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Issa M, Kalliri V, Euteneuer S, Krümpelmann A, Seitz A, Sommerburg O, Westhoff JH, Syrbe S, Lenga P, Grutza M, Scherer M, Neumann JO, Baumann I, Unterberg AW, El Damaty A. The association of COVID-19 pandemic with the increase of sinogenic and otogenic intracranial infections in children: a 10-year retrospective comparative single-center study. Neurosurg Rev 2024; 47:205. [PMID: 38713418 PMCID: PMC11076320 DOI: 10.1007/s10143-024-02442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/26/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Otitis media and sinusitis are common childhood infections, typically mild with good outcomes. Recent studies show a rise in intracranial abscess cases in children, raising concerns about a link to COVID-19. This study compares a decade of data on these cases before and after the pandemic. METHODS This retrospective comparative analysis includes pediatric patients diagnosed with otitis media and sinusitis, who later developed intracranial abscesses over the past decade. We collected comprehensive data on the number of cases, patient demographics, symptoms, treatment, and outcomes. RESULTS Between January 2013 and July 2023, our center identified 10 pediatric patients (median age 11.1years, range 2.2-18.0 years, 60% male) with intracranial abscesses from otitis media and sinusitis. Of these, 7 cases (70%, median age 9.7 years, range 2.2-18.0 years) occurred since the onset of the COVID-19 pandemic, while the remaining 3 cases (30%, median age 13.3 years, range 9.9-16.7 years) were treated before the pandemic. No significant differences were found in otolaryngological associations, surgical interventions, preoperative symptoms, lab findings, or postoperative antibiotics between the two groups. All patients showed positive long-term recovery. CONCLUSION This study reveals 5-fold increase of pediatric otogenic and sinogenic intracranial abscess cases in the last three-years since the onset of the COVID-19 pandemic. While further investigation is needed, these findings raise important questions about potential connections between the pandemic and the severity of otitis media and sinusitis complications in children. Understanding these associations can improve pediatric healthcare management during infectious disease outbreaks.
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Affiliation(s)
- Mohammed Issa
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany.
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
| | - Vasiliki Kalliri
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Sara Euteneuer
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Otorhinolaryngology, Heidelberg University Hospital, Heidelberg, Germany
| | - Arne Krümpelmann
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Center for Pediatric and Adolescent Medicine, Department I, University Hospital Heidelberg, Heidelberg, Germany
| | - Angelika Seitz
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Deptartment of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Olaf Sommerburg
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Center for Pediatric and Adolescent Medicine, Department I, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens H Westhoff
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Center for Pediatric and Adolescent Medicine, Department I, University Hospital Heidelberg, Heidelberg, Germany
| | - Steffen Syrbe
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Center for Pediatric and Adolescent Medicine, Department I, University Hospital Heidelberg, Heidelberg, Germany
| | - Pavlina Lenga
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Martin Grutza
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Moritz Scherer
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Jan-Oliver Neumann
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Ingo Baumann
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Otorhinolaryngology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas W Unterberg
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
| | - Ahmed El Damaty
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany
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Kavya S, Arvinda HR, Veenakumari HB, PrabuRaj AR, Smitha NR, Jyothi D, Dwarakanath S, Nagarathna S. Pertinence of Streptococcus anginosus group in intracerebral abscesses in the era of extended antibiotic resistance. Indian J Med Microbiol 2023; 45:100395. [PMID: 37573041 DOI: 10.1016/j.ijmmb.2023.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/30/2023] [Accepted: 05/26/2023] [Indexed: 08/14/2023]
Abstract
AIMS • To study the incidence of Streptococcus anginosus group (SAG) in pyogenic or community acquired intra cerebral abscess. • To understand the risk factors for the same. • To analyze the specific radiological features and clinical outcome after surgery and antibiotic therapy. METHODS This is a retrospective observational study of case series over a period of one year. Patients diagnosed with intracerebral abscess were included in the study. Pus collected from were received in the laboratory and processed according to the standard protocols. Data regarding the clinical findings and demographics were collected from medical records. FINDINGS A total of 202 samples were studied. 103 were found to be pyogenic. SAG were isolated from 21 samples (20.38%) and all the isolates were sensitive to Penicillin. Age of the patients ranged from 18months to 68years. Male preponderance was noted with male to female ratio of 4:1. Otogenic infections were the most common predisposing factors and focus of infection could not be ascertained in 5 patients. All patients were treated with surgical intervention and antibiotics (Vancomycin, Amikacin and Metronidazole) for 6 weeks and recovery was remarkable. One patient succumbed to the illness. CONCLUSION SAG can be an aggressive pathogen with propensity for abscess formation. Chronic Suppurative Otitis Media (CSOM) is still a major cause of intracerebral abscess in developing country like India which is a benign and curable disease and should not be neglected. Injudicious use of antibiotics and negligence regarding the dose and duration of therapy from both patients and health care providers is the major cause for common infections to become more difficult to treat and succumbing to complications.
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Affiliation(s)
- S Kavya
- Department of Neuromicrobiology, NIMHANS, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, India
| | | | | | - N R Smitha
- Department of Neuromicrobiology, NIMHANS, India
| | | | | | - S Nagarathna
- Department of Neuromicrobiology, NIMHANS, India.
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George M, Kolethekkat AA, Torrigiani E, Marston SS, Thomas CM, Raphael M. Management of Otogenic Sigmoid Sinus Thrombosis: A Systematic Review on the Role of Anticoagulation and its Outcome. Indian J Otolaryngol Head Neck Surg 2023; 75:450-456. [PMID: 37275038 PMCID: PMC10235279 DOI: 10.1007/s12070-022-03289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
To provide a systematic review on the use of additional anticoagulation in the management of otogenic sigmoid sinus thrombosis when compared with the cohort not receiving the anticoagulation. A systematic review until 2021 was done and relevant studies were screened. Based on a selective criteria, a database is constituted which were then rearranged and studied. 16 articles were selected with 113 patients. The group who received anticoagulation had more complications (23.33%) in comparison (21.74%), whereas the recanalization was successful in the anticoagulated group, 76.67%, as against 39.13%. In 74/90 patients who underwent mastoidectomy with anticoagulation, the recanalization and complication were 72.97% and 25.68% respectively. The second group with 16/90 patients who received conservative treatment, the recanalization and complication rates were 93.75% and 12.50% respectively. The third group with 23 patients were treated with mastoidectomy and antibiotics but didn't receive anticoagulants in which the recanalization achieved in 39.13% with a complication rate of 21.74%. For those patients who underwent mastoidectomy with concurrent anticoagulation, 44 showed radiological evidence of recanalization, and in sixteen patients that received the same treatment, no recanalization was achieved whereas in patients who received conservative treatment with anticoagulation, 12 patients showed recanalization and finally, for the patients underwent surgery without anticoagulation, five patients achieved recanalization and 7 did not become recanalized (14.29%). Recanalization seems more pronounced in those who were anticoagulated, but, did not seem to influence the clinical outcome. Complications were more in those who were undergone surgery with or without anticoagulation.
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Affiliation(s)
- Mercy George
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Arif Ali Kolethekkat
- ENT, Department of Surgery, Sultan Qaboos University Hospital, P O 38, PC 123 Al Khoud, Oman
| | - Elio Torrigiani
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | | | - Maire Raphael
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Finneran M, Duran I, Schaible K. From Toothpick to Intraparenychmal Otogenic Pneumocephalus: A Case Report. World Neurosurg 2020; 138:253-256. [PMID: 32194265 DOI: 10.1016/j.wneu.2020.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intracranial pneumocephalus, the accumulation of air, occurs most frequently from trauma, tumor, cranial surgeries, or infection. Intraparenchymal otogenic pneumocephalus is a rare but well-documented development. We describe a patient who developed pneumocephalus in the context of eardrum perforation secondary to toothpick use for ear wax. CASE DESCRIPTION An 86-year-old female presented to the emergency room with a 1-day history of dysarthria and a few days of cough and sneezing. History revealed she had recently been advised to avoid Q-Tips to clean her ears and instead was using toothpicks. She denied otalgia or otorrhea and had no signs of infection near the ear. On otoscopic examination, the right tympanic membrane was perforated. On head computed tomography, she was found to have a large right temporal pneumocephalus extending from the petrous bone. Magnetic resonance imaging of the brain revealed a defect in the right tegmen. She was started on empiric antibiotics and subsequently taken to the operating room for craniotomy and repair of bony and dural defects. CONCLUSIONS Otogenic pneumocephalus is a rare occurrence. This is the first reported case of pneumocephalus related to self-induced middle ear trauma with a toothpick that ultimately required craniotomy for repair.
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Affiliation(s)
- Megan Finneran
- Department of Neurosurgery, Advocate Health Care, Downers Grove, Illinois, USA.
| | - Isis Duran
- Neurointensive Care, Advocate Health Care, Downers Grove, Illinois, USA
| | - Keith Schaible
- Department of Neurosurgery, Advocate Health Care, Downers Grove, Illinois, USA
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Glikson E, Sagiv D, Wolf M, Shapira Y. Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series. Diagn Microbiol Infect Dis 2016; 87:74-78. [PMID: 27806892 DOI: 10.1016/j.diagmicrobio.2016.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/13/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
We reviewed 25 cases of patients diagnosed with necrotizing otitis externa in our tertiary university-affiliated medical center between 2009 and 2015. Mean overall hospitalization duration was 14.52days, 95% of the patients showed specific seasonal incidence. Mean duration of symptoms prior to hospitalization was 6weeks and the duration correlated with outcome. Only 8% of the patients presented with cranial neuropathies; however, this presentation correlated with adverse outcome. Pseudomonas aeruginosa was the main causative organism (50%), with a 30% multidrug-resistance rate. A high rate (35%) of fungal pathogens was noted. Seventeen patients (68%) were eventually operated; however, only 5 patients needed extensive surgery under general anesthesia. Computed tomography (CT) evidence of adjacent structures' involvement correlated with adverse outcome. Eighty percent of our patients improved clinically. The overall death rate was 12% and the disease-related mortality rate was 8%. Our findings state the importance of limited surgical intervention and microbiologic cultures in disease treatment. This is particularly important in patients with cranial neuropathies and CT finding of adjacent structural involvement that correlate with adverse prognosis. A rising pseudomonal antibiotic resistance and fungal infections may challenge antibiotic treatment in the future.
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Affiliation(s)
- Eran Glikson
- Department of Otolaryngology, Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Israel.
| | - Doron Sagiv
- Department of Otolaryngology, Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Israel
| | - Michael Wolf
- Department of Otolaryngology, Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yisgav Shapira
- Department of Otolaryngology, Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mukherjee D, Das C, Paul D. 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] [What about the content of this article? (0)] [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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