Acute mastoiditis in children: the "Ferrara" experience

OBJECTIVE

This study aims to investigate the clinical features and outcomes of acute mastoiditis in children referred to the ENT/Audiology Department of the University of Ferrara from January 1994 to December 2005. It also aims to discuss risk factors and to find predictors for surgery.

METHODS

A retrospective study on case sheets of children with an acute mastoiditis diagnosis was carried out. Fifty-five cases fulfilled the inclusion criteria: they presented otoscopical evidence of acute otitis media and inflammatory findings of the mastoid area such as post-auricular swelling, redness or tenderness, protrusion of the auricle and/or radiological findings.

RESULTS

Twenty-six patients were only treated with antibiotic therapy, tympanocentesis alone was performed in 11 cases; in 5, a ventilation tube was positioned. Mastoidectomy was performed in 13 patients. The group who underwent mastoidectomy had a median hospital stay of 15 days (5-54), in this group were found the following complications: 1 meningitis, 1 meningo-encephalitis, 1 lateral and sigmoid sinus thrombosis, 1 facial palsy.

CONCLUSION

the incidence of otomastoiditis does not seem to be decreasing, on the contrary, in some countries, it seems to be on the increase. Our experience cannot confirm a real increase of the incidence but we noted periodic variations during the time of observation. It is important, that careful attention is paid to the clinical assessment of children who are 2-years old or under, as they seem to be more exposed to the risk of clinical complications; therefore, it is highly recommended that the otologist and the paediatrician collaborate closely.

Measuring the psychosocial consequences of hearing loss in a working adult population: focus on validity and reliability of the Italian translation of the hearing handicap inventory

Despite increasing demand for questionnaires for assessing hearing handicap and the effectiveness of some tools across different languages, empirical studies to evaluate the reliability and the validity of translations of original English questionnaires into an Italian version have not been reported in the literature, thus making comparisons of Italian experimental and clinical data across cultures and countries impossible. This study tested the global assumption that the Hearing Handicap Inventory for Adults (HHIA), that is one of the most widely used instruments in English-speaking countries, can be adapted to the Italian language maintaining the reliability and clinical validity of the original version. The English version of this 25-item, self-assessment questionnaire was developed by Newman et al. in 1990 and special emphasis was placed on emotional reaction and social limitations perceived by hearing-impaired subjects and scored separately. This tool was translated into the Italian language by a forward and backward technique, as established by the IQOLA (International Quality of Life Assessment) project. Overall, 94 subjects, aged 18-65 years, with acquired hearing impairment and 104 individuals with no hearing problems, well-matched for socio-demographic variables, were enrolled in the study in a case-control design. Reliability of the Italian version of HHIA was tested by measuring internal consistency and test-retest reproducibility. Validity was assessed by using construct, convergent and discriminant methods. A Cronbach's alpha coefficient near 0.90 confirmed a more than acceptable internal consistency and a highly statistically significant Spearman's correlation coefficient (< 0.005) between scores of the two administrations at an interval of one month documented an excellent stability of the questionnaire over time. Construct validity was demonstrated by a correlation between the severity of hearing loss and the score of questionnaire (< 0.005) and convergent validity was supported by a significant correlation between the scores of the emotional and socio/situational subscales of the HHIA to the analogous subscales of a health-related quality of life questionnaire (MOS 36-Item Short Form Health Survey) (< 0.005). Finally, since hearing-impaired subjects scored significantly higher than controls on HHIA (< 0.005), it clearly emerged that also the Italian version of HHIA differentiates the two populations (those with and those without hearing problems) demonstrating a robust discriminant validity. Given the lack of appropriate measures to assess hearing handicap in Italy, the results achieved in this study, confirm that the HHIA, Italian version, is suitable for both experimental and clinical use.

Pneumocephalus and meningitis as a complication of acute otitis media: case report

Otogenic pneumocephalus is a rare condition. The case is described of pneumocephalus and meningitis secondary to acute otitis media. Although the rate of intracranial complications related to middle ear disease is only 0.5 to 4%, mortality still ranges between 5 and 15%.