr Otorhinolaryngol 2017; 102:56-60. [PMID: 29106876 DOI: 10.1016/j.ijporl.2017.08.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to review the clinical presentation and early signs and symptoms of otogenic intracranial complications (OIC) in children and adults. METHODS retrospective chart review. The medical records of all children and adults admitted in our center with OIC during the period 2008-2017 were reviewed. Data concerning clinical presentation, treatment and outcomes were reviewed and analyzed. RESULTS We included 47 patients with OIC: 21 children (range 1-13 years) and 26 adults (range 22-71 years). We included more patients with acute otitis media than with chronic otitis media (children 5% adults 19%, all with cholesteatoma). In children; the most common OIC was central cerebral venous thrombosis. In both children and adults; otogenic symptoms such as otalgia and otorrhea were present. Children presented more frequently with headache and nausea. Adults presented more frequently with decreased consciousness. Hearing loss was the most common long-term sequel. Three adults died. CONCLUSIONS In our series, we found that OIC in children present as 'mimicking meningitis' (e.g. nausea and vomiting). Adults on the other hand have a clinical presentation 'mimicking stroke' (e.g. neurological deficits and decreased level of consciousness). In children, sinus thrombosis was observed more frequently than in adults. Despite the low mortality rate, death still occurs. Long -term sequelae most frequently include hearing loss in children as well as in adults.
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31
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Aquila I, Gratteri S, Sacco MA, Ricci P. A rare case of fatal meningoencephalitis with septic thromboembolism due to otitis media: a forensic case and review of literature. BMJ Case Rep 2017; 2017:bcr-2017-220594. [PMID: 28739620 DOI: 10.1136/bcr-2017-220594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Isabella Aquila
- Institute of Legale Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Matteo Antonio Sacco
- Institute of Legale Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pietrantonio Ricci
- Institute of Legale Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Bruschini L, Fortunato S, Tascini C, Ciabotti A, Leonildi A, Bini B, Giuliano S, Abbruzzese A, Berrettini S, Menichetti F. Otogenic Meningitis: A Comparison of Diagnostic Performance of Surgery and Radiology. Open Forum Infect Dis 2017; 4:ofx069. [PMID: 28534037 PMCID: PMC5434250 DOI: 10.1093/ofid/ofx069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/03/2017] [Indexed: 11/28/2022] Open
Abstract
Development of intracranial complications from middle ear infections might be difficult to diagnose. We compared radiological and surgical findings of 26 patients affected by otogenic meningitis. Results of our analysis showed that surgery is more reliable than imaging in revealing bone defects. Therefore, suggest that surgery be performed for diagnosis and eventual management of all cases of suspected otogenic meningitis.
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Affiliation(s)
| | | | - Carlo Tascini
- Infectous Disease Unit, Cotugno Hospital, Napoli, Italy; and
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Abstract
Most otolaryngology-related complaints are straightforward and easily recognized and treated. However, given the proximity of the ears, nose, and throat to numerous vital structures in the head and neck, the potential for serious consequences exists if disease processes go unrecognized and untreated. This article serves to familiarize the primary care provider with the clinical presentation of various complications associated with common otolaryngologic complaints. Clinicians who care for patients presenting with otolaryngologic complaints should keep these entities in mind and attempt to rule out any serious complication.
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34
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Gulì C, Basile L, Graziano F, Di Carlo P, Iacopino DG, Cascio A, Maugeri R. Successful management of a cerebral abscess secondary to chronic cholesteatoma caused by Prevotella melaninogenica and Peptococcus anaerobius – A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2016. [DOI: 10.1016/j.inat.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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35
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Rare complications of acute otitis media in a 2-year-old child. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:451-452. [PMID: 27555303 DOI: 10.1016/j.anorl.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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36
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Fonte purulente de la cornée : une complication inattendue de l’otite moyenne aiguë. Arch Pediatr 2016; 23:823-6. [DOI: 10.1016/j.arcped.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/16/2015] [Accepted: 05/11/2016] [Indexed: 11/17/2022]
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37
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Single-Stage Trans-mastoid Drainage of Otogenic Brain Abscess: A Single-Institution Experience. Indian J Otolaryngol Head Neck Surg 2016; 68:179-84. [PMID: 27340633 DOI: 10.1007/s12070-016-0969-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022] Open
Abstract
Brain abscess is the ultimate otogenic complication, both in severity and difficulty of management. In developing countries with high incidence of cholesteatoma, brain abscess is not a rare complication. In India, brain abscesses constitute about 8 % of all intracranial lesions. The surgical treatment of brain abscess is very controversial. This prospective study was done in ENT department of a tertiary care hospital in Kolkata, during the period from May 2009 to April 2014. 22 such cases of otogenic brain abscess managed by single-stage trans-mastoid drainage along with meticulous mastoid clearance. On the basis of clinical, radiological and operative findings, data of all patients with otogenic brain abscess were analyzed. There was male predominance and 9 (40.91 %) of them were younger than 20 years. 15 (68.18 %) cases were of cerebellar abscess and in 7 (31.82 %) cases were of the temporal abscess. Lateral sinus thrombosis was the most common associated complication found (22.73 %) in our study. All the patients peri-operatively revealed cholesteatoma. All the patients recovered well and there was no recurrence of symptoms on a minimum 15 months follow-up. This approach suits the otologists in clearing the cause and effect of pathology, at the same sitting. This single-stage approach decreases the peri-operative morbidity and mortality of the two-stage procedure. It also decreases the hospital stay and financial burden.
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Heah H, Soon SR, Yuen HW. A case series of complicated infective otitis media requiring surgery in adults. Singapore Med J 2016; 57:681-685. [PMID: 26843060 DOI: 10.11622/smedj.2016025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION With the advent of antibiotics, complications of otitis media have become less common. It is crucial for physicians to recognise otitis media and treat its complications early. Herein, we present our institution's experience with patients who required emergency surgical intervention for complications of otitis media. METHODS Data on patients who underwent emergency surgery for complications of otitis media from 2004 to 2011 was retrieved from the archives of the Department of Otolaryngology, Changi General Hospital, Singapore. RESULTS A total of 12 patients (10 male, two female) underwent emergency surgery for complications of otitis media. The median age of the patients was 25 years. Otalgia, otorrhoea, headache and fever were the main presenting symptoms. Extracranial complications were observed in 11 patients, and six patients had associated intracranial complications. The primary otologic disease was acute otitis media in six patients, chronic otitis media without cholesteatoma in three patients and chronic otitis media with cholesteatoma in three patients. Mastoidectomy and drainage of abscess through the mastoid, with insertion of grommet tube, was the main surgical approach. Two patients required craniotomy. The mean length of hospital stay was 16.2 days and the mean follow-up period was 16.3 months. Five patients had residual conductive hearing loss; two patients with facial palsy had full recovery. CONCLUSION Otitis media can still result in serious complications in the post-antibiotic era. Patients with otitis media should be monitored, and prompt surgical intervention should be performed when necessary to attain good outcomes.
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Affiliation(s)
- Harold Heah
- Department of Otolaryngology, Singapore General Hospital, Singapore
| | - Sue Rene Soon
- Department of Otolaryngology, Ng Teng Fong General Hospital, Singapore
| | - Heng-Wai Yuen
- Department of Otolaryngology, Changi General Hospital, Singapore
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Suppurative labyrinthitis associated with otitis media: 26 years’ experience. Braz J Otorhinolaryngol 2016; 82:82-7. [PMID: 26718959 PMCID: PMC9444629 DOI: 10.1016/j.bjorl.2014.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/24/2014] [Indexed: 11/20/2022] Open
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40
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Case of Chronic Otitis Media with Intracranial Complication and Contralateral Extracranial Presentation. Case Rep Otolaryngol 2016; 2016:7810857. [PMID: 27668115 PMCID: PMC5030454 DOI: 10.1155/2016/7810857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/11/2016] [Indexed: 11/17/2022] Open
Abstract
Intracranial complications of chronic otitis media have been on the decline with advent of antibiotics. Septic thrombosis of the sigmoid sinus is rarer compared to commoner complications such as otogenic brain abscesses and meningitis. This patient presented with recurrent infection after left mastoidectomy secondary to cholesteatoma and a contralateral internal jugular vein thrombosis with parapharyngeal abscess, which was drained. He recovered well postoperatively with antibiotics.
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Yanov YK, Krivopalov AA, Shcherbuk YA, Artyushkin SA, Vakhrushev SG, Dorofeev VI, Komarov MV, Tuzikov NA. [The specific clinical features of otogenic intracranial complications: the current views]. Vestn Otorinolaringol 2015; 80:23-29. [PMID: 26525467 DOI: 10.17116/otorino201580523-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the present study was to elucidate the specific clinical features of otogenic intracranial complications (ICC) encountered in the current otorhinolaryngological practice. The work is based on the results of the retrospective analysis of 106 adult patients presenting with otogenic intracranial complications admitted for the treatment to multidisciplinary clinics of Sankt-Peterburg and Krasnoyarsk. Forty six (42.5%) patients presented with acute otitis media. 90% of them had suppurative destructive mastoiditis. In sixty (56.6%) patients, chronic suppurative otitis media (epitympanophonia) was associated with the extensive destructive process spreading toward dura mater of the medial and posterior cranial fossae and onto the sigmoid sinus. The prevalence of intracranial complications among the adult patients suffering from suppurative otitis media and treated in the otorhinolaryngological clinics amounted to 3.17%. The overall structure of otogenic intracranial complications was as follows: meningitis 42.5%, brain and cerebellum abscess 24.5%, suppurative meningoencephalitis 19.8%, sinus thrombosis 5.7%, epidural and subdural empyemas 4.7%, the combined suppurative brain lesions 2.8%. Systemic inflammatory response syndrome (sepsis) was diagnosed in 33 (31%) patients with otogenic ICC. The high intrahospital mortality rate among the patients with this condition (20.8%) is emphasized. The main causes of the fatal outcome in the patients with otogenic intracranial complications are supposed to be brain oedema with the concomitant development of dyslocation syndrome and sepsis.
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Affiliation(s)
- Yu K Yanov
- St.-Petersburg Research Institute of Ear, Nose, Throat, and Speech, Russian Ministry of Health, St.-Petersburg, Russia, 190013
| | - A A Krivopalov
- St.-Petersburg Research Institute of Ear, Nose, Throat, and Speech, Russian Ministry of Health, St.-Petersburg, Russia, 190013
| | - Yu A Shcherbuk
- St.-Petersburg State University, St.-Petersburg, Russia, 199034
| | - S A Artyushkin
- I.I. Mechnikov North-Western State Medical University, Russian Ministry of Health, St.-Petersburg, Russia, 199016
| | - S G Vakhrushev
- Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Russian Ministry of Health, Krasnoyarsk, Russia, 660022
| | - V I Dorofeev
- City Clinical Hospital No 26, St.-Petersburg, Russia, 196247
| | - M V Komarov
- City Clinical Hospital No 26, St.-Petersburg, Russia, 196247
| | - N A Tuzikov
- City Polyclinic No 17, St.-Petersburg, Russia, 195176
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42
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The changing epidemiological and complications profile of chronic suppurative otitis media in a developing country after two decades. Eur Arch Otorhinolaryngol 2015; 273:2461-6. [PMID: 26611685 DOI: 10.1007/s00405-015-3840-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
To evaluate the shift in epidemiological and complication profiles of chronic suppurative otitis media (CSOM) over two decades in a resource-limited economy. A retrospective analysis of the prevalence of CSOM and its complications in tertiary health institution a over a period of 2 years were compared between 203 cases seen in 2009 and December 2010 (present era); and 343 cases seen in 1990 and 1991 (previous era). Data were collected on the demographic characteristics of the patients, age of onset of otorrhoea, the disease type, laterality and complications of CSOM. The prevalence of CSOM significantly reduced from 9 % in the previous era to 5.1 % in the present era (P < 0.0001). The mean age of the recent group was 27.6 ± 19.3 years, and was 21.6 ± 18.2 years in the previous group. (P = 0.009). Although both group had peak age prevalence at 11-20 years, recent group saw more significant adult population >20 years of age (P ≤ 0.001). More significant cases of cholesteatoma were documented in the recent group (3.4 %) than previous era (0.9 %) (P = 0.02). Although no significant change was noted regarding the rates of complication of CSOM in the two eras (P = 0.18), there was a notable shift toward predominant extracranial pattern of complication in the recent group (P = 0.04). The prevalence of CSOM has shown a significant reduction after two decades and it appears that there has been a shift in the epidemiology of CSOM towards a predominantly adult population in the recent years. Despite an overall reduction in the incidence of intracranial complications of CSOM in our series, its complication rates have not changed remarkably after 20 years.
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43
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Pasha HM, Mirsky DM, Streubel SO. Massive ischemic stroke as a complication of otitis media. Int J Pediatr Otorhinolaryngol 2015; 79:1771-3. [PMID: 26304069 DOI: 10.1016/j.ijporl.2015.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 11/25/2022]
Abstract
Cerebral artery infarction as a complication of acute otitis media is a rare complication. The mechanism appears to be the spread of meningeal inflammation to involve the walls of intracranial vessels, resulting in arterial thrombosis with ischemia or rupture with hemorrhage. We report the case of a 3 year old female with a history of global developmental delay who sustained a large left hemispheric stroke after middle cerebral artery infarction as a complication of an acute otitis media.
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Affiliation(s)
- Hamza M Pasha
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO 80045, United States.
| | - David M Mirsky
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO 80045, United States.
| | - Sven O Streubel
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO 80045, United States.
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44
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Penido NDO, Chandrasekhar SS, Borin A, Maranhão ASDA, Gurgel Testa JR. Complications of otitis media - a potentially lethal problem still present. Braz J Otorhinolaryngol 2015; 82:253-62. [PMID: 26420564 PMCID: PMC9444657 DOI: 10.1016/j.bjorl.2015.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/12/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. Objective This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM). Methods Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. Results 80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. Conclusion ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.
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Affiliation(s)
- Norma de Oliveira Penido
- Department of Otorhinolaryngology Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil.
| | | | - Andrei Borin
- Department of Otorhinolaryngology Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - André Souza de Albuquerque Maranhão
- Department of Otorhinolaryngology Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - José Ricardo Gurgel Testa
- Department of Otorhinolaryngology Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil
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Karandikar A, Loke SC, Goh J, Yeo SB, Tan TY. Evaluation of cholesteatoma: our experience with DW Propeller imaging. Acta Radiol 2015; 56:1108-12. [PMID: 25260417 DOI: 10.1177/0284185114549568] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/13/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cholesteatoma management includes early detection and surgical exploration. Due to its tendency to recur, it can be potentially locally aggressive. Magnetic resonance imaging (MRI), and in particular diffusion weighted imaging (DWI), plays an important role in management of these lesions. PURPOSE To assess the accuracy of Propeller (Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction) DW sequence in detecting middle ear and mastoid cholesteatomas in non-operated ears by surgical correlation. MATERIAL AND METHODS A retrospective review of 15 patients was done who underwent Propeller DWI with either clinically confirmed or suspected cholesteatomas. Surgical correlation was done in all cases. RESULTS All patients had hyperintense foci on Propeller DWI. Surgical correlation performed revealed that 13 patients had cholesteatomas while two patients had mastoid abscesses. The location, extent, and size of cholesteatomas on Propeller DWI matched with the operative findings. Of the 13 patients with cholesteatomas, three patients had multiple foci of hyperintensity on Propeller DWI, which corroborated with the surgical finding of multiple cholesteatomas. The average apparent diffusion coefficient value of cholesteatoma was 0.868 × 10(-3) mm(2)/s, found to be higher than that of abscess, which was 0.425 × 10(-3) mm(2)/s. CONCLUSION Propeller DWI was accurate in assessing the location, extent, and size of cholesteatomas as corroborated with surgical findings. Propeller DWI is useful in detecting number of cholesteatoma foci, a vital finding as it may impact the choice of surgery.
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Affiliation(s)
| | - Siu Cheng Loke
- Department of Radiology, Tan Tock Seng Hospital, Singapore
| | - Julian Goh
- Department of Radiology, Tan Tock Seng Hospital, Singapore
| | - Seng Beng Yeo
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Tiong Yong Tan
- Department of Radiology, Changi General Hospital, Singapore
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Otogenic Brain Abscess Mimicking as Stroke. Otol Neurotol 2015; 36:e117-8. [DOI: 10.1097/mao.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ratre S, Yadav Y, Choudhary S, Parihar V, Kher Y, Hedaoo K. Pneumocephalus in cerebellopontine angle and meningitis secondary to chronic otitis media in a child. J Neurosci Rural Pract 2015; 6:413-6. [PMID: 26167031 PMCID: PMC4481802 DOI: 10.4103/0976-3147.158795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pneumocephalus is a rare complication of chronic otitis media. Despite its rarity intra-cranial air carries a potential risk of increased intra-cranial pressure or meningitis, which requires immediate therapy. A 10-year-old child presented to us with complaints of fever, headache, vomiting, and decreased hearing from left ear. He had history of left ear discharge since 2 years. Clinical examination revealed neck rigidity and left chronic otitis media. Contrast enhanced computed axial tomography scan of head [Figures 1 and 2] showed pneumocephalus in left cerebellopontine angle, opacification of left middle ear and nonpneumatisation of left mastoid. Child was immediately put on empirical intravenous antibiotics and decongestants. He showed clinical improvement in 3 days. Pneumocephalus secondary to chronic otitis media is extremely rare; we are reporting one such case in a child with review of literature.
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Affiliation(s)
- Shailendra Ratre
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Yadram Yadav
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Sushma Choudhary
- Department of Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Vijay Parihar
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Yatin Kher
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Ketan Hedaoo
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
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48
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Wu CC, Chang YP. Cerebral Ventriculitis Associated with Otogenic Meningoencephalitis in a Dog. J Am Anim Hosp Assoc 2015; 51:272-8. [PMID: 26083434 DOI: 10.5326/jaaha-ms-6174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A dog was evaluated for rapidly progressive mentation change, ataxia, and tetraparesis. The dog's neurological status deteriorated drastically. It became comatose with bilateral mydriasis, and the pupillary light reflex was absent. An anti-inflammatory dose of methylprednisolone was administered, and temporary stabilization of neurological status was achieved. MRI findings were suggestive of ventriculitis and meningoencephalitis originating from the left tympanic cavity. A gadolinium leakage phenomenon was noted, likely resulting from severe damage to the blood-cerebrospinal fluid barrier during the inflammatory process. Analysis of the cerebrospinal fluid and materials in the left tympanic cavity further confirmed the diagnosis. Following surgical and antibiotic treatment, the dog recovered well with only a mild residual head tilt. Seven months after surgery, the dog had a recurrent infection of the left tympanic cavity without intracranial involvement. A second surgery led to an uneventful recovery, and the dog was clinically normal except for a mild head tilt 3 yr after the initial presentation. This is the first report describing ventriculitis associated with otogenic meningoencephalitis in dogs and a gadolinium leakage phenomenon displayed on MRI. The long-term outcome of ventriculitis-complicated otogenic meningoencephalitis in dogs could be satisfied with prompt diagnosis and treatment.
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Affiliation(s)
- Chih-Ching Wu
- From the Graduate Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan, Province of China
| | - Ya-Pei Chang
- From the Graduate Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan, Province of China
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Choi J, Choi JI, Kim SD. Management of otogenic brain abscess using the transmastoid approach. J Korean Neurosurg Soc 2014; 55:178-80. [PMID: 24851158 PMCID: PMC4024822 DOI: 10.3340/jkns.2014.55.3.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/06/2013] [Accepted: 02/13/2014] [Indexed: 11/27/2022] Open
Abstract
Despite significant advances in the treatment of all forms of chronic otitis media (COM), complications still can and do occur, with intracranial complications representing the most life-threatening cases, often requiring immediate therapeutic intervention. Herein, we present a rare case of rapidly progressing facial paralysis with concomitant severe headache and ipsilateral hearing loss secondary to an otogenic brain abscess, treated with the transmastoid approach, drainage, and facial nerve decompression.
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Affiliation(s)
- June Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Jong Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Sang-Dae Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
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50
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Current trends in the management of the complications of chronic otitis media with cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 2014; 21:446-54. [PMID: 23892792 DOI: 10.1097/moo.0b013e3283646467] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Complications of cholesteatoma can be of a different nature from those of other otitis media. This review aims to undertake an analysis of current literature regarding management of the complications of cholesteatoma. RECENT FINDINGS Despite a significant decline in the incidence of complications secondary to cholesteatoma in developed countries it is still a considerable problem in the developing countries. Among intratemporal complications, facial nerve paralysis and labrynthine fistula and among intracranial complications, meningitis, brain abscess and lateral sinus thrombosis are most common. In cases of facial nerve paralysis, decompression with complete disease eradication is considered to be the mainstay of treatment and usefulness of an epineural incision and the range of the decompression are still debatable. Labyrinthine fistula is commonly managed by a single staged matrix removal, followed by closure of the fistula. Partial labrynthectomy in difficult cases is gaining favor among surgeons today. Meningitis and brain abscesses are treated with antibiotics and steroid therapy followed by surgery when the patient is neurologically stable. In lateral sinus thrombosis, mastoidectomy and removal of infected tissue is the primary treatment. Sinus incision and thrombectomy does not seem to improve recanalization and anticoagulation is usually not necessary. Treatment of meningoencephalic herniations is based mainly on the diameter of the herniation. SUMMARY There is considerable debate in the management of almost every complication of cholesteatoma. Multicentric studies to compare the efficacies of various treatment modalities are the need of the hour to come to definitive conclusions regarding the best treatment options.
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