Acute and chronic scarlatina otitis

Abstract

The present investigation colriprises 2,606 cases of scarlet fever. Suppurative middle ear infections occurred in 528 patients, or in 20.3 %. Otitis is, next to nasal infections and lymphadenitis, the comnionest complication to scarlet fever. In 34.5 % of the cases the otitis was bilateral.Nasal infections are very common, and run a relatively protracted course, in scarlet fever patients. They begin either simultaneously with scarlet fever or, still more often, during its later phase.The numerical and relative frequencies of otitis cases are highest driring the winter and spring months and lowest in summer.The number of otitis patients and the relative frequency of ear infections were highest in children under 5 years, and decreased with increasing age of the patient. Also bilateral otitis occurred most frequently in infants. The relative frequency of early otitides (beginning within the two first weeks) is highest in the older age groups, and of late otitides in children under 5 years. In persons over 15 years, the risk of contracting an ear infection during a late phase is very small. Bilateral otitides occur more often in the early phase than in the late one. Early otitides are in most cases direct results of scarlatina angina. On the other hand, late otitis is caused chiefly by nasal infections. Its prevalence in children is due to the prevalence of scarlatina rhinitis in this age group.ScarlatiIia otitis is generally feverish, at least during the priinary phase. Suppurative feverless ear infections occurred in about 2 % of the cases.The average duration of discharge in acute cases of scarlatina otitis is relatively long (20.2 days). This is due to their streptococcal etiology and to the prevalence and long duration of nasal infections in this disease. With children under 5 years, cases of otitis duration are relatively more frequent, and those of brief duration less frequent, than with older persons. Cases with long discharge period are relatively frequent in the group of early otitis, whereas in late otitides cases with brief discharge period are commoner.Typical necrotic otitis occurred in 7 patients or in 1.3% of the total number of otitis patients. All these cases were children. In 5 patients the necrotic ear infection was bilateral and in 2 patients unilateral. I all cases it developed as a complication to a severe, often septic scarlet fever during an early phase of the illness. Necrotic mastoiditis (foul-smelling pus, necrosis of the mucous membrane and possibly also of the bone) was diagnosed in 5 patients, which were treated operatively. Two of them died of otogenic complications. In one case, necrotic sinusitis was diagnosed simultaneously (foul-smelling pus and sequester formation).There were 49 patients (9.3 %) with operatively treated mastoiditis. Bilateral mastoiditis occurred in 5 cases. The relative frequency of inastoiditis was, contrary to the otitis frequency, lowest in the youngest age group, and increased with increasing age. The operation frequency was in the early-otitis group slightly higher (7.9 %) than in the late-otitis group (7.0 %). In the whole material, including the bilateral cases, this frequency was 7.6 %.The prognosis quoad vitam of scarlatina otitis is generally good. Out of a total of 528 otitis cases, 3 (0.6 04) died of otogenic complications. In two fatal cases the death was caused by a necrotic ear infection. The mortality in ear infections (0.1%) was only about one-tenth of the total mortality (1.1%) in scarlet fever.The follow-up examined material comprises 131 patients with altogether 182 otitides. Changes (scars, perforations and defects) due lo scarlatina otitis were found in 30.2 %, and impaired hearing in 8.3 %.The 10-years material from the Oto-Laryngologic Clinic comprises 1038 chronic otitis patients, of which 105 (10.1 %) were caused by scarlet fever. The number of bilateral cases was 52 (49.5 %).In 50 % of the cases the scarlet fever, which caused otitis, had occurred at an age below 5 years.The prevalent drum picture was a large marginal or total defect in the pars tensa.Cholesteatoma occurred in 38.2 % of the cases.Complete deafness was noted in 21 ears (13.4 %), in 17 patients. In scarlatina otitis deafness may develop at any stage of the illness, from the very beginning of the otitis to several years afterwards.Labyrinth affections are rare during the early phase but frequent in the chronic phase.