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Storch-De-Gracia P, Antoñanzas-Bernar V, Vergara-Muñoz B, Lamagrande-Casanova N, Di Campli-Zaghlul M, Suárez-Bustamante M, Añón-Hidalgo J, Maiques M. Comparison of amoxicillin administered twice and three times daily in children with acute otitis media. Eur J Pediatr 2023; 182:5599-5605. [PMID: 37816980 DOI: 10.1007/s00431-023-05243-2] [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: 06/09/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023]
Abstract
To compare the effectiveness of amoxicillin administered in regimens of two or three daily doses in children with acute otitis media (AOM). As a secondary aim, we measured and compared treatment adherence between the two groups.A prospective observational study was conducted in the emergency department of a children's hospital.We recruited a total of 353 patients having a median age of 1.58 years. Twice-daily dosing was prescribed to 58%, while 42% received three doses per day. The clinical course of AOM was favourable in 92% of the patients who received two doses of amoxicillin and in 95% of those who received three doses (p = 0.25). Four patients (1%) had persistent symptoms beyond day 7. None developed intracranial complications. In the group receiving three doses daily, 31% reported difficulties with the dosing schedule, and 9.6% faced challenges when administering the medication at the specified volume, compared with 5.8% and 25% of those who received the two-dose regimen, respectively. Conclusion: Twice-daily amoxicillin has similar efficacy to a three-dose daily regimen and can offer advantages for caregivers in terms of administration schedule. What is Known: • Amoxicillin given in two daily doses is as effective as a three doses regimen in the treatment of acute otitis media in children. • The lower the number of daily doses, the higher the adherence to a drug treatment. What is New: • Administration of amoxicillin in twice-daily doses may improve adherence, as it is less frequently associated with family-perceived problems with dosing schedules.
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Affiliation(s)
- Pilar Storch-De-Gracia
- Emergency Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain.
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
| | | | | | | | | | | | | | - Miguel Maiques
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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2
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Wesson T, Sharma D, Rodman C, Tucker BJ, Romano DR, Chen J, Mulinaro L, Carroll AE, Illing EA, Bennett W, Burgin SJ. Evolving microbial patterns of acute mastoiditis in pediatric patients undergoing mastoidectomy. Int J Pediatr Otorhinolaryngol 2023; 172:111690. [PMID: 37544073 DOI: 10.1016/j.ijporl.2023.111690] [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: 03/31/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To investigate the microbial patterns and clinical outcomes of pediatric patients undergoing mastoidectomy for acute coalescent mastoiditis and to identify factors associated with poor outcomes and/or prolonged treatment. STUDY DESIGN Monocentric retrospective cohort study. SETTING Tertiary referral pediatric hospital in Indiana. METHODS By cross-referencing database data from the Pediatric Health Information System (PHIS) querying for all inpatient stays (patients younger than eighteen) with a diagnostic code of mastoiditis between January 1st, 2010 and August 31, 2019, and the electronic health record (Cerner) for Riley Hospital for Children, 46 patients with mastoidectomy were included. A two-tailed T-test was used to evaluate continuous parametric data. Statistical significance was determined as P < 0.05. For continuous variables, data was analyzed using continuous logistic regression. A criteria of p > 0.1 was used for inclusion in the multivariate regression. RESULTS Inclusion criteria was met by 46 patients. From 2010 to 2019, S. pyogenes and S. pneumoniae were the most common bacteria, each isolated in 11 of 42 bacterial isolates (26.2%). There was no growth in 35.4% (17/48) of intra-operative wound cultures. On univariate analysis, patients with negative cultures had longer length of hospital stay (LOS) (7.7 days [6.5] vs. 4.3 [2.8]; p = 0.018) as well as higher rates of PICC (peripherally inserted central catheter) placement (53.3% vs. 19.4%; p = 0.021). There was a statistically significant difference in terms of gender (p = 0.021), with 15 males and 16 females in the positive culture cohort and 13 males and 2 females in the negative culture cohort. On multivariate analysis, which included gender, PICC placement, both intracranial and extracranial complications, duration of antibiotics, and LOS, female gender was the only significant predictor of positive culture status (p = 0.039). CONCLUSION S. pyogenes and S. pneumoniae were the predominant etiologic agents in acute coalescent mastoiditis between 2010 and 2019, and negative wound cultures were associated with worse clinical outcomes.
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Affiliation(s)
- Troy Wesson
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dhruv Sharma
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Cole Rodman
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Brady J Tucker
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel R Romano
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jerry Chen
- Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Lindsay Mulinaro
- Indiana University School of Medicine, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA
| | - Aaron E Carroll
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Pediatrics, Indianapolis, IN, USA
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA
| | - William Bennett
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Pediatrics, Indianapolis, IN, USA
| | - Sarah J Burgin
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA. http://sburgin.iupui.edu
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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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Jamal A, Alsabea A, Tarakmeh M, Safar A. Etiology, Diagnosis, Complications, and Management of Acute Otitis Media in Children. Cureus 2022; 14:e28019. [PMID: 36134092 PMCID: PMC9471510 DOI: 10.7759/cureus.28019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 11/30/2022] Open
Abstract
Acute otitis media (AOM) is the most common infectious disease encountered by children under the age of two years and the most common cause of antibiotic use in children in the United States. AOM causes irritability, sleeplessness, decreased appetite, imbalance, and dizziness in patients, especially young children. This assessment was conducted to measure the effectiveness of surgical interventions in treating AOM. We reviewed the present findings regarding the etiology, clinical presentations, diagnosis, treatment, and surgical treatment of complications of AOM. Pain associated with AOM (otalgia) can be severe enough to cause parents to seek treatment for their infants or children. Various suggested measures have been used to treat AOM; antibiotic treatment with amoxicillin is still the treatment of choice for AOM, yet other antibiotics may be used in cases of allergy to penicillin or recent use of amoxicillin. Surgical intervention has been introduced and studied as a diagnostic, therapeutic, and preventive measure for AOM; nevertheless, a few studies have shown that surgical interventions are beneficial in treating and preventing AOM compared to the common practice of using antibiotics. Overdiagnosis of AOM is widespread, leading to injudicious antibiotic use, which contributes to antibiotic resistance. Further management should be determined together with the parent, particularly if observation is the primary intervention.
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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
Acute otitis media (AOM) is an acute infection of the middle ear and, depending on the age of the child, the certainty of diagnosis, and the severity of symptoms, should be either observed closely or treated (with high-dose amoxicillin, if not allergic). Host-related risk factors such as age, sex, cleft palate, or genetic predisposition or environmental risk factors such as seasonality, day care attendance, or tobacco smoke exposure may contribute to recurrent AOM (RAOM) episodes. Tympanostomy tubes are recommended in children with RAOM and an abnormal ear examination at the time of the clinic evaluation.
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Affiliation(s)
- Todd Otteson
- Pediatric Otolaryngology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Suite 4500, Cleveland, OH 44106, USA.
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Feussner O, Haase R, Baier J. Case report: Otitis media with subsequent mastoiditis and cerebral herniation in a patient with Arnold chiari malformation. Front Pediatr 2022; 10:1013300. [PMID: 36756533 PMCID: PMC9901363 DOI: 10.3389/fped.2022.1013300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023] Open
Abstract
We present the case of a 13-year-old boy who unexpectedly needed to be resuscitated at home after an assumed uncomplicated otitis media. Imaging at our clinic showed mastoiditis and a cystoid mass in the left cerebellopontine angle compressing the brainstem, as well as an Arnold-Chiari-Malformation. Both the laboratory examination of cerebrospinal fluid (CSF) and surgical biopsy with pathological evaluation of the mastoid supported the inflammatory etiology of the mass. Microbiologically, Streptococcus intermedius was detected in the blood culture and CSF. Due to brain death, which most likely already existed preclinically, the organs were released for donation during the course. Our case demonstrates a very rare lethal complication of acute otitis media on the basis of a cerebral malformation and emphasizes the need to stay alert when patients complain of symptoms after assumed resolution.
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Affiliation(s)
- Oskar Feussner
- Department for Operative and Nonoperative Pediatrics and Adolescent Medicine, Section for Neonatology and Pediatric Critical Care, University Hospital, Halle, Germany
| | - Roland Haase
- Department for Operative and Nonoperative Pediatrics and Adolescent Medicine, Section for Neonatology and Pediatric Critical Care, University Hospital, Halle, Germany
| | - Jan Baier
- Department for Operative and Nonoperative Pediatrics and Adolescent Medicine, Section for Neonatology and Pediatric Critical Care, University Hospital, Halle, Germany
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Capobussi M, Moja L. An open-access and inexpensive 3D printed otoscope for low-resource settings and health crises. 3D Print Med 2021; 7:36. [PMID: 34787772 PMCID: PMC8595962 DOI: 10.1186/s41205-021-00127-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Limited access to key diagnostic tools is detrimental to priority health needs of populations. Ear pain, tenderness, itching, and different degree of hearing loss are common problems which require otoscopy as first diagnostic assessment. Where an otoscope is not available because of budget constraints, a self-fabricated low-cost otoscope might represent a feasible opportunity. In this paper, we share the design and construction process of an open-source, 3D printed, otoscope. The prototype was compared to a commercial solution, demonstrating similar overall quality between the instruments.
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Affiliation(s)
- Matteo Capobussi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy. .,Interuniversity Center in Clinical Research, University of Milan, Milan, Italy.
| | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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9
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Smith ME, Jones GH, Hardman JC, Nichani J, Khwaja S, Bruce IA, Rea P. Acute paediatric mastoiditis in the UK before and during the COVID-19 pandemic: A national observational study. Clin Otolaryngol 2021; 47:120-130. [PMID: 34606691 PMCID: PMC8652842 DOI: 10.1111/coa.13869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK. DESIGN National retrospective and prospective audit. SETTING 48 UK secondary care ENT departments. PARTICIPANTS Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis. MAIN OUTCOME MEASURES Cases were divided into Period 1 (01/11/19-15/03/20), before the UK population were instructed to reduce social contact, and Period 2 (16/03/20-30/04/21), following this. Periods 1 and 2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical). RESULTS 286 cases met criteria (median 4 per site, range 0-24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in December 2020-Febraury 2021. Patient age differed between periods 1 and 2 (3.2 vs 4.7 years respectively, p < 0.001). 85% of children in period 2 were tested for COVID-19 with a single positive test. In period, 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% vs 24.3%, p = 0.001). Treatment success was high, with failure of initial management in 6.3%, and 30-day re-admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2. CONCLUSION The COVID-19 pandemic led to a significant change in the presentation and case mix of acute paediatric mastoiditis in the UK.
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Affiliation(s)
- Matthew E Smith
- Department of Otolaryngology, Salford Royal Hospital, Manchester, UK
| | - G Huw Jones
- Department of Otolaryngology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - John C Hardman
- The Head and Neck Unit, The Royal Marsden Hospital, London, UK
| | - Jaya Nichani
- Paediatric Otolaryngology Department, Royal Manchester Children's Hospital, University of Manchester, UK
| | - Sadie Khwaja
- Department of Otolaryngology, Manchester University Foundation Trust, Manchester, UK
| | | | - Iain A Bruce
- Paediatric ENT Department, Royal Manchester Children's Hospital, MAHSC, University of Manchester, UK
| | - Peter Rea
- Department of Otolaryngology, Leicester Royal Infirmary, Leicester, UK
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Leiva LM, Delgado H, Holguín LV, Rojas C. Cranial complications of otitis media with paralysis of the contralateral sixth cranial pair in pediatrics. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2021; 41:218-224. [PMID: 34214262 PMCID: PMC8372842 DOI: 10.7705/biomedica.5763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/03/2020] [Indexed: 12/04/2022]
Abstract
Otitis media is a frequent infection during childhood. Complications may be present in up to 4 of 100 children including serious neurological complications, particularly in developing countries. We report the case of a 9-year-old girl with no disease history who presented with otitis media, otorrhea, intracranial hypertension syndrome, and paralysis of the VI cranial nerve contralateral to the lesion. A computed tomography scan of the skull and a brain magnetic resonance imaging revealed chronic otomastoiditis, petrous apicitis, and thrombosis of the transverse and sigmoid sinus, the jugular bulb, and the right internal jugular vein. She received antibiotics and surgical treatment. This case shows the spectrum of intra and extracranial complications associated with acute otitis media in the antibiotic era. The physical examination allows early identification of intracranial hypertension with signs such as papilledema and sixth contralateral nerve palsy as an unusual finding.
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Affiliation(s)
- Luz Miriam Leiva
- Departamento de Medicina Física y Rehabilitación, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia.
| | - Hamilton Delgado
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.
| | | | - Christian Rojas
- Neurología Infantil, Departamento de Pediatría, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia.
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Temporal Trends and Regionalization of Acute Mastoiditis Management in the United States. Otol Neurotol 2021; 42:733-739. [PMID: 33481546 DOI: 10.1097/mao.0000000000003050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe demographics and to analyze temporal trends in the inpatient management of acute mastoiditis admissions. STUDY DESIGN Cross-sectional analysis. SETTING National Inpatient Sample, 2002-2014. PATIENTS 26,072 nonelective inpatient admissions with primary diagnosis of acute mastoiditis. INTERVENTION Myringotomy, mastoidectomy, or no procedure. MAIN OUTCOME MEASURES We described the patient- and hospital-level demographics of acute mastoiditis admissions and the frequency of complications. We evaluated the percentage of patients requiring surgical management. Binary logistic regression was performed to determine whether there was a significant increase in the percentage of patients treated at academic institutions. RESULTS The majority of patients were ≤40 years old (64.9%) and Elixhauser comorbidity index ≥4 (57.4%); 23.3% (SE 0.8%) presented with complications associated with acute mastoiditis, the most common of which was a subperiosteal abscess (11.5%, SE 0.7%). Among all admissions, 30.9% (SE 1.1%) underwent myringotomy, 13.8% (SE 0.8%) required both myringotomy and mastoidectomy. On multivariate analysis, there was a statistically significant increase in the percentage of mastoiditis admissions to teaching hospitals for all admissions (OR 1.55 [CI 1.22-1.97], p < 0.001) and even more evident for cases with associated complications (OR 1.85 [CI 1.21-2.83], p = 0.004). CONCLUSIONS AND RELEVANCE A sizeable percentage of patients with acute mastoiditis present with complications which may require surgical intervention. From 2002 to 2014, inpatient care of acute mastoiditis became increasingly regionalized to teaching hospitals, suggestive of increased specialization within certain facilities. This trend may have significant impacts on the cost and subsequent quality of care provided to these patients.
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Favre N, Patel VA, Carr MM. Complications in Pediatric Acute Mastoiditis: HCUP KID Analysis. Otolaryngol Head Neck Surg 2021; 165:722-730. [PMID: 33588620 DOI: 10.1177/0194599821989633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and mortality. The aim of this study was to evaluate the incidence and management of complications related to pediatric acute mastoiditis using a national database. STUDY DESIGN Retrospective review of 2016 Kids' Inpatient Database, part of the Healthcare Cost and Utilization Project. SETTING Academic, community, general, and pediatric specialty hospitals in the United States. METHODS International Classification of Diseases, Tenth Revision, Clinical Modification code H70.XXX was used to retrieve records for children admitted with a diagnosis of mastoiditis. Data included patient demographics, intracranial infections, procedures (middle ear drainage, mastoidectomy, and intracranial drainage), length of stay (LOS), and total charges. RESULTS In total, 2061 children aged ≤21 years were identified with a diagnosis of acute mastoiditis. Complications included subperiosteal abscess (6.90%), intracranial thrombophlebitis/thrombosis (5.30%), intracranial abscess (3.90%), otitic hydrocephalus (1.20%), encephalitis (0.90%), subperiosteal abscess with intracranial complication (0.60%), petrositis (0.60%), and meningitis (0.30%). Children with intracranial abscesses were more likely (P < .001) to undergo myringotomy ± ventilation tube insertion (63.7%), mastoidectomy (53.8%), mastoidectomy with ventilation tube or myringotomy (42.5%), intracranial drainage procedure (36.3%), or all 3 key procedures (15.0%). Children with any type of intracranial complication had a significantly longer LOS (P < .001) and higher total charges (P < .001). Both a diagnosis of bacterial meningitis and undergoing an intracranial drainage procedure (P < .001) contributed significantly to LOS and total charges. CONCLUSION Patients with intracranial complications are more likely to undergo surgical procedures; however, there is still wide variability in practice patterns, illustrating that controversies in the management of otitis media complications persist.
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Affiliation(s)
- Nicole Favre
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
| | - Vijay A Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Center for Cranial Base Surgery, Pittsburgh, Pennsylvania, USA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
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Ravera J, Stevens MW. Invasive Bacterial Infections in Afebrile Infants With Otitis Media: Worry Less but Still Worry. Pediatrics 2021; 147:peds.2020-039602. [PMID: 33288729 DOI: 10.1542/peds.2020-039602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joseph Ravera
- Section of Pediatric Emergency Medicine, Division of Emergency Medicine, Department of Surgery and
| | - M W Stevens
- Department of Pediatrics, Robert Larner, MD, College of Medicine, The University of Vermont, Burlington, Vermont
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Duygu E, Şevik Eliçora S. Our experience on the management of acute mastoiditis in pediatric acute otitis media patients. Int J Pediatr Otorhinolaryngol 2020; 138:110372. [PMID: 32927353 DOI: 10.1016/j.ijporl.2020.110372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The incidence of complications due to acute otitis media (AOM) in childhood has decreased significantly with the use of new antibiotics in recent years. However, acute mastoiditis (AM) is still the most common complication that can lead to further intracranial conditions with high morbidity. Our study aimed to evaluate the clinical characteristics of children with AM and identify possible indicators for further intracranial complications associated with this condition. METHODS Children hospitalized in our clinic with a diagnosis of AM were reviewed. Demographic data, disease-related symptoms, types of complications accompanied by AM, medical/surgical treatments modalities, and culture results were screened. The patients were divided into two groups as those with and without intracranial complications (ICCs). Routine complete blood count tests, biochemical analysis, and C-reactive protein (CRP) level measurement were evaluated and compared between the groups. RESULTS Of the 28 AM patients, five (17.9%) had isolated AM. Complications associated with AM included sub-periosteal abscess (28.6%), facial paralysis (25%), meningitis (17.9%), meningitis with sigmoid sinus thrombosis (7.1%), and meningitis with cerebellar abscess (3.6%). Eight patients developed ICCs (28.6%), of whom three had more than one complication. Ceftriaxone was found to be the first-line medical treatment (57.1%). Streptococcus pneumoniae was the most common pathogen isolated from the cultures (42.9%). Three patients (10.7%) were treated non-surgically, eight (28.6%) with myringotomy and ventilation tube (VT) insertion, eight patients (28.6%) with abscess drainage and VT insertion, and nine (32.1%) with cortical mastoidectomy and VT insertion. There was no significant difference between the patients with and without ICCs in terms of complete blood count parameters. The CRP level and the CRP-albumin ratio were significantly higher in patients with ICCs than those without these complications (p < 0.001). CONCLUSION AM remains to be the most common complication of AOM in childhood and can lead to further life-threatening conditions. Additional interventions according to the type of the complication with VT insertion is safe and effective in the management of AM. In patients with AM, it is of great importance to determine whether there is an accompanying ICC. The CRP-albumin ratio is a simple and reliable calculation to detect ICCs in patients with AM.
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Affiliation(s)
- Erdem Duygu
- Department of Otorhinolaryngology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey.
| | - Sultan Şevik Eliçora
- Department of Otorhinolaryngology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey.
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Kaufmann MR, Camilon PR, Levi JR, Devaiah AK. Predicting Anticoagulation Need for Otogenic Intracranial Sinus Thrombosis: A Machine Learning Approach. J Neurol Surg B Skull Base 2020; 82:233-243. [PMID: 33777638 DOI: 10.1055/s-0040-1713105] [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: 11/19/2019] [Accepted: 04/15/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The role of anticoagulation (AC) in the management of otogenic cerebral venous sinus thrombosis (OCVST) remains controversial. Our study aims to better define when AC is used in OCVST. Methods MEDLINE, EMBASE, and The Cochrane Library were searched from inception to February 14, 2019 for English and English-translated articles. References cited in publications meeting search criteria were searched. Titles and abstracts were screened and identified in the literature search, assessing baseline risk of bias on extracted data with the methodological index for nonrandomized studies (MINORS) scale. Random effects meta-regression followed by random forest machine learning analysis across 16 moderator variables between AC and nonanticoagulated (NAC) cohorts was conducted. Results A total of 92% of treated patients were free of neurologic symptoms at the last follow-up (mean 29.64 months). Four percent of AC and 14% of NAC patients remained symptomatic (mean 18.72 and 47.10 months). 3.5% of AC patients experienced postoperative wound hematomas. AC and NAC recanalization rates were 81% (34/42) and 63% (five-eights), respectively. OCVST was correlated with cholesteatoma and intracranial abscess. Among the analyzed covariates, intracranial abscess was most predictive of AC and cholesteatoma was most predictive of NAC. Comorbid intracranial abscess and cholesteatoma were predictive of AC. Conclusion The present study is the first to utilize machine learning algorithms in approaching OCVST. Our findings support the therapeutic use of AC in the management of OCVST when complicated by thrombophilia, intracranial abscess, and cholesteatoma. Patients with intracranial abscess and cholesteatoma may benefit from AC and surgery. Patients with cholesteatoma can be managed with NAC and surgery.
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Affiliation(s)
- Matthew R Kaufmann
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - Philip Ryan Camilon
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States
| | - Anand K Devaiah
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States.,Department of Neurological Surgery and Ophthalmology, Boston, Massachusetts, United States.,Institute for Health System Innovation and Policy, Boston University, Boston, Massachusetts, United States
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16
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Abstract
BACKGROUND Mastoiditis is the most common intra-temporal complication of acute otitis media. Despite potentially lethal sequelae, optimal management remains poorly defined. METHOD A retrospective case review was conducted of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017. RESULTS Fifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0-27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred. CONCLUSION A detailed contemporary description of paediatric mastoiditis presentation and management is presented. The findings broadly mirror those published by other UK centres, but suggest a higher rate of identified disease complications and surgical interventions.
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17
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McLaren J, Cohen MS, El Saleeby CM. How well do we know Gradenigo? A comprehensive literature review and proposal for novel diagnostic categories of Gradenigo's syndrome. Int J Pediatr Otorhinolaryngol 2020; 132:109942. [PMID: 32065876 DOI: 10.1016/j.ijporl.2020.109942] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/08/2023]
Abstract
Gradenigo's Syndrome is a rare complication of otitis media and/or mastoiditis resulting in inflammation of the petrous apex of the temporal bone. Here, we highlight an interesting case from our institution, summarize available pediatric cases from the past fifty years to provide an updated diagnostic categorization for this rare condition with confusing nomenclature, and suggest guidance for diagnosis and management.
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Affiliation(s)
- John McLaren
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michael S Cohen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Chadi M El Saleeby
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Divisions of Hospital Medicine, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA; Divisions of Infectious Disease, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA.
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18
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Gilard V, Beccaria K, Hartley JC, Blanot S, Marqué S, Bourgeois M, Puget S, Thompson D, Zerah M, Tisdall M. Brain abscess in children, a two-centre audit: outcomes and controversies. Arch Dis Child 2020; 105:288-291. [PMID: 31431437 DOI: 10.1136/archdischild-2018-316730] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to better characterise clinical presentation, management and outcome in infants and children with brain abscess. METHODS The authors conducted a retrospective, multicentre study in two national reference centres over a 25-year period (1992-2017). During this period, 116 children and 28 infants (age <1 year) with brain abscess were treated. RESULTS The median age at diagnosis was 101.5 (range: 13-213) months in children and 1 (0-11) month in infants. Significant differences were observed between children and infants. The most common predisposing factor was meningitis in infants (64% of cases vs 3% in children), while it was otolaryngology-related infection in children (31% of cases vs 3.6% in infants). Infants presented more frequently with fever and meningism compared with children. 115 patients were treated with aspiration and 11 with excision. Reoperation was required in 29 children vs 1 infant. The overall mortality rate was 4% (3.4% for children, 7.1% for infants). At 3-month follow-up, the outcome was favourable in 86% of children vs in 68% of infants. CONCLUSION There is a clear difference between children and infants with brain abscess in terms of predisposing factors, causative organisms and outcome. Despite surgical drainage and directed antibiotic therapy, 25% of patients with brain abscess require reoperation. Mortality is improved compared with historical series; however, long-term morbidity is significant particularly in the infant population.
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Affiliation(s)
- Vianney Gilard
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France .,Department of Pediatric Neurosurgery, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Kévin Beccaria
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France
| | - John C Hartley
- Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stéphane Blanot
- Department of Paediatric Neuro-Critical Care and Anaesthesia, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France
| | - Sophie Marqué
- Department of Paediatric Neuro-Critical Care and Anaesthesia, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France
| | - Marie Bourgeois
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France
| | - Stephanie Puget
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France
| | - Dominic Thompson
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France
| | - Michel Zerah
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Martin Tisdall
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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19
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Acute Otitis Media and Associated Complications in United States Emergency Departments. Otol Neurotol 2019; 39:1005-1011. [PMID: 30113560 DOI: 10.1097/mao.0000000000001929] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications. STUDY DESIGN Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011. SETTING Emergency Department. PATIENTS Patients who presented with a primary diagnosis of AOM or acute mastoiditis. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted. RESULTS A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons). CONCLUSIONS ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.
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20
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Sambulov VI, Stepanova EA. [Clinical and diagnostic observations of a complicated course of chronic otitis media, cholesteatoma in children]. Vestn Otorinolaringol 2019; 84:51-54. [PMID: 31579059 DOI: 10.17116/otorino20198404151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Formation of labyrinth fistulas and destruction of the facial nerve canal in children with middle ear cholesteatoma is rare. Data of children with cholesteatoma of the middle ear, operated in the ENT department of MONIKI, is analyzed. Several clinical observations of multiple-aged patients with the presence of cholesteatoma intra-temporal complications are presented. The preoperative computer tomography made it possible to diagnose the presence of the labyrinth fistula and the destruction of the facial nerve channel, which was confirmed intraoperatively.
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Affiliation(s)
- V I Sambulov
- The ENT clinic, the Department of Radiation Diagnosis of the M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia, 129110
| | - E A Stepanova
- The ENT clinic, the Department of Radiation Diagnosis of the M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia, 129110
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21
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Castellazzi ML, Senatore L, Di Pietro G, Pinzani R, Torretta S, Coro I, Russillo A, Borzani I, Bosis S, Marchisio P. Otogenic temporomandibular septic arthritis in a child: a case report and a review of the literature. Ital J Pediatr 2019; 45:88. [PMID: 31331358 PMCID: PMC6647282 DOI: 10.1186/s13052-019-0682-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022] Open
Abstract
Background Acute otitis media is one of the most common infectious diseases in the paediatric age and although its complications such as acute mastoiditis have become rare thanks to improvements in therapeutic approaches, possible serious complications such as septic arthritis of the temporomandibular joint may develop. A prompt diagnosis and adequate treatment are essential to achieving the best outcome and avoiding serious sequelae. We describe a case occurring in a previously healthy 6-year-old female and review the literature currently available on this topic. Case presentation The patient presented a right temporomandibular septic arthritis with initial mandibular bone involvement secondary to acute otitis media. She presented with torcicollis, trismus, right preauricular swelling over the temporomandibular joint and was successfully treated with antibiotic treatment alone. Conclusions Septic arthritis of the temporomandibular joint is a rare complication of acute otitis media or acute mastoiditis in children. It should be suspected in patients presenting with trismus, preauricular swelling or fever. No guidelines on the diagnosis and treatment of this infectious disease are currently available.
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Affiliation(s)
- Massimo Luca Castellazzi
- ASST NORDMILANO, Sesto San Giovanni Hospital, Paediatric and Neonatology Unit, Sesto San Giovanni, Milan, Italy
| | - Laura Senatore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giada Di Pietro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Raffaella Pinzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, ENT Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ilaria Coro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy
| | - Antonio Russillo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Maxillofacial and Dental Unit, Milan, Italy
| | - Irene Borzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Radiology Unit - Paediatric Division, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy.
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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22
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Posa M, Nestor K, Coleman R, Rajderkar D, Kelly MN. An 11-Month-Old Male With Acute-Onset Left-Sided Facial Paralysis. Clin Pediatr (Phila) 2019; 58:594-598. [PMID: 30897949 DOI: 10.1177/0009922819837354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Molly Posa
- 1 University of Florida, Gainesville, FL, USA
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23
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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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24
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Coutinho G, Júlio S, Matos R, Santos M, Spratley J. Otogenic cerebral venous thrombosis in children: A review of 16 consecutive cases. Int J Pediatr Otorhinolaryngol 2018; 113:177-181. [PMID: 30173980 DOI: 10.1016/j.ijporl.2018.07.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Management of otogenic cerebral venous thrombosis (OCVT) is controversial. Despite the modern antibiotic era OCVT still represents a potential life-threatening condition. This study aims to report the clinical presentation and management in a series of children with OCTV. The coexisting intracranial complications (ICC), the extent of the surgical treatment and the role of hypocoagulation were the analysed outcomes. MATERIAL AND METHODS Retrospective chart review of patients aged less than 16 years and consecutively treated for OCVT at a tertiary university hospital between January 2007 and March 2015. RESULTS Sixteen children with ages ranging between 25 months and 16 years (9 girls/7 boys) with OCVT were identified. Acute otitis media was the causative factor in the majority of cases (n = 13). The remaining cases resulted from chronic otitis media with cholesteatoma (COMC). Eleven patients were under antibiotic therapy prior to admission. Other ICC were simultaneously present: intracranial abscess (n = 6); otitic hydrocephalus (n = 3); and meningitis (n = 1). Thrombus extension correlated with the presence of additional ICC (p = 0.035). Treatment in all cases comprised of broad-spectrum antibiotics, mastoidectomy, and long-range hypocoagulation with warfarin. Transtympanic ventilation tubes were inserted in all cases but one with COMC. Perioperative sigmoid sinus exposure was performed in seven patients, with drainage of perisinus empyema in three cases. Five children underwent simultaneous craniotomy for intracranial abscess drainage. Follow-up imaging performed in 12 cases revealed partial or complete recanalization in three and seven cases, respectively. After a mean hypocoagulation duration of nine months, no hemorrhagic or major neurologic complications were observed. CONCLUSIONS The clinical course of OCVT can be masked by previous antibiotic therapy. As such, a high suspicion index is needed for diagnosis. Simultaneous ICC appears to be more frequently found if an extensive thrombosis was present. The high recanalization rate in this series with low morbidity and no mortality can be obtained with a timely combination of antibiotics, mastoidectomy with transtympanic tube insertion and hypocoagulation. However, the decision to start hypocoagulation and its duration should be undertaken on an individual basis owing the possible adverse effects. Prospective and case-control studies are still needed to better clarify the role of the hypocoagulation treatment in OCVT.
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Affiliation(s)
- Gil Coutinho
- Department of Otorhinolaryngology, Centro Hospitalar São João, Porto, Portugal; Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Medical School, Porto, Portugal.
| | - Sara Júlio
- Department of Otorhinolaryngology, Centro Hospitalar São João, Porto, Portugal; Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Medical School, Porto, Portugal
| | - Ricardo Matos
- Department of Otorhinolaryngology, Centro Hospitalar São João, Porto, Portugal; Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Medical School, Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, Centro Hospitalar São João, Porto, Portugal
| | - Jorge Spratley
- Department of Otorhinolaryngology, Centro Hospitalar São João, Porto, Portugal; Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Medical School, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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25
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Devaraja K. Vertigo in children; a narrative review of the various causes and their management. Int J Pediatr Otorhinolaryngol 2018; 111:32-38. [PMID: 29958611 DOI: 10.1016/j.ijporl.2018.05.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/03/2023]
Abstract
Vertigo is a not an uncommon symptom in children, but often the treating doctors are unsure of the diagnosis and the management of these cases. This narrative review of the literature discusses the brief etiopathology, the clinical manifestations and the management algorithm of most of the conditions causing vertigo in children. The relevant information has been condensed into a table for the perusal of the readers, which would assist in the appropriate management of these children.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Udupi, Karnataka, 576104, India.
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26
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D'Anna C, Diplomatico M, Tipo V. Facial palsy in a baby with acute otitis media. Arch Dis Child Educ Pract Ed 2018; 103:155-157. [PMID: 28363956 DOI: 10.1136/archdischild-2017-312743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/21/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Carolina D'Anna
- Pediatric Emergency Department, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon di Napoli, Napoli, Italy
| | - Mario Diplomatico
- Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
| | - Vincenzo Tipo
- Pediatric Emergency Department, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon di Napoli, Napoli, Italy
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Abstract
PURPOSE OF REVIEW The aim of this study is to discuss the symptoms, diagnosis, and management of the neurologic complications of acute and chronic otitis media. RECENT FINDINGS Antibiotic therapy has greatly reduced the frequency of complications of otitis media. However, it is of vital importance to remain aware of the possible development of neurologic complications. There is a trend toward less severe presenting symptoms including otorrhea, headache, nausea, and fever, with altered mental status and focal neurologic deficits presenting later. In order to reduce morbidity, early deployment of a multidisciplinary approach with prompt imaging and laboratory studies is imperative to guide appropriate management. Complications of acute and chronic otitis media may present with neurologic signs and symptoms. It is important to recognize the possible otitic origin of such complications to ensure proper management and to decrease overall morbidity and mortality.
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Affiliation(s)
- Michael J Hutz
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA.
| | - Dennis M Moore
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
- Division of Otolaryngology - Head and Neck Surgery, Hines VA Medical Center, Hines, IL, USA
| | - Andrew J Hotaling
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
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Talathi S, Gupta N, Sethuram S, Khanna S, Sitnitskaya Y. Otitis Media in Fully Vaccinated Preschool Children in the Pneumococcal Conjugate Vaccine Era. Glob Pediatr Health 2018; 4:2333794X17749668. [PMID: 29308427 PMCID: PMC5751904 DOI: 10.1177/2333794x17749668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives. To evaluate the effect of pneumococcal conjugate vaccine (PCV13) on the burden of acute otitis media (AOM) and to evaluate the characteristics of AOM versus otitis media with effusion (OME) in the 2 PCV periods. Methods. A cohort of fully vaccinated children aged 18 to 60 months diagnosed with AOM from 2006 to 2015 was identified. Patients with otorrhea/bulging tympanic membrane were considered as true AOM, while those without bulging/otorrhea were considered to have OME. Burden of true AOM in the PCV7 and PCV13 periods and clinical features of true AOM versus OME were compared. Results. Of 393 episodes in our cohort, 50.8% occurred in PCV7 period. Burden of true AOM in the 2 PCV groups was similar: 26% in PCV7 versus 26.4% in PCV13 (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.65-1.60). Factors significantly associated with OME were cold season (OR = 1.54, 95% CI = 1.04-2.4), fever (OR = 2.05, 95% CI = 1.29-3.3), and recurrence (OR = 2.24, 95% CI = 1.22-4.09). No complications of AOM were identified. Majority episodes were treated with antibiotics. Conclusion. Unlike the role of PCV13 in reducing invasive pneumococcal disease, its effect on reducing the burden of AOM is minimal as compared with PCV7. With regard to characteristics of AOM versus OME, findings of tympanic membrane should be used to suggest a diagnosis of AOM, instead of occurrence of fever or recurrence of AOM episodes. Using this approach would help in guiding the use of antibiotics appropriately.
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Early signs and symptoms of intracranial complications of otitis media in pediatric and adult patients: A different presentation? Int J Pediatr Otorhinolaryngol 2017; 102:56-60. [PMID: 29106876 DOI: 10.1016/j.ijporl.2017.08.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to review the clinical presentation and early signs and symptoms of otogenic intracranial complications (OIC) in children and adults. METHODS retrospective chart review. The medical records of all children and adults admitted in our center with OIC during the period 2008-2017 were reviewed. Data concerning clinical presentation, treatment and outcomes were reviewed and analyzed. RESULTS We included 47 patients with OIC: 21 children (range 1-13 years) and 26 adults (range 22-71 years). We included more patients with acute otitis media than with chronic otitis media (children 5% adults 19%, all with cholesteatoma). In children; the most common OIC was central cerebral venous thrombosis. In both children and adults; otogenic symptoms such as otalgia and otorrhea were present. Children presented more frequently with headache and nausea. Adults presented more frequently with decreased consciousness. Hearing loss was the most common long-term sequel. Three adults died. CONCLUSIONS In our series, we found that OIC in children present as 'mimicking meningitis' (e.g. nausea and vomiting). Adults on the other hand have a clinical presentation 'mimicking stroke' (e.g. neurological deficits and decreased level of consciousness). In children, sinus thrombosis was observed more frequently than in adults. Despite the low mortality rate, death still occurs. Long -term sequelae most frequently include hearing loss in children as well as in adults.
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Management of paediatric acute mastoiditis: systematic review. The Journal of Laryngology & Otology 2017; 132:96-104. [DOI: 10.1017/s0022215117001840] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Acute mastoiditis remains the commonest intratemporal complication of otitis media in the paediatric population. There has been a lack of consensus regarding the diagnosis and management of acute mastoiditis, resulting in considerable disparity in conservative and surgical management.Objectives:To review the current literature, proposing recommendations for the management of paediatric acute mastoiditis and appraising the treatment outcomes.Method:A systematic review was conducted using PubMed, Web of Science and Cochrane Library databases.Results:Twenty-one studies were included, with a total of 564 patients. Cure rates of medical treatment, conservative surgery and mastoidectomy were 95.9 per cent, 96.3 per cent and 89.1 per cent, respectively.Conclusion:Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy may be an appropriate first-line management when treating acute mastoiditis.
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Schilder AGM, Marom T, Bhutta MF, Casselbrant ML, Coates H, Gisselsson-Solén M, Hall AJ, Marchisio P, Ruohola A, Venekamp RP, Mandel EM. Panel 7: Otitis Media: Treatment and Complications. Otolaryngol Head Neck Surg 2017; 156:S88-S105. [PMID: 28372534 DOI: 10.1177/0194599816633697] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
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Affiliation(s)
- Anne G M Schilder
- 1 evidENT, Ear Institute, University College London, London, United Kingdom.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tal Marom
- 3 Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Mahmood F Bhutta
- 4 Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Margaretha L Casselbrant
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harvey Coates
- 6 Department of Otolaryngology, School of Paediatrics and Child Health, The University of Western Australia, Nedlands, WA, Australia
| | - Marie Gisselsson-Solén
- 7 Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Amanda J Hall
- 8 University Hospitals Bristol NHS Foundation Trust and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Paola Marchisio
- 9 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aino Ruohola
- 10 Department of Pediatrics, University of Turku, Turku, Finland
| | - Roderick P Venekamp
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen M Mandel
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Pont E, Mazón M. Indications and Radiological Findings of Acute Otitis Media and Its Complications. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Margaret A Kenna
- From the Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston
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Fonte purulente de la cornée : une complication inattendue de l’otite moyenne aiguë. Arch Pediatr 2016; 23:823-6. [DOI: 10.1016/j.arcped.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/16/2015] [Accepted: 05/11/2016] [Indexed: 11/17/2022]
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Pont E, Mazón M. Indications and radiological findings of acute otitis media and its complications. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:29-37. [PMID: 27241558 DOI: 10.1016/j.otorri.2016.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/12/2016] [Accepted: 02/24/2016] [Indexed: 11/19/2022]
Abstract
Most cases of acute otitis media resolve with antibiotics and imaging is not required. When treatment fails or a complication is suspected, imaging plays a crucial role. Since the introduction of antibiotic treatment, the complication rate has decreased dramatically. Nevertheless, given the critical clinical relevance of complications, the importance of early diagnosis is vital. Our objective was to review the clinical and radiological features of acute otitis media and its complications. They were classified based on their location, as intratemporal or intracranial. Imaging makes it possible to diagnose the complications of acute otitis media and to institute appropriate treatment. Computed tomography is the initial technique of choice and, in most cases, the ultimate. Magnetic resonance is useful for evaluating the inner ear and when accurate evaluation of disease extent or better characterization of intracranial complications is required.
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Affiliation(s)
- Elena Pont
- Servicio de Otorrinolaringología, Hospital General de Onteniente, Valencia, España.
| | - Miguel Mazón
- Sección de Neurorradiología y Radiología de cabeza-cuello, Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, España
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Le Saux N, Robinson JL. Management of acute otitis media in children six months of age and older. Paediatr Child Health 2016; 21:39-50. [PMID: 26941560 DOI: 10.1093/pch/21.1.39] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Acute otitis media (AOM) continues to be a common infection in young children. Milder disease, usually due to viruses or less virulent bacteria, resolves equally quickly with or without antibiotics. A bulging tympanic membrane, especially if yellow or hemorrhagic, has a high sensitivity for AOM that is likely to be bacterial in origin and is a major diagnostic criterion for AOM. Perforation of the tympanic membrane with purulent discharge similarly indicates a bacterial cause. Immediate antibiotic treatment is recommended for children who are highly febrile (≥39°C), moderately to severely systemically ill or who have very severe otalgia, or have already been significantly ill for 48 h. For all other cases, parents can be provided with a prescription for antibiotics to fill if the child does not improve in 48 h or the child can be reassessed if this occurs. Amoxicillin remains the clear drug of choice. Ten days of therapy is appropriate for children <2 years of age, whereas older children can be treated for five days.
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Luc abscess: an extraordinary complication of acute otitis media. Am J Emerg Med 2016; 34:117.e1-3. [DOI: 10.1016/j.ajem.2015.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/14/2015] [Indexed: 11/21/2022] Open
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Zielnik-Jurkiewicz B, Bielicka A. Antibiotic resistance of Streptococcus pneumoniae in children with acute otitis media treatment failure. Int J Pediatr Otorhinolaryngol 2015; 79:2129-33. [PMID: 26454530 DOI: 10.1016/j.ijporl.2015.09.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The emergence of antibiotic-resistant bacteria is a major cause of treatment failure in children with acute otitis media (AOM). This study aimed to analyze the types of bacterial strains in fluid isolated from the middle ear of children with AOM who did not respond to oral antibiotic treatment. We also determined the antibiotic resistance of the most frequently isolated bacterial strain (Streptococcus pneumoniae) found in these children. METHODS This was a prospective study of 157 children with AOM aged from 6 months to 7 years admitted due to unsuccessful oral antibiotic treatment. All children underwent a myringotomy, and samples of the middle ear fluid were collected for bacteriological examination. RESULTS Positive bacterial cultures were obtained in 104 patients (66.2%), with Streptococcus pneumoniae (39.69%), Haemophilus influenzae (16.03%) Staphylococcus aureus (16.03%), Staphylococcus haemolyticus (6.9%) and Streptococcus pyogenes (5.34%) found most frequently. The majority (65.4%) of S. pneumoniae strains were penicillin-intermediate-resistant or penicillin-resistant, and 67.2% strains of S. pneumoniae were multidrug-resistant. CONCLUSIONS We identified S. pneumoniae as the most frequently isolated pathogen from the middle ear in children with AOM treatment failure and determined that the majority of strains were antibiotic-resistant. We propose that the microbiological identification of bacterial strains and their degree of antibiotic resistance should be performed prior to therapy in order to choose the most appropriate antibiotic therapy for children with AOM treatment failure.
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Affiliation(s)
| | - Anna Bielicka
- ENT Department, Children's Hospital, 4/24 Niekłańska Str. 03-924 Warsaw, Poland
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Lavin JM, Rusher T, Shah RK. Complications of Pediatric Otitis Media. Otolaryngol Head Neck Surg 2015; 154:366-70. [DOI: 10.1177/0194599815611860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/24/2015] [Indexed: 12/21/2022]
Abstract
Objective Otitis media (OM) is a common diagnosis in the pediatric population that is usually managed on an outpatient basis. A small proportion of children are admitted due to a complex disease course. The aim of this study was to investigate the demographics of those patients and the resources utilized during their admissions. Study Design Retrospective review based on the 2009 Kids’ Inpatient Database. Setting Nationwide administrative database. Subjects and Methods A review based on the 2009 Kids’ Inpatient Database was conducted. Inclusion criteria were clinical modification codes for OM ( ICD-9 code 382). Data recorded included patient demographics, concurrent discharge diagnosis codes, length of stay, total charges, and frequency of procedures performed. Results There were 61,783 (92,548 nationally weighted) admissions with OM, which were analyzed. The average age (SD) for the patients was 2.18 (3.49) years, and the average length of stay was 2.88 days. The majority (80.75%) of patients did not have to undergo a procedure during admission, whereas a small proportion (5.4%) underwent a major operating room procedure. There were 21 deaths recorded (0.03%). A diagnosis of mastoiditis, meningitis, venous sinus thrombosis, or intracranial abscess was associated with significantly increased length of stay, incidence of procedures, and total cost of admission. Conclusions Complicated pediatric OM remains of concern requiring prompt and thorough management. Major complications include mastoiditis and meningitis, and unfortunately, fatalities still occur in patients with OM. An understanding of resource utilization and socioeconomic implications can identify and drive opportunities for targeted quality improvement.
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Affiliation(s)
- Jennifer M. Lavin
- Divison of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC, USA
| | - Thomas Rusher
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rahul K. Shah
- Divison of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC, USA
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Pasha HM, Mirsky DM, Streubel SO. Massive ischemic stroke as a complication of otitis media. Int J Pediatr Otorhinolaryngol 2015; 79:1771-3. [PMID: 26304069 DOI: 10.1016/j.ijporl.2015.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 11/25/2022]
Abstract
Cerebral artery infarction as a complication of acute otitis media is a rare complication. The mechanism appears to be the spread of meningeal inflammation to involve the walls of intracranial vessels, resulting in arterial thrombosis with ischemia or rupture with hemorrhage. We report the case of a 3 year old female with a history of global developmental delay who sustained a large left hemispheric stroke after middle cerebral artery infarction as a complication of an acute otitis media.
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Affiliation(s)
- Hamza M Pasha
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO 80045, United States.
| | - David M Mirsky
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO 80045, United States.
| | - Sven O Streubel
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO 80045, United States.
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