Risk Factors Associated With Mortality in Patients With Otogenic Brain Abscess

Otogenic brain complications: a systematic review and meta-analysis

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.

Evaluating Equity Through the Social Determinants of Hearing Health

Hearing loss in adults is a significant public health problem throughout the world. Undiagnosed and untreated hearing loss causes a measurable impact on health and social, occupational, and emotional well-being of those affected. In spite of a wide array of health care resources to identify and manage hearing loss, there exist vast disparities in outcomes, as well as access to and utilization of hearing healthcare. Hearing rehabilitation outcomes may vary widely among different populations and there is a pressing need to understand, in a broader sense, the factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which is defined by the World Health Organization as "the conditions in which people are born, grow, work, live, and age." According to Healthy People 2030, these determinants can be broken into the following domains: healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment. This article defines these domains and examines the published research and the gaps in research of each of these domains, as it pertains to hearing health and healthcare. Herein, we review foundational sources on the social determinants of health and hearing-related research focused on the topic. Further consideration is given to how these factors can be evaluated in a systematic fashion and be incorporated into translational research and hearing health care.

Bacterial meningitis complicated by cerebral venous thrombosis

Introduction

Community-acquired bacterial meningitis may be complicated by cerebral venous thrombosis (CVT), but this has not systematically been studied.

Methods

We evaluated clinical characteristics and outcome of CVT in adults with community-acquired bacterial meningitis in a prospective nationwide cohort study of bacterial meningitis (2006–2018) in the Netherlands.

Results

CVT occurred in 26 of 2220 episodes with bacterial meningitis (1%). The diagnosis of CVT was made on the day of presentation in 15 patients (58%) and during hospital stay in 11 patients after a median of 6 days (IQR 2–7). Sinusitis or otitis was present in 16 of 24 patients (67%). Patients with CVT presented more often in a coma than those without CVT (53 vs. 18%; P = 0.001) and the clinical course was more often complicated by focal neurologic deficits (58 vs. 22%; P < 0.001). Twelve patients of 26 (46%) had parenchymal lesions on neuroimaging, of whom two (8%) were specific for CVT. The transverse sinus was most frequently thrombosed (18 of 26; 69%). Streptococcus pneumoniae was the most common causative pathogen, occurring in 17 of 26 patients (65%). Eleven patients (44%) received anticoagulant therapy with heparin and none of them developed intracerebral hemorrhage during admission. Unfavorable outcome, as defined as a score on the Glasgow Outcome Scale <5, occurred in 14 of 26 patients (54%) and 4 patients (15%) died.

Discussion and conclusion

CVT is a rare complication of bacterial meningitis and mainly occurs in patients with coma, ear, nose and throat infections, and focal neurologic deficits.

Clinical outcomes of different treatments and risk factors in patients with otogenic brain abscess, a real-world evidence-based retrospective study

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.