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Draut S, Müller J, Hempel JM, Schrötzlmair F, Simon F. Tenfold Increase: Acute Pediatric Mastoiditis Before, During, and After COVID-19 Restrictions. Otol Neurotol 2024; 45:777-782. [PMID: 38956778 DOI: 10.1097/mao.0000000000004238] [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: 07/04/2024]
Abstract
INTRODUCTION Acute mastoiditis (AM) is a relatively rare complication arising from acute otitis media, a common condition among children. The COVID-19 pandemic has significantly impacted AM cases. We noted a surge in pediatric AM cases in Germany after COVID-19 restrictions were lifted in 2022. This study assesses AM incidence and the clinical course in children before, during, and after the pandemic. The study also explores complication rates and microbial changes. METHODS Participants: We included children (0-18 yr) diagnosed with AM who underwent mastoidectomy at a tertiary-care university hospital from January 2012 to June 2023.Objectives: We aimed to evaluate AM incidence during pre-COVID, COVID, and post-COVID periods; assess complications; and analyze the microbial spectrum.Data Analysis: Incidence and complication rates were compared between periods, along with the microbial spectrum. RESULTS Population: 75 children were included (median age, 3.3 yr).Incidence: Significant increases in AM cases occurred in the post-COVID period compared to pre-COVID and COVID periods. No significant difference was observed between pre-COVID and COVID periods.Complications: Complication rates increased notably in the post-COVID period compared to pre-COVID and COVID periods with respect to more sensitive imaging methods being used in the post-COVID period. No significant difference was observed between pre-COVID and COVID periods.Spectrum of Pathogens: No significant differences were found in pathogen distribution between periods. Streptococcus pyogenes and Streptococcus pneumoniae were common throughout. DISCUSSION The study highlights a substantial rise in AM cases and complications after COVID-19 restrictions were lifted in Germany. This underscores the importance of monitoring infectious diseases and their complications during health crises. Additionally, the study highlights the importance of contrast-enhanced imaging. Further research is needed to explore the mechanisms behind this trend. CONCLUSION The study reveals a significant increase in pediatric AM cases and complications following the COVID-19 pandemic in Germany. Adequate computed tomographic or magnetic resonance imaging, including contrast enhancement, is shown to be a very important parameter beside clinical symptoms in deciding for the right therapy. Thus, surgical treatment became more important. Continuous monitoring and adaptive healthcare strategies during health crises are vital for optimal patient care. Further research is warranted to understand the reasons behind these trends and to inform future pandemic preparedness efforts.
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Affiliation(s)
- Sarah Draut
- Department of Otorhinolaryngology, Head and Neck Surgery, LMU University Hospital, München, Germany
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Guillén-Lozada E, Bartolomé-Benito M, Moreno-Juara Á. Surgical management of mastoiditis with intratemporal and intracranial complications in children. Outcome, complications, and predictive factors. Int J Pediatr Otorhinolaryngol 2023; 171:111611. [PMID: 37352591 DOI: 10.1016/j.ijporl.2023.111611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Intratemporal or intracranial complications of acute mastoiditis are often of significant severity, can be life-threatening, and require prompt and usually aggressive treatment. This study focused on analyzing the outcomes and complications of different surgical techniques used in intracranial and intratemporal complications of acute mastoiditis, the most common complication of acute otitis media. METHODS A retrospective study of pediatric patients with mastoiditis with intratemporal and intracranial complications was designed at the Niño Jesús University Children's Hospital in Madrid, Spain, from 2005 to 2021. RESULTS Of 417 patients with mastoiditis, 112 patients developed intratemporal and intracranial complications, with subperiosteal abscess being the most frequent complication. The most frequently isolated pathogens were Streptococcus pneumoniae, Streptococcus pyogenes, and Fusobacterium necrophorum. The most used surgical technique was myringotomy with placement of transtympanic drainage, in 86.6% of all cases. In patients with intracranial complications, neurosurgical procedures were necessary for 19.2%, with craniotomy with mastoidectomy being the most frequent. Most of the cases evolved favorably, and only 5.4% of the patients required surgical reintervention, being more frequent in intratemporal complications. In terms of complications, we found cases of neutropenia in 3.6%, neurological sequelae in 5.4%, and permanent hearing loss in 2.7%. CONCLUSIONS There was a favorable evolution with a low incidence of reoperation and sequelae within our series. The surgical technique of choice correlated with the severity of the complication. If the mean size of the abscess exceeds 20 mm, incision and drainage, along with myringotomy and tube placement, should be considered as the initial treatment. Closed mastoidectomy should be reserved for deteriorating of clinical evolution or acute mastoiditis with intracranial complications. Intracranial and multiple concomitant complications were associated with a more extended hospital stay, ICU occupancy, neurosurgical intervention, and risk of neurological sequelae and neutropenia. Conversely, intratemporal complications may result in permanent hearing loss.
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Affiliation(s)
- Enrique Guillén-Lozada
- Otorhinolaryngology Department, Niño Jesus University Children's Hospital, Madrid, Spain.
| | | | - Ángel Moreno-Juara
- Otorhinolaryngology Department, Niño Jesus University Children's Hospital, Madrid, Spain
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Intratemporal and intracranial complications of acute mastoiditis in children. Why do they occur? An analysis of risk factors. Int J Pediatr Otorhinolaryngol 2022; 156:111124. [PMID: 35378485 DOI: 10.1016/j.ijporl.2022.111124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
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Abstract
BACKGROUND The objective of our study was to evaluate the efficacy of treatment options for the most frequently reported complications of acute mastoiditis in the English literature. PubMed, EMBASE, and The Cochrane Library were searched from database inception through March 29, 2019. METHODS Two independent reviewers (M.R.K., K.S.) evaluated search results for study inclusion. References cited in publications meeting inclusion criteria were reviewed. Twenty-three included studies were published from 1998 through 2018. Treatment efficacy was determined by comparing the change in number of complication subtypes in each treatment subgroup (medical, conservative, or surgical) from admission to discharge (range: 5-30 days) or postdischarge follow-up (range: 1-27.5 months) with a random effects model. RESULTS Among 733 identified articles, 23 met inclusion criteria. Of the 883 included patients, 203 were managed medically (23%), 300 conservatively (34%) and 380 surgically (43%). Conservative patients had more extracranial complications (ECC, P = 0.04) and intratemporal complications (IT, P = 0.04) at follow-up compared with medical patients. Medical patients had more total number of complications (TNC, P = 0.03), ECC (P = 0.02), and IT (P = 0.01) at discharge compared with surgical patients. Conservative patients had more of all complications except intracranial/extracranial abscess and "other" at discharge and follow-up compared with surgical patients. CONCLUSIONS There were larger reductions in TNC, ECC, and IT at discharge and follow-up among surgical patients compared with medical and conservative patients. There were greater reductions in TNC, ECC, IT, intracranial complications, subperiosteal abscess and lateral sinus thrombosis at discharge and follow-up among surgical patients compared with conservative patients.
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Bernatz S, Mahmoudi S, Martin SS, Burck I, Vogl TJ, Ackermann J, Stöver T, Balster S, Gröger M. Differences in mastoid and middle-ear cavity opacification in CT between intensive care patients and patients with acute mastoiditis requiring surgical treatment. Eur J Radiol Open 2021; 8:100365. [PMID: 34195304 PMCID: PMC8227832 DOI: 10.1016/j.ejro.2021.100365] [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: 05/01/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To stratify differences in visual semantic and quantitative imaging features in intensive care patients with nonspecific mastoid effusions versus patients with acute mastoiditis (AM) requiring surgical treatment. Methods We included 48 patients (male, 28; female, 20; mean age, 59.5 ± 18.1 years) with mastoid opacification (AM, n = 24; control, n = 24) who underwent clinically indicated cerebral CT between 12/2007 and 07/2018 in this retrospective study. Semantic features described the extend and asymmetry of mastoid and middle-ear cavity opacification and complications like erosive changes. Minimum, maximum and mean Hounsfield unit (HU) values were obtained as quantitative features. We analyzed the features employing univariate testing. Results Compared to intensive care patients, AM patients revealed asymmetric mastoid or middle-ear cavity opacification (likelihood-ratio (LR) < 0.001). Applying a dedicated threshold of the extent of opacification, AM patients reached significance levels of LR = 0.042 and 0.002 for mastoid and middle-ear cavity opacification. AM cases showed higher maximum and mean HU values (p = 0.009, p = 0.024). Conclusions We revealed that the extent and asymmetry of mastoid and middle-ear cavity opacification differs significantly between AM patients and intensive care patients. Multicenter research is needed to expand our cohort and possibly pave the way to build a non-invasive predictive model for AM in the future.
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Affiliation(s)
- Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Corresponding author.
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Simon S. Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Iris Burck
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jörg Ackermann
- Department of Molecular Bioinformatics, Institute of Computer Science, Johann Wolfgang Goethe-University, Robert-Mayer-Str. 11-15, 60325 Frankfurt am Main, Germany
| | - Timo Stöver
- Department of Otorhinolaryngology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Sven Balster
- Department of Otorhinolaryngology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Maximilian Gröger
- Department of Otorhinolaryngology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Saat R, Kurdo G, Laulajainen-Hongisto A, Markkola A, Jero J. Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT. Clin Neuroradiol 2020; 31:589-597. [PMID: 32696283 PMCID: PMC8463380 DOI: 10.1007/s00062-020-00931-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
Purpose Current imaging standard for acute mastoiditis (AM) is contrast-enhanced computed tomography (CT), revealing inflammation-induced bone destruction, whereas magnetic resonance imaging (MRI) outperforms CT in detecting intracranial infection. Our aim was to compare the diagnostic performance of MRI with CT in detecting coalescent AM and see to which extent MRI alone would suffice to diagnose or rule out this condition. Methods The MR images of 32 patients with AM were retrospectively analyzed. Bone destruction was evaluated from T2 turbo spin echo (TSE) and T1 Gd magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images. Intramastoid enhancement and diffusion restriction were evaluated subjectively and intramastoid apparent diffusion coefficient (ADC) values were measured. The MRI findings were compared with contrast-enhanced CT findings of the same patients within 48 h of the MR scan. Results Depending on the anatomical subsite, MRI detected definite bone defects with a sensitivity of 100% and a specificity of 54–82%. Exception was the inner cortical table where sensitivity was only 14% and specificity was 76%. Sensitivity for general coalescent mastoiditis remained 100% due to multiple coexisting lesions. The absence of intense enhancement and non-restricted diffusion had a high negative predictive value for coalescent mastoiditis: an intramastoid ADC above 1.2 × 10−3 mm2/s excluded coalescent mastoiditis with a negative predictive value of 92%. Conclusion The MRI did not miss coalescent mastoiditis but was inferior to CT in direct estimation of bone defects. When enhancement and diffusion characteristics are also considered, MRI enables dividing patients into low, intermediate and high-risk categories with respect to coalescent mastoiditis, where only the intermediate risk group is likely to benefit from additional CT.
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Affiliation(s)
- R Saat
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, POB 340 Haartmaninkatu 4, HUS 00029, Helsinki, Finland.
- Radiology, East Tallinn Central Hospital, Ravi tn. 18, 10138, Tallinn, Estonia.
| | - G Kurdo
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, POB 340 Haartmaninkatu 4, HUS 00029, Helsinki, Finland
| | - A Laulajainen-Hongisto
- Otorhinolaryngology and Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, POB 263 Kasarmikatu 11-13, HUS 00029, Helsinki, Finland
| | - A Markkola
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, POB 340 Haartmaninkatu 4, HUS 00029, Helsinki, Finland
| | - J Jero
- Otorhinolaryngology and Head and Neck Surgery, University of Turku and Turku University Hospital, POB 52 Kiinamyllynkatu 4-8, 20521, Turku, Finland
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The National Landscape of Acute Mastoiditis: Analysis of the Nationwide Readmissions Database. Otol Neurotol 2020; 41:1084-1093. [PMID: 32569137 DOI: 10.1097/mao.0000000000002745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine risk factors for readmission, prolonged length of stay, and discharge to a rehabilitation facility in patients with acute mastoiditis. Trends in treatment and complication rates were also examined. STUDY DESIGN Retrospective cohort study. SETTING Nationwide Readmissions Database (2013, 2014). PATIENTS Pediatric and adult patients in the Nationwide Readmissions Database with a primary diagnosis of acute mastoiditis. INTERVENTIONS Medical treatment, surgical intervention. OUTCOME MEASURES Rates of and risk factors for readmission, prolonged length of stay, and discharge to a rehabilitation facility. Procedure and complication rates were also examined. RESULTS Four thousand two hundred ninety-five pediatric and adult admissions for acute mastoiditis were analyzed. The overall rates of readmission, prolonged length of stay, and discharge to a rehabilitation facility were 17.0, 10.4, and 10.2%, respectively. Children 4 to 17 years of age had the highest rates of intracranial complications, and children ≤3 years were most likely to undergo operative intervention. Any procedure was performed in 31.2% of cases, and undergoing myringotomy or mastoidectomy was associated with lower rates of readmission but higher rates of prolonged length of stay. Those with intracranial complications and subperiosteal abscesses had the highest surgical intervention rates. CONCLUSIONS Readmission, prolonged length of stay, and discharge to a rehabilitation facility are common in patients with acute mastoiditis with various sociodemographic and disease-related risk factors. While once a primarily surgical disease, a minority of patients in our cohort underwent procedures. Undergoing a surgical procedure was protective against readmission but a risk factor for prolonged length of stay.
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Anne S, Schwartz S, Ishman SL, Cohen M, Hopkins B. Medical Versus Surgical Treatment of Pediatric Acute Mastoiditis: A Systematic Review. Laryngoscope 2018; 129:754-760. [DOI: 10.1002/lary.27462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Samantha Anne
- Department of Otolaryngology-Head and Neck Surgery; Cleveland Clinic; Cleveland Ohio
| | - Seth Schwartz
- Department of Otolaryngology-Head and Neck Surgery; Virginia Mason Medical Center; Seattle Washington
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Division of Pulmonary Medicine; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
| | - Michael Cohen
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Brandon Hopkins
- Department of Otolaryngology-Head and Neck Surgery; Cleveland Clinic; Cleveland Ohio
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Saat R, Kurdo G, Brandstack N, Laulajainen-Hongisto A, Jero J, Markkola A. A New Classification System is Helpful in Diagnosing Intracranial Complications of Acute Mastoiditis in CT. Clin Neuroradiol 2017; 28:523-528. [PMID: 28801828 DOI: 10.1007/s00062-017-0617-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the usefulness of the new computed tomography (CT) classification criteria proposed by Horowitz et al. and their effect on inter-observer agreement when estimating intracranial complications of acute mastoiditis. METHODS In this study 53 contrast-enhanced CT scans of patients with acute mastoiditis were each retrospectively reviewed by two radiologists, using two different assessment criteria for intracranial complications. According to the new criteria, intracranial CT findings in the perisinuous area were graded into four classes (I normal, II linear halo, III nodular halo ≤4 mm thick and IV nodular halo >4 mm thick), where classes III and IV indicate a high risk for epidural abscesses. Inter-reader agreement was estimated by weighted kappa analysis for both methods. RESULTS With the old method, epidural abscesses were suspected in six and venous sinus thrombosis in five patients. With the new method, high-risk perisinuous lesions (classes III or IV) were detected in 11 patients, and sinus thrombosis outside the perisinuous area in 3 patients. All epidural abscesses were in the perisinuous area. Of the patients four, in whom intracranial pathology was not suspected with the old method, fell into the high-risk group (class III) according to the new method. All class IV lesions were also determined to be pathological with the old method. The inter-observer agreement (weighted kappa) rose from 0.21 (old method) to 0.80 (new method) when assessing epidural abscesses and from 0.44 (old method) to 0.85 (new method) when assessing sinus thrombosis. CONCLUSION The new assessment method raised the inter-observer agreement for detection of intracranial acute mastoiditis complications, namely epidural abscesses and venous sinus thrombosis.
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Affiliation(s)
- R Saat
- Dept. of Radiology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, HUS 00029, POB 340, Helsinki, Finland. .,Dept. of Radiology, East Tallinn Central Hospital, Ravi tn.18, 10138, Tallinn, Estonia.
| | - G Kurdo
- Dept. of Radiology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, HUS 00029, POB 340, Helsinki, Finland
| | - N Brandstack
- Dept. of Radiology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, HUS 00029, POB 340, Helsinki, Finland
| | - A Laulajainen-Hongisto
- Dept. of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, HUS 00029, Helsinki, Finland
| | - J Jero
- Dept. of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, HUS 00029, Helsinki, Finland.,Dept. of Otorhinolaryngology and Head and Neck Surgery, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, P.O.BOX 52, 20521, Turku, Finland
| | - A Markkola
- Dept. of Radiology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, HUS 00029, POB 340, Helsinki, Finland
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Xiang Y, Jin C, Wang W, Wang Z, Huang Y, Fan F, Ma Y, Zhang X, Xu W, Yin Y, He Y. The critical role of myeloperoxidase in Streptococcus pneumoniae clearance and tissue damage during mouse acute otitis media. Innate Immun 2017; 23:296-306. [PMID: 28359218 DOI: 10.1177/1753425917693907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We have recently reported that neutrophils play a pivotal role in innate defense against Streptococcus pneumoniae ( Spn) during mouse acute otitis media (AOM). However, the underlying mechanism remains unclear. By constructing models of pneumococcal AOM in C57BL/6 mice and using a specific inhibitor in vivo, we investigated the role of myeloperoxidase (MPO), one of the most important protein components of neutrophils. Experiment results showed a significant increase in MPO production of the recruited neutrophils in Spn-infected mice. Neutrophils killed Spn in a MPO-dependent manner. MPO facilitated the generation of reactive oxygen species (ROS), and consequently promoted Spn clearance at an early stage and exacerbated tissue damage. Moreover, MPO induced neutrophil apoptosis and necrosis, which, in turn, worsened tissue damage. In summary, our study demonstrates that neutrophil MPO plays a paradoxical role in bacterial clearance and tissue damage in pneumococcal AOM.
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Affiliation(s)
- Yun Xiang
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
| | - Chunfang Jin
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China.,2 Department of Laboratory Medicine, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People's Republic of China
| | - Wei Wang
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China.,3 The Sixth People's Hospital of Chongqing City, Chongqing, People's Republic of China
| | - Zimeng Wang
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
| | - Yifei Huang
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
| | - Fangmei Fan
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
| | - Yurong Ma
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
| | - Xuemei Zhang
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
| | - Wenchun Xu
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
| | - Yibing Yin
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
| | - Yujuan He
- 1 Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, People's Republic of China
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Ghadersohi S, Young NM, Smith-Bronstein V, Hoff S, Billings KR. Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital. Laryngoscope 2016; 127:2321-2327. [PMID: 27796038 DOI: 10.1002/lary.26365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/31/2016] [Accepted: 09/09/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the presentation and management of acute complicated mastoiditis in children. STUDY DESIGN Retrospective case series. METHODS An analysis of pediatric patients with acute complicated mastoiditis treated at an urban, tertiary care children's hospital from 2007 to 2014 was performed. RESULTS Forty-eight patients presented with a total of 67 complications of acute mastoiditis. Mean age at presentation was 4.8 years (range = 0.1-15.3 years). The most common complications were subperiosteal abscess (n = 22, 45.8%), epidural abscess (n = 16, 33.3%), and sigmoid sinus thrombosis (n = 14, 29.2%). The most common pathogens isolated included Streptococcus pneumoniae (n = 14, 29.2%) and group A streptococcus (n = 10, 20.8%). Multidrug resistance was not associated with complication type. Surgical management included myringotomy ± tympanostomy tube placement in 46 (95.8%) patients (the only surgery in 10), drainage of subperiosteal abscess without mastoidectomy in 18 (37.5%) patients, and mastoidectomy in 21 (43.8%) total patients. Patients presenting with intracranial complications were the most likely to undergo a mastoidectomy. Anticoagulation was used in the management of nine of 14 (64.3%) patients presenting with sigmoid sinus thrombosis. Neurosurgical interventions (n = 7, 14.6% patients) were primarily performed to manage increased intracranial pressure. CONCLUSIONS Subperiosteal abscess was the most common complication of acute mastoiditis, and when occurring as the sole complication was successfully managed with antibiotics and surgical intervention that did not include mastoidectomy. Epidural abscess and sigmoid sinus thrombosis were more prevalent than reported in prior series and were managed more aggressively. These patients were more likely to need neurosurgical interventions. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2321-2327, 2017.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Nancy M Young
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Virginia Smith-Bronstein
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Stephen Hoff
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Kathleen R Billings
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
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12
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Saat R, Mahmood G, Laulajainen-Hongisto A, Lempinen L, Aarnisalo AA, Jero J, Markkola A. Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images. Eur Radiol 2015; 26:2632-9. [PMID: 26607577 DOI: 10.1007/s00330-015-4113-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/14/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare MR imaging features in patients with incidental mastoid T2-hyperintensity with those of clinical acute mastoiditis, to ascertain characteristic differences between them. METHODS MR images of 35 adult and paediatric patients with clinical acute mastoiditis and 34 consecutive age-matched controls without relevant middle ear pathology and with incidental T2-hyperintensity that covered ≥ 50 % of the mastoid were retrospectively analysed with regard to signal, diffusion, and enhancement characteristics, and presence of complications. RESULTS Incidental mastoid T2-hyperintensity that covered ≥ 50 % of the mastoid volume was found in 4.6 % of reviewed MR scans (n = 2341), and associated significantly (p < 0.05) less with the involvement of the tympanic cavity (38 % vs. 74 %) and mastoid antrum (56 % vs. 80 %), hypointense-to-CSF signal intensity on T2 FSE (6 % vs. 86 %), intramastoid diffusion restriction (0 % vs. 62 %), intense intramastoid enhancement (0 % vs. 51 %), periosteal enhancement (3 % vs. 69 %), perimastoid dural enhancement 3 % vs. 43 %), bone destruction (0 % vs 49 %), intratemporal abscess or cholesteatoma (0 % vs. 24 %), labyrinth involvement (0 % vs. 14 %), and extracranial abscesses (0 % vs. 20 %). CONCLUSION Hypointense-to-CSF signal intensity on T2WI, restricted diffusion, intense intramastoid enhancement among other MR imaging characteristics favoured an acute mastoiditis diagnosis over clinically non-relevant incidental mastoid pathology. KEY POINTS • Intramastoid T2-hyperintensity alone is not a reliable sign for acute mastoiditis. • In acute mastoiditis, intramastoid T2-weighted signal intensity is usually hypointense to CSF. • Diffusion restriction and intense intramastoid enhancement are absent in incidental mastoid effusion. • An ADC value ≥ 1.72 × 10 (-3) mm (2) /s contradicts the AM diagnosis.
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Affiliation(s)
- R Saat
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, POB 340, Haartmaninkatu 4, Helsinki, 00029, Finland. .,Department of Radiology, East Tallinn Central Hospital, Tallinn, Estonia.
| | - G Mahmood
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, POB 340, Haartmaninkatu 4, Helsinki, 00029, Finland
| | - A Laulajainen-Hongisto
- Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - L Lempinen
- Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A A Aarnisalo
- Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Jero
- Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Markkola
- Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, POB 340, Haartmaninkatu 4, Helsinki, 00029, Finland
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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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Urík M, Machač J, Šlapák I, Hošnová D. Pott's puffy tumor: a rare complication of acute otitis media in child: a case report. Int J Pediatr Otorhinolaryngol 2015; 79:1589-91. [PMID: 26148429 DOI: 10.1016/j.ijporl.2015.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/18/2022]
Abstract
To describe a rare case of Potts' puffy tumor (PPT) in the zygomatic area, which developed as a complication of acute otitis media in a 6-year-old child. To date, only one case of PPT has been described in the literature as a complication of latent mastoiditis in an adult, and one case of PPT as a complication of acute mastoiditis in a 10-year-old child. Urgent surgical intervention, including evacuation of the purulent lesion, removal of inflamed soft tissue and osteolysis of the involved bone, and antromastoidectomy, intravenous treatment with broad-spectrum antibiotics, including G+, G-, anaerobes and fungi, and local therapy.
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Affiliation(s)
- Milan Urík
- Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno, Černopolní 9, 61300, Czech Republic.
| | - Josef Machač
- Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno, Černopolní 9, 61300, Czech Republic
| | - Ivo Šlapák
- Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno, Černopolní 9, 61300, Czech Republic
| | - Dagmar Hošnová
- Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno, Černopolní 9, 61300, Czech Republic
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Takahashi K, Yamamoto Y, Ogi M, Ohshima S, Morita Y, Takahashi S. A case of lateral sinus insufficiency with acute otitis media: Early surgical intervention for prevention of lateral sinus thrombosis. Auris Nasus Larynx 2015; 42:492-5. [PMID: 26031937 DOI: 10.1016/j.anl.2015.04.007] [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: 01/19/2015] [Revised: 04/08/2015] [Accepted: 04/27/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a case of lateral sinus insufficiency, presumably occurring just prior to lateral sinus thrombosis (LST), and to discuss the importance of early surgical intervention and the pathophysiology of full-blown LST. CASE REPORT A 4-year-old boy developed headaches and vomiting after exhibiting typical symptoms of acute otitis media. Contrast-enhanced CT revealed narrowing of the sigmoid sinus medially by gas and low-density material. We diagnosed the patient with suspected LST and consequently performed mastoidectomy. A large amount of bloody pus was found in the mastoid cavity and below the bony sinus plate. Sigmoid sinus blood flow was completely restored after drainage of the hemorrhagic and purulent material, and the patient recovered fully. CONCLUSION Because of the anatomical features of the dural venous sinus, hemorrhage per diapedesis may be strongly associated with the development of LST. In the patient with suspected LST, early diagnosis and surgery prior to the development of intravenous thrombus are key for full recovery from this condition.
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Affiliation(s)
- Kuniyuki Takahashi
- Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan.
| | - Yutaka Yamamoto
- Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan
| | - Manabu Ogi
- Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan
| | - Shinsuke Ohshima
- Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan
| | - Yuka Morita
- Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan
| | - Sugata Takahashi
- Department of Otolaryngology, Head and Neck Surgery, Niigata University Faculty of Medicine, Japan
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Mattos JL, Colman KL, Casselbrant ML, Chi DH. Intratemporal and intracranial complications of acute otitis media in a pediatric population. Int J Pediatr Otorhinolaryngol 2014; 78:2161-4. [PMID: 25447953 DOI: 10.1016/j.ijporl.2014.09.032] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review all cases intratemporal and intracranial complications of acute otitis media (AOM) in infants and children from 1998 to 2013. METHODS Retrospective chart review of 109 consecutive patients admitted for complications of AOM during a 15-year period at a tertiary-care children's hospital. The main outcomes are: (1) complications of AOM, (2) bacteriology, (3) management strategies. RESULTS In our population, complications included mastoiditis (86.1%), subperiosteal abscess (38%), facial nerve palsy (16.7%), sigmoid sinus thrombosis (8.3%) and epidural abscess (7.4%). Other complications included post-auricular cellulitis, otic hydrocephalus and elevated intracranial pressure, internal jugular thrombosis, cranial nerve VI palsy and Gradenigo's syndrome, labyrinthine fistula, sensorineural hearing loss, and cerebellar infarct. Sixty-one patients (56%) received antibiotics prior to presentation. Cultures revealed Streptococcus pneumoniae in 36 patients (33.3%), other bacteria in 30 patients (27.8%), and "no growth" in 33 patients (30.5%). Nine patients (8.3%) did not undergo culture. Of the patients with S. pneumoniae, 20 cultures (55%) were found to be multidrug-resistant. Eleven patients (10.2%) were treated non-surgically, 31 (31%) were treated with myringotomy and intravenous antibiotics. Forty patients (97.5%) presenting with subperiosteal abscess required mastoid surgery. Thirteen of 18 (72.2%) patients with facial paralysis had full recovery. Eight of 10 (80%) patients with epidural abscess empyema required mastoid surgery and incision and drainage of the abscess. CONCLUSION Complications of AOM are uncommon, yet continue to have potentially serious consequences. The bacteriology in this population reveals an increasing trend of multi-drug resistant S. pneumoniae as the causative organism.
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Affiliation(s)
- Jose L Mattos
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States
| | - Kathryn L Colman
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States
| | - Margaretha L Casselbrant
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States
| | - David H Chi
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States.
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Rosdy B, Csákányi Z, Kollár K, Móser J, Mellár M, Kulcsár A, Kovács É, Várallyay G, Katona G. Visual and neurologic deterioration in otogenic lateral sinus thrombosis: 15 year experience. Int J Pediatr Otorhinolaryngol 2014; 78:1253-7. [PMID: 24933360 DOI: 10.1016/j.ijporl.2014.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/27/2014] [Accepted: 05/03/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Otogenic lateral sinus thrombosis is a rare complication of acute otitis media whose clinical presentation has changed with the early use of antibiotics. The aim of this study was to analyze the changing clinical signs, vaccination status, therapeutic management and outcome of these patients. METHODS Retrospective chart review of 10 children treated with otogenic lateral sinus thrombosis in a tertiary level teaching hospital in Budapest, Hungary, from January 1998 till August 2013. RESULTS Patients were divided into Early and Late presenting groups. In the Early presenting group, sepsis developed within one week after the onset of acute otitis media. At admission otological symptoms were predominant. The Late presenting group experienced acute otitis media several weeks prior to presentation and in this group neurologic symptoms dominated the clinical picture at admission. All patients received antibiotics. Eight of them were also treated with low molecular weight heparin. All children underwent cortical mastoidectomy. After surgery, the clinical signs of elevated intracranial pressure transiently worsened. This manifested as progression of papilledema in seven children, causing severe visual disturbance in two cases. After medical treatment and serial lumbar punctures all patients except one recovered. This child has permanent visual acuity failure of 0.5D unilaterally. At one year follow up complete and partial recanalization were noted in five and two patients, respectively. CONCLUSIONS After mastoidectomy the signs of elevated intracranial pressure can transiently worsen, papilledema can progress. Daily bedside monitoring of visual acuity and regular ophthalmoscopy with neurologic examination is recommended during hospitalization. Close follow up is advised up to one year. When the dominant sinus is occluded, the clinical scenario is more protracted and severe.
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Affiliation(s)
- Beáta Rosdy
- Department of Neurology, Heim Pál Children's Hospital, Budapest, Hungary.
| | - Zsuzsanna Csákányi
- Department of ENT & Bronchology, Heim Pál Children's Hospital, Budapest, Hungary.
| | - Katalin Kollár
- Department of Neurology, Heim Pál Children's Hospital, Budapest, Hungary.
| | - Judit Móser
- Department of Neurology, Heim Pál Children's Hospital, Budapest, Hungary.
| | - Mónika Mellár
- Department of Neurology, Heim Pál Children's Hospital, Budapest, Hungary
| | - Andrea Kulcsár
- Department of Paediatric Infectology, United St István and St László Hospital, Budapest, Hungary.
| | - Éva Kovács
- Department of Radiology, Heim Pál Children's Hospital, Budapest, Hungary.
| | - György Várallyay
- Semmelweis Medical School MR Research Center, Budapest, Hungary.
| | - Gábor Katona
- Department of ENT & Bronchology, Heim Pál Children's Hospital, Budapest, Hungary.
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19
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Novoa E, Podvinec M, Angst R, Gürtler N. Paediatric otogenic lateral sinus thrombosis: therapeutic management, outcome and thrombophilic evaluation. Int J Pediatr Otorhinolaryngol 2013; 77:996-1001. [PMID: 23639339 DOI: 10.1016/j.ijporl.2013.03.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Otogenic lateral sinus thrombosis (LST) in children represents a serious condition with potential long-lasting morbidity. The role of adjunct anticoagulation therapy and the benefit of an analysis of prothrombotic factors are unclear. The aim of the study was to report therapeutic management and outcome, analyze prothrombotic factors in children with otogenic LST treated with mastoidectomy/antibiotics/anticoagulation and to evaluate the results with a review of the literature. METHODS Retrospective chart review of 9 children with otogenic LST (2000-2009) and literature search in PubMed. RESULTS The most frequent sign was fever in 88%, while neurologic findings were seen in 55%. Streptococci was the most common bacteria (55%). Prothrombotic factors were normal in all children. All patients received therapeutic anticoagulation, without experiencing bleeding complications. Eight children made a full recovery, neurologic sequelae persisted in one. The literature review of 115 children identified fever as the most prominent sign, reported the absence of neurologic findings in almost 50% of cases and confirmed the major role of streptococci. Anticoagulation, as adjunct therapy, was given to 38% of patients in the therapeutic range with a trend towards better neurologic outcome. A prothrombotic analysis was reported in 5 studies with positive results in 2. CONCLUSIONS Surgery and antibiotics represent the mainstay of the therapy. Anticoagulation can be safely added in view of the high potential for morbidity and might reduce neurologic sequelae. Bacteria with thrombotic activity seem to be an important aetiology. In contrast, a prothrombotic disposition seems to play a minor role in the development of otogenic LST.
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Affiliation(s)
- Eva Novoa
- Klinik für Hals-Nasen-Ohrenkrankheiten, Hals-Gesichtschirurgie, Kantonsspital Aarau, Switzerland
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Jung TTK, Alper CM, Hellstrom SO, Hunter LL, Casselbrant ML, Groth A, Kemaloglu YK, Kim SG, Lim D, Nittrouer S, Park KH, Sabo D, Spratley J. Panel 8. Otolaryngol Head Neck Surg 2013; 148:E122-43. [DOI: 10.1177/0194599812467425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Objectives Although serious complications of otitis media (OM) such as brain abscess are rare, sequelae of OM such as tympanic membrane perforation and atelectatic tympanic membrane are quite common. Inner ear sequelae can cause hearing loss and speech and language problems. The objectives of this article are to provide a state-of-the-art review on recent articles on complications and sequelae of OM in different anatomic locations, from the tympanic membrane to intracranial sites, as well as hearing loss and speech and language development. Data Sources Primarily PubMed supplemented by Ovid MEDLINE and the Cochrane Database. Review Methods All types of articles related to OM complications and sequelae published in English between January 2007 and June 2011 were identified. A total of 127 relevant quality articles are summarized and included in this report. Results Key findings are summarized based on the following major anatomic locations and categories: tympanic membrane; cholesteatoma; ossicular problems; mucosal sequelae; inner ear sequelae; speech and language development; extracranial areas, including mastoiditis and facial nerve paralysis; intracranial complications; and future research goals. New information and insights were gained to prevent complications and sequelae. Conclusion and Implications for Practice Over the past 4 years, progress has been made in advancing the knowledge on the complications and sequelae of OM, which can be used to prevent and treat them effectively. Areas of potential future research have been identified and outlined.
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Affiliation(s)
- Timothy T. K. Jung
- Department of Otolaryngology, Loma Linda University, Loma Linda, California, USA
| | - Cuneyt M. Alper
- Division of Pediatric Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sten O. Hellstrom
- Department of Audiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa L. Hunter
- Division of Audiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Anita Groth
- Department of Otolaryngology, University of Lund, Lund, Sweden
| | | | - Sang Gyoon Kim
- Department of Otolaryngology, Loma Linda University, Loma Linda, California, USA
| | - David Lim
- House Ear Institute, Los Angeles, California, USA
| | - Susan Nittrouer
- Division of Audiology, Ohio State University, Columbus, Ohio, USA
| | - Kee Hyun Park
- Department of Otolaryngology, Ajou University, Suwon, Korea
| | - Diane Sabo
- Division of Audiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jorge Spratley
- Department of Otolaryngology, University of Porto, Porto, Portugal
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Mastoid subperiosteal abscess in children: drainage or mastoidectomy? The Journal of Laryngology & Otology 2012; 126:1204-8. [PMID: 23098060 DOI: 10.1017/s0022215112002332] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the management of mastoid subperiosteal abscess using two different surgical approaches: simple mastoidectomy and abscess drainage. METHOD The medical records of 34 children suffering from acute mastoiditis with subperiosteal abscess were retrospectively reviewed. In these cases, the initial surgical approach consisted of either myringotomy plus simple mastoidectomy or myringotomy plus abscess drainage. RESULTS Thirteen children were managed with simple mastoidectomy and 21 children were initially managed with abscess drainage. Of the second group, 12 children were cured without further treatment while 9 eventually required mastoidectomy. None of the children developed complications during hospitalisation, or long-term sequelae. CONCLUSION Simple mastoidectomy remains the most effective procedure for the management of mastoid subperiosteal abscess. Drainage of the abscess represents a simple and risk-free, but not always curative, option. It can be safely used as an initial, conservative approach in association with myringotomy and sufficient antibiotic coverage, with simple mastoidectomy reserved for non-responding cases.
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Luntz M, Bartal K, Brodsky A, Shihada R. Acute mastoiditis: The role of imaging for identifying intracranial complications. Laryngoscope 2012; 122:2813-7. [DOI: 10.1002/lary.22193] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 06/12/2011] [Accepted: 06/15/2011] [Indexed: 11/11/2022]
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Psarommatis IM, Voudouris C, Douros K, Giannakopoulos P, Bairamis T, Carabinos C. Algorithmic management of pediatric acute mastoiditis. Int J Pediatr Otorhinolaryngol 2012; 76:791-6. [PMID: 22405736 DOI: 10.1016/j.ijporl.2012.02.042] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 02/11/2012] [Accepted: 02/13/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Today, no uniformly accepted diagnostic and therapeutic criteria have been established for the management of pediatric acute mastoiditis. The aim of this study is determine the efficacy and safety of an algorithmic approach for treating pediatric acute mastoiditis. METHODS The medical records of all children (n=167) with a diagnosis of AM admitted in our center during the period 2002-2010 were retrospectively studied. Data concerning medical history, symptomatology, laboratory and imaging findings, presence of complications, treatment methods and final outcomes were reviewed and analyzed. Parenteral antibiotics and myringotomy were applied to all children on the day of admission. Initial surgical approach also included drainage or simple mastoidectomy for subperiosteal abscesses and simple mastoidectomy for children suffering from intracranial complications. Finally, simple mastoidectomy was performed as a second line treatment in children showing poor response to the initial conservative approach. RESULTS All children were cured after a mean hospitalization of 9.8 days. The rate of intracranial complications at admission was 6.5% and the overall rate of the use of mastoidectomy 42%. Following the presented treatment scheme in all cases, no child developed additional complications while in-hospital and under treatment or after discharge. CONCLUSIONS Although simple mastoidectomy represents the most reliable and effective surgical method to treat acute mastoiditis, a more conservative approach consisting of adequate parenteral antibiotic coverage and myringotomy can be safely adopted for all children suffering from uncomplicated acute mastoiditis. Non-responsive cases should undergo simple mastoidectomy within 3-5 days in order to avoid further in-hospital acquired complications. Simple mastoidectomy should also be performed in every case of unsuccessful subperiosteal abscess drainage or presence of intracranial complications.
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Affiliation(s)
- Ioannis M Psarommatis
- ENT Department, P. & A. Kyriakou Children's Hospital of Athens, Thivon & Levadias St., Goudi, Athens, Greece.
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Kuczkowski J, Narozny W, Plichta L. Lateral sinus thrombosis as a complication of acute mastoiditis in children. Int J Pediatr Otorhinolaryngol 2010; 74:433-4. [PMID: 20185183 DOI: 10.1016/j.ijporl.2010.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 01/15/2010] [Indexed: 10/19/2022]
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