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Yueh HZ, Chu HL, Lu SC, Lee YJ, Lin CH. The role of vestibular function tests in nontuberculous mycobacterial otomastoiditis: A case report. Medicine (Baltimore) 2024; 103:e37007. [PMID: 38306553 PMCID: PMC10843242 DOI: 10.1097/md.0000000000037007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM), an extremely rare pathogen causing cervicofacial infections, may result in permanent hearing impairment or intracranial complications. Due to the lack of specific manifestations during the initial onset of NTM otomastoiditis, physicians may misdiagnose it as cholesteatoma or other common bacterial infections. PATIENT CONCERNS A 44-year-old male who complained of left-sided aural fullness, otalgia, and dizziness for 2 months. DIAGNOSIS The initial diagnosis was hypothesized to be cholesteatoma based on a whitish mass with mucoid discharge filling the entire outer ear canal on otoscopy and left-sided mixed hearing loss. However, NTM was identified by microbial culture at the 2-month follow-up after surgery. INTERVENTIONS The patient underwent a left-sided exploratory tympanotomy. Because NTM otomastoiditis was diagnosed, 3 weeks of starting therapies were administered with azithromycin (500 mg/day, oral administration), cefoxitin (3 g/day, intravenous drip), and amikacin (750 mg/day, intravenous drip). The maintenance therapies were azithromycin (500 mg/day, oral administration) and doxycycline (200 mg/day, oral administration) for 7 months. OUTCOMES The patient's clinical condition improved initially after surgery, but the otomastoiditis gradually worsened, combined with subtle meningitis, 2 months after surgery. The external auditory canal became swollen and obstructed, making it difficult to monitor the treatment efficacy through otoscopy. Thus, we used regular vestibular function tests, including static posturography, cervical vestibular evoked myogenic potentials, and video Head Impulse Test, to assess recovery outcomes. After antibiotic treatment, the infectious symptoms subsided significantly, and there was no evidence of infection recurrence 7 months after treatment. Improvements in static posturography and cervical vestibular evoked myogenic potentials were compatible with the clinical manifestations, but video Head Impulse Test showed an unremarkable correlation. LESSONS The clinical condition of NTM otomastoiditis may be evaluated using vestibular tests if patients have symptoms of dizziness.
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Affiliation(s)
- Hann-Ziong Yueh
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hung-Lun Chu
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of General Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shih-Chun Lu
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yuarn-Jang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Che-Hsuan Lin
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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2
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Mishael T, Philip B, George A, S S. Co-existing Paraganglioma, Cholesteatoma, and Otomastoiditis With Overlapping Imaging Features: A Diagnostic Challenge. Cureus 2023; 15:e42373. [PMID: 37621839 PMCID: PMC10445775 DOI: 10.7759/cureus.42373] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Head and neck paragangliomas are rare neuroendocrine tumors arising from the autonomic nervous system. Imaging hallmarks of paragangliomas of the head and neck include an enhancing soft-tissue mass in the carotid space, jugular foramen, or tympanic cavity on computed tomography; a salt-and-pepper appearance on standard spin-echo magnetic resonance imaging; and an intense blush on angiography. Imaging studies depict the location and extent of tumor involvement, help determine the surgical approach, and predict operative morbidity and mortality. However, an atypical presentation of paragangliomas, especially when co-existing with other middle ear pathologies that have overlapping imaging findings, can often be misleading. Here, we report a case of simultaneous occurrence of paraganglioma, cholesteatoma, and otomastoiditis in a young adult female.
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Affiliation(s)
- Tom Mishael
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Babu Philip
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Arun George
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Sandeep S
- Radiology, St. John's Medical College Hospital, Bangalore, IND
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3
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Rajakumar I, Karthikeyan K, C R P, Hussain A, Madhavan K. Relapsing Polychondritis: A Rare Case Report. Cureus 2023; 15:e40172. [PMID: 37431345 PMCID: PMC10329812 DOI: 10.7759/cureus.40172] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Relapsing polychondritis is an uncommon disorder of unknown cause characterized by inflammation of cartilage, predominantly affecting the ear, nose, and laryngotracheobronchial tree. The case under discussion is a 50-year-old female with a classical presentation of relapsing polychondritis with saddle nose deformity, bilateral auriculitis, and laryngotracheobronchomalacia with joint involvement.
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Affiliation(s)
- Ilakyaa Rajakumar
- General Medicine, SRM Medical College Hospital and Research Centre, Chengalpattu, IND
| | | | | | - Aamina Hussain
- Community Medicine, SRM Medical College Hospital and Research Centre, Chengalpattu, IND
| | - Krishnaswamy Madhavan
- General Medicine, SRM Medical College Hospital and Research Centre, Chengalpattu, IND
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4
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Pérez Ramos IS, Unzaga Barañano MJ, Espallargas Ruiz-Ogarrio MC, Diaz De Tuesta Del Arco JL. [Tuberculous otomastoiditis: a case report]. Rev Esp Quimioter 2023; 36:332-333. [PMID: 36966385 DOI: 10.37201/req/139.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Affiliation(s)
- I S Pérez Ramos
- Iris Sharon Pérez Ramos, Servicio de Microbiología y Parasitología Clínica. Hospital Universitario de Basurto, Bilbao. Spain.
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5
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Li F, Wang J, Chen C, Yang H, Man R, Yu S. Otomastoiditis Caused by Nocardia Farcinica: A Case Report and Literature Review. Ear Nose Throat J 2023:1455613231165166. [PMID: 36941739 DOI: 10.1177/01455613231165166] [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] [Indexed: 03/23/2023] Open
Abstract
Nocardia farcinica usually infects people with impaired immune status and usually manifests in the lungs. Otomastoiditis caused by Nocardia infection is extremely rare, with only 4 cases reported to date. This report describes a case of otomastoid N. farcinica infection in an immunocompetent patient. The case was a 10-month-old immunocompetent infant who presented with an approximately 3-month history of right ear discharge for which treatment with various antibiotics had not resulted in significant improvement. Multiple cultures of secretions and pathologic examination failed to identify the causative organism. The patient then underwent right mastoidectomy. Finally, metagenomic next-generation sequencing identified the pathogen to be N. farcinica. The patient was infection-free at the 6-month follow-up but had developed labyrinthitis ossificans. Otomastoid Nocardia infection has characteristic clinical features, namely, formation of a large amount of granulation tissue and coexistence of bone destruction and new bone formation. Traditionally, Nocardia is challenging to diagnose. Metagenomic next-generation sequencing of lesions is helpful. Complete local debridement and free drainage are key to treatment.
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Affiliation(s)
- Feifan Li
- Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
- Shandong First Medical University, Shandong Academy of Medical Science, Jinan, China
| | - Jun Wang
- Shandong Provincial Qianfoshan Hospital, Affiliated to Shandong First Medical University, Jinan, China
| | - Chengfang Chen
- Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
| | - Huiming Yang
- Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
| | - Rongjun Man
- Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
| | - Shudong Yu
- Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, China
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6
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Wong K, Arrighi-Allisan AE, Fan CJ, Wanna GB, Cosetti MK, Perez ER. A Review of Noninfectious Diseases Masquerading as Acute Mastoiditis. Otolaryngol Head Neck Surg 2022; 167:901-911. [PMID: 34874762 DOI: 10.1177/01945998211064190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Acute mastoiditis is commonly attributed to infection. Rarely do clinicians encounter cases that do not respond to traditional antibiotics or surgical management. The goal of this study was to systematically review the literature to characterize diseases masquerading as acute infectious mastoiditis. DATA SOURCES PubMed, Embase, and Scopus. REVIEW METHODS A systematic review was performed to identify all publications that reported on diseases with presentations mimicking acute mastoiditis, defined as postauricular redness, swelling, and tenderness. We included clinical prospective studies, retrospective studies, and case series/reports. Exclusion criteria included non-English articles, letters/commentaries, abstracts, and review articles. RESULTS Out of 3339 results, 35 studies met final inclusion criteria. In children, 11 diseases were reported to mimic mastoiditis, including solid tumors, hematologic diseases, and autoimmune/inflammatory diseases. The most common disease in children was Langerhans cell histiocytosis, followed by rhabdomyosarcoma and acute myelogenous leukemia. In adults, 8 additional diseases were reported. The most common disease in adults was squamous cell carcinoma, followed by nasopharyngeal carcinoma and Langerhans cell histiocytosis. Presenting symptoms are reviewed, as well as characteristic radiographic, laboratory, and intraoperative features that may assist with diagnosis. A diagnostic algorithm for atypical cases of acute mastoiditis is proposed. CONCLUSION A small but significant group of diseases in children and adults can mimic acute mastoiditis. In such cases, history and examination alone may be insufficient to reach a diagnosis, and further investigation may be necessary. Otolaryngologists should always be mindful of the possibility that noninfectious pathologies may present with a constellation of symptoms similar to mastoiditis.
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Affiliation(s)
- Kevin Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Annie E Arrighi-Allisan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Caleb J Fan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - George B Wanna
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Maura K Cosetti
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Enrique R Perez
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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7
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Leow TYS, Bekkers S, Janssen AM, Pegge SAH, Kunst HPM, Waterval JJ, Jansen TTG, Henriet SSV, van Aerde KJ, van Ingen J, Hol MKS. Quality of life in children receiving treatment for Mycobacterium abscessus otomastoiditis. Clin Otolaryngol 2022; 47:529-535. [PMID: 35340110 PMCID: PMC9314591 DOI: 10.1111/coa.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/31/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Theresa Y S Leow
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arno M Janssen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sjoert A H Pegge
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.,Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen, The Netherlands
| | - Jerome J Waterval
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen, The Netherlands
| | - Thijs T G Jansen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefanie S V Henriet
- Department of Pediatric Infectious Disease and Immunology, Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen J van Aerde
- Department of Pediatric Infectious Disease and Immunology, Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jakko van Ingen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Myrthe K S Hol
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands.,Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
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8
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Giorelli M, Altomare S, Aniello MS, Leone R, Liuzzi D, Plasmati I, Sardaro M, Superbo M, Mennea G, Fioretto N, Guglielmi G, Balzano R, Scarabino T, Cuccorese G, Cialdella F, Campobasso G, Barbara M. Lemierre's syndrome complicated by cerebral venous sinus thrombosis: A life threatening and rare disease successfully treated with empiric antimicrobial therapy and conservative approach. Intractable Rare Dis Res 2022; 11:37-39. [PMID: 35261851 PMCID: PMC8898395 DOI: 10.5582/irdr.2021.01142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/23/2022] [Accepted: 02/06/2022] [Indexed: 11/05/2022] Open
Abstract
Lemierre's syndrome (LS) is a "forgotten" condition characterized by septic thrombophlebitis of the jugular vein that follows an otolaryngological infection. Fusobacterium necrophorum is the aetiological agent responsible for the syndrome in adolescents and young adults whereas in older people even common bacteria are involved. Complications arise from spreading of septic emboli distally, i.e. to the brain, lungs, bones and internal organs everywhere in the body. We report a middle-aged woman who presented with headache and bilateral sixth cranial nerve palsy following a sphenoidal sinusitis and left mastoiditis. Imaging revealed thrombotic involvement of the left internal jugular vein as well as of several cerebral venous sinuses thrombosis (CVT). Currently, precise management protocols of LS with CVT complication do not exist although a combination of macrolides and second or third-generation cephalosporins, as well as anti-coagulants represent the mainstream of therapeutics. Surgical drainage is associated to remove septic foci but is burdened by severe complications and side effects. Complete recovery was achieved following pharmacological treatment in our patient. This report adds further evidence that LS complicated by CVT may be effectively treated adopting a conservative approach thus avoiding surgical drainage and severe complications.
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Affiliation(s)
- Maurizio Giorelli
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
- Address correspondence to:Maurizio Giorelli, Operative Unit of Neurology, "Dimiccoli" General Hospital, Viale Ippocrate 11, Barletta 76121, Italy. E-mail:
| | - Sergio Altomare
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | | | - Ruggiero Leone
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Daniele Liuzzi
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | | | - Michele Sardaro
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Maria Superbo
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Mennea
- Operative Unit of Internal Medicine, "Bonomo" General Hospital, Andria, Italy
| | - Nicola Fioretto
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Guglielmi
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Rosario Balzano
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Tommaso Scarabino
- Operative Unit of Radiology, "Bonomo" General Hospital, Andria, Italy
| | - Giuseppe Cuccorese
- Operative Unit of Internal Medicine, "Dimiccoli" General Hospital, Barletta, Italy
| | - Francesca Cialdella
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Campobasso
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Michele Barbara
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
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9
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Mishra SC, Tyagi I, Gupta A, Sharma S, Tyagi L. Cerebral Venous Sinus Thrombosis Complicating Middle Ear Infections: A Rare Complication in Post-Antibiotic Era. Cureus 2021; 13:e18964. [PMID: 34812329 PMCID: PMC8604434 DOI: 10.7759/cureus.18964] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
In the post-antibiotic era, intracranial and extracranial complications of middle ear infections have become rare. Similarly, cerebral venous sinus thrombosis (CVST), a frequent complication of middle ear infections, has become rare now. Here, we present a case of a 27-year-old male who presented with a short history of severe headache and associated episodes of intractable vomiting. There was also a prior history of right ear discharge one year back which responded to medical management. The patient did not improve clinically even after prompt symptomatic management. Contrast-enhanced magnetic resonance imaging (CEMRI) of the head and contrast-enhanced magnetic resonance venogram (CEMRV) were done, which showed right-sided otomastoiditis complicated with CVST and meningitis. Although the clinical signs of meningeal irritation and mastoid tenderness were not present on clinical examination. The patient was started on anticoagulant therapy and antibiotics for two weeks following which there was marked clinical improvement.
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Affiliation(s)
- Sarvesh C Mishra
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Isha Tyagi
- Neuro-otology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Aviral Gupta
- Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Srishti Sharma
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, IND
| | - Lavanya Tyagi
- Obstetrics and Gynecology, Javitri Hospital and Test Tube Baby Centre, Lucknow, IND
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10
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Chacon-Cruz E, Lopatynsky EZ. Continuous Effectiveness of Pneumococcal 13-Valent Conjugate Vaccine on Pediatric Pneumococcal Otomastoiditis: Results of 15 Years of Active/Prospective Surveillance in a Mexican Hospital on the Mexico-US Border. Cureus 2021; 13:e17608. [PMID: 34646659 PMCID: PMC8483408 DOI: 10.7759/cureus.17608] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) on sepsis, meningitis, pneumonia, and even acute otitis media has been proved in many studies. Nonetheless, the impact of PCV13 on otomastoiditis (OM) in children has barely been reviewed. In the past, we published a 13 years pneumococcal OM study from our hospital. This is a continuation of our active surveillance and is the first Latin American, prospective study examining the effectiveness of this vaccine on pneumococcal pediatric OM. Methods Active surveillance identifying patients < 16 years of age with OM admitted at the “Hospital General de Tijuana” was performed from October 1, 2005, to September 30, 2019. Diagnosis of OM was based on clinical exam (postauricular tenderness, erythema, and swelling causing protrusion of the auricle) and computerized tomographic signs (opacification of the mastoid air cells and middle ear). We used either conventional culturing or PCR to isolate bacterial pathogens, while to further Streptococcus pneumoniae serotype identification we used the Quellung Reaction (Statens Serum Institute®) or PCR. To assess pneumococcal conjugate vaccines effectiveness (VE), we counted cases per month before any pneumococcal conjugate vaccine was implemented (19 months surveillance), during the 7-valent pneumococcal conjugate vaccine (PCV7) use in the pediatric community (61 months surveillance), after PCV13 implementation in children (100 months surveillance), and calculated as follows: VE = 1 -(cases per month with specific pneumococcal conjugate vaccination/cases per month without any pneumococcal conjugate vaccination). Results Following 15 years of active surveillance, we identified 21 cases of OM. At admission the median age of patients was 38 months (six months to 15 years old), the median hospitalization days was 12 (5 to 115). All patients underwent mastoidectomy. Identification of bacterial pathogens was possible in 19 (90.5%), among which. Streptococcus pneumoniae was the leading cause with 15 cases (79%). PCV7 VE was 27.8%, however, after PCV13 introduction, VE increased to 68%, with only one case of pneumococcal OM in the last two years, without incremental OM cases by other bacteriae. Conclusion After 15 years of active/prospective surveillance in our hospital, a continuous and high VE (68%) of PCV13 on pediatric OM caused by Streptococcus pneumoniae has been found, with only one case in the last two years.
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Affiliation(s)
| | - Erika Z Lopatynsky
- Family Medicine and Public Health, University of California San Diego, San Diego, USA
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11
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Bergsma P, Kunz S, Kienle AL, Brand Y. Case Report: Petrous Apicitis and Otogenic Thrombosis of the Cavernous Sinus in a 10-Year-Old Boy. Front Surg 2021; 8:667817. [PMID: 34268332 PMCID: PMC8275649 DOI: 10.3389/fsurg.2021.667817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Petrous apicitis and cavernous sinus thrombosis are exceedingly rare complications of acute otitis media with only few reported cases in the post-antibiotic era. Especially in children, the appropriate management is a subject of controversy. Case Presentation: We report the case of a 10-year-old boy who presented to the emergency department with left-sided otalgia, otorrhea, and hearing loss, accompanied by somnolence and high spiking fevers. CT and MRI revealed partially obstructed mastoid air cells including a pneumatized petrous apex. Furthermore, thrombosis of the cavernous sinus and vasculitis of the internal carotid artery on the left side were present. The patient was treated with antibiotics for 6 weeks and anticoagulant therapy for 3 months. Follow-up carried out 3 months post-admission showed complete recanalization of the cavernous sinus on MRI and fatigue as the only remaining symptom. Conclusion: A complicated otitis media with petrous apicitis and cavernous sinus thrombosis in a child can in some cases be managed without a surgical intervention.
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Affiliation(s)
- Patrick Bergsma
- Department of Otolaryngology, Cantonal Hospital of Graubunden, Chur, Switzerland
| | - Seraina Kunz
- Department of Otolaryngology, Cantonal Hospital of Graubunden, Chur, Switzerland
| | - Anna-Lena Kienle
- Department Radiology, Cantonal Hospital of Graubunden, Chur, Switzerland
| | - Yves Brand
- Department of Otolaryngology, Cantonal Hospital of Graubunden, Chur, Switzerland.,University Basel, Basel, Switzerland
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lim R, Zulkifli S, Hailani I, Hashim ND. Managing a Complicated Acute Otomastoiditis at Day Four of Life. Cureus 2021; 13:e12905. [PMID: 33654590 PMCID: PMC7904499 DOI: 10.7759/cureus.12905] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Acute mastoiditis in a newborn complicated by the presence of facial nerve palsy is an alarming finding requiring rapid assessment and further investigation. Such an early presentation should point the clinician towards an underlying systemic pathology or congenital anatomical abnormality. Facial nerve involvement indicates severe infection and possible dehiscence of the facial canal. Although more frequent in children, it is rare in neonates. We would like to share our experience in managing the youngest known presentation of otomastoiditis at four days of life. The patient presented with otorrhea and facial paralysis and progressed to meningitis. He was finally diagnosed with chronic granulomatous disease.
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Affiliation(s)
- Rachel Lim
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.,Otolaryngology - Head and Neck Surgery, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Shifa Zulkifli
- Otorhinolaryngology - Head and Neck Surgery, Hospital Tunku Azizah (Women and Children's Hospital) Kuala Lumpur, Kuala Lumpur, MYS
| | - Iskandar Hailani
- Otolaryngology - Head and Neck Surgery, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Noor Dina Hashim
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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Baltasar-Corral J, Martín-Rojas RM, Parra-Virto A, Galeano-Valle F, Del-Valle-Diéguez M, Del-Toro-Cervera J, Demelo-Rodríguez P. Torcular herophili and lateral sinus thrombosis: An atypical presentation of Lemièrre's syndrome. Intractable Rare Dis Res 2019; 8:206-209. [PMID: 31523600 PMCID: PMC6743426 DOI: 10.5582/irdr.2019.01071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lemièrre's syndrome (LS) is an uncommon disease characterized by septic thrombophlebitis of the jugular vein in the context of otorhinolaryngologic infections. These patients are often young and the pharyngotonsillar infection is the most frequent primary focus, but other foci like acute otitis media or otomastoiditis have been described. Although the internal jugular vein is the most commonly affected site, a few case reports have been published with thrombosis of other veins, such as the facial vein or transverse sinus. We report the case of a 93-year-old woman with an atypical presentation of LS presenting with thrombophlebitis of the internal jugular vein, transverse sinuses and Herophili torcula after an acute otitis media complicated with acute otomastoiditis. Infectious cerebral venous thrombosis (CVT) is rare and accounts for 6-12% of the total in large adult series and is usually associated to otorhinolaryngologic infections. CVT is an atypical presentation of LS that can be potentially lethal, especially during the acute phase. For this reason, clinical suspicion and early treatment are vital to improve the prognosis of these patients. Although surgical treatment is recommended in cases of LS complicated with CVT, conservative management with antibiotics and anticoagulation lead to ad integrum restitutio without neurological sequelae in our case, suggesting that surgical treatment may not be necessary in all cases of LS complicated with CVT.
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Affiliation(s)
- Jesús Baltasar-Corral
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
| | | | - Alejandro Parra-Virto
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
- Address correspondence to:Dr. Alejandro Parra-Virto. Internal Medicine Department, Hospital General Universitario Gregorio Marañón. Calle Doctor Esquerdo, 46, Madrid 28007, Spain. E-mail:
| | - Francisco Galeano-Valle
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | - Jorge Del-Toro-Cervera
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
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Guerpillon B, Boibieux A, Guenne C, Ploton C, Ferry T, Maurin M, Forestier E, Dauwalder O, Manipoud P, Ltaïef-Boudrigua A, Gürkov R, Vandenesch F, Bouchiat C. Keep an Ear Out for Francisella tularensis: Otomastoiditis Cases after Canyoneering. Front Med (Lausanne) 2016; 3:9. [PMID: 26973838 PMCID: PMC4776157 DOI: 10.3389/fmed.2016.00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/18/2016] [Indexed: 11/17/2022] Open
Abstract
We report here three unusual cases of otomastoiditis due to Francisella tularensis, complicated by cervical abscesses and persistent hearing loss, plus facial paralysis for one patient. Intriguingly, the three patients had practiced canyoneering independently in the same French river, between 2009 and 2014, several days before clinical symptoms onset. The results point out that fresh water exposure may be a potential contamination route for tularemia. Besides, due to the frequent complications and sequelae, we believe that F. tularensis should be considered as a possible etiology in case of otitis media, failure of the conventional antibiotic treatment, and suspicious exposure of the bacteria.
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Affiliation(s)
- Brice Guerpillon
- Infectious Diseases Department, Hospices civils de Lyon , Lyon , France
| | - Andre Boibieux
- Infectious Diseases Department, Hospices civils de Lyon , Lyon , France
| | | | - Christine Ploton
- Bacteriology Laboratory, Hospices civils de Lyon , Lyon , France
| | - Tristan Ferry
- Infectious Diseases Department, Hospices civils de Lyon , Lyon , France
| | - Max Maurin
- French National Reference Center for Francisella tularensis , Grenoble , France
| | - Emmanuel Forestier
- Infectious Diseases Department, Centre Hospitalier Métropole Savoie , Chambéry , France
| | | | - Patrick Manipoud
- ENT Department, Centre Hospitalier Métropole Savoie , Chambéry , France
| | | | - Robert Gürkov
- ENT Department, Ludwig-Maximilians-Universität München , Munich , Germany
| | | | - Coralie Bouchiat
- Bacteriology Laboratory, Hospices civils de Lyon , Lyon , France
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Yeh CF, Tu TY, Wang MC, Chu CH, Huang CY, Su WJ, Shiao AS. Emergence of Refractory Otomastoiditis Due to Nontuberculous Mycobacteria: Institutional Experience and Review of the Literature. Clin Infect Dis 2015; 62:739-745. [PMID: 26689957 DOI: 10.1093/cid/civ1033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 09/30/2015] [Accepted: 12/10/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) infection has attracted increasing attention in recent years; however, NTM otomastoiditis is extremely rare. Surgery combined with antibiotic therapy is the current mainstay of treatment; however, the reported duration of medication still varies. In this study, we aimed to analyze patients with NTM otomastoiditis and establish a more efficient treatment strategy. METHODS Medical records and temporal bone images of patients with NTM otomastoiditis were retrospectively analyzed. In addition, a comprehensive review of cases with NTM otomastoiditis in the literature was also performed. RESULTS Twenty-two patients were identified in our institution, and all patients had refractory otorrhea. The rates of granulation tissue, otalgia, and facial palsy were 90.9%, 31.8%, and 9.1%, respectively. Soft tissue attenuation via imaging studies was demonstrated in all of the middle ear cavities. All patients received medical treatment, 20 (90.9%) underwent surgery, and 4 (18.2%) underwent revision surgery. The median time to cure was similar between the "prolonged-course" and "standard-course" antibiotic groups (3.0 vs 3.3 months; P = .807). However, the former had a longer median duration of antibiotic therapy (6.0 vs 3.0 months; P = .01). In the literature review, 54 (96.4%) patients received medical treatment, 51 (91.1%) underwent surgery, and 27 (48.2%) underwent revision surgery. CONCLUSIONS NTM otomastoiditis should be suspected if a patient has chronic refractory otorrhea and ear granulation tissue. Surgery, which is the mainstay of treatment, should be complemented with antibiotics. In those without temporal bone osteomyelitis, antibiotic treatment can be stopped after a dry ear is achieved.
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Affiliation(s)
- Chien-Fu Yeh
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine.,Department of Otolaryngology-Head & Neck Surgery, National Defense Medical Center
| | - Tzong-Yang Tu
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine
| | - Mao-Che Wang
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine
| | - Chia-Huei Chu
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine
| | - Chii-Yuan Huang
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine
| | - Wei-Juin Su
- Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taipei Veterans General Hospital.,Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - An-Suey Shiao
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital.,Department of Otolaryngology, National Yang Ming University School of Medicine.,Department of Otolaryngology-Head & Neck Surgery, National Defense Medical Center
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Chen XC, Lu CW, Liu CH, Wei CC. Facial palsy complicated by masked otomastoiditis in a 3-month-old infant. J Emerg Med 2014; 46:e47-50. [PMID: 24113482 DOI: 10.1016/j.jemermed.2013.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 05/03/2013] [Accepted: 08/14/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The most common cause of facial palsy is idiopathic or Bell's palsy. Although uncommon in the postantibiotic era, otomastoiditis should receive more attention as a cause of facial palsy, especially in young children. Delay of identification and treatment may result in permanent neurological sequelae. OBJECTIVES To describe a 3-month-old infant eventually diagnosed with masked otomastoiditis with initial presentation of facial palsy. CASE REPORT We report a case of facial palsy complicated by masked otomastoiditis in a 3-month-old male infant. The facial palsy completely recovered after parenteral antibiotics and myringotomy. CONCLUSION We use this case to emphasize that otomastoiditis should be considered in the differential diagnosis of young children with facial palsy. Diagnosis may be difficult as signs and symptoms of otitis media in young children are often nonspecific and subtle, particularly in infants. Early diagnosis and careful investigation of middle ear regions should be performed to avoid permanent sequelae.
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