Increase in middle ear infections of Streptococcus pyogenes etiology among patients of the Department of Pediatric Otolaryngology of the Medical University of Warsaw in correlation with world reports

Children hospitalized due to acute otitis media: How does this condition differ from acute mastoiditis?

The objective was to review our experience with clinical course, diagnostic and therapeutic profile of children treated for acute mastoiditis, and to investigate for possible susceptibility factors. Study was designed as retrospective review of pediatric patients presenting with acute mastoiditis secondary to acute otitis media over the last 6 years, from 2000 to 2006. The study involved children aged from 1 to 16 years treated for acute mastoiditis and subsequent intratemporal and intracranial complications in Clinic for otorhinolaryngology, Clinic Center Banja Luka. Selected clinical parameters, mastoid coalescence and risk factors for necessity of surgical intervention were analyzed. Medical history review of a total of 13 patients with acute mastoiditis was analyzed. Acute coalescent mastoiditis occurred 11 patients (84%) while noncoalescent form of acute mastoiditis occurred in 2 cases (16%). Intracranial complication occurred in 3 patients (2 meningitis and 1 peridural intracranial abscess), while 2 patients had intratemporal complication (subperiostal abscess) associated to coalescent mastoiditis. We observed clinical profile of acute mastoiditis in regard to pathology found on the tympanic membrane, middle ear mucosa and destructions on the bony wall of the middle ear and mastoid. The main signs of progressive infection were tympanic membrane perforation, pulsatile suppurative secretion from the mucosa, and intratemporal abscess. All patients with coalescent mastoiditis required mastoidectomy, while noncoalescent mastoiditis was treated conservatively with broad-spectrum intravenous antibiotics and myringotomy. In conclusion acute mastoiditis is uncommon but serious complication of acute otitis media in children associated with significant morbidity. Coalescent mastoiditis concomitant with subperiostal abscess, intracranial complications and mastoiditis not responsive after 48 hours to intravenous antibiotics should urge clinician to timely mastoid surgery.

Aim: Aim of the study was retrospective analysis of the patients documentation treated for acute mastoiditis (AM) in Department of Pediatric Otolaryngology in Bialystok and available literature on this subject to determine the optimal rules of treatment in AM. Material and methods: A retrospective analysis of 40 patients treated for AM in 2001-2017. We have adopted Anthonsen et al. [15] AM diagnosis criteria to include patients to this study. Results: The mean age of the respondents was 46 months, 37% of children were less than 2 years old. 2/3 of the cases were not preceded by previous acute otitis media(AOM) episodes. 69% of patients received antibiotics before admission to the hospital. In laboratory studies, 95% of patients had elevated indices of inflammation (CRP, leukocytosis), and their value was higher among patients qualified for surgery. The indications for computed tomography (CT) were the lack of improvement after conservative treatment for 48 hours or symptoms of the presence of subperiosteal abscess. CT was performed in 35% of patients. 24 patients (60%) were treated only conservatively: myringotomy without / with the insertion of a ventilation tubes and intravenous antibiotic therapy. The most commonly used antibiotic was ceftriaxone - 75% of patients. 16 patients required mastoidectomy. The most common indication (30%) for mastoidectomy was the presence of subperiosteal abscess. Conclusion: In uncomplicated AM cases CT does not have to be routinely performed, a myringotomy should be performed with or without drains insertion and an empiric intravenous antibiotic therapy should be started. In presence of a subperiosteal abscess, it is recommended to perform CT with contrast and mastoidectomy. Deterioration of the patient's condition or lack of improvement after 48 hours of conservative treatment obliges us to make a CT and on the basis of the decision on mastoidectomy.

Acute mastoiditis (AM) is a relatively rare complication arising from acute otitis media, a common condition among children. The COVID-19 pandemic has significantly impacted AM cases. We noted a surge in pediatric AM cases in Germany after COVID-19 restrictions were lifted in 2022. This study assesses AM incidence and the clinical course in children before, during, and after the pandemic. The study also explores complication rates and microbial changes. Participants: We included children (0-18 yr) diagnosed with AM who underwent mastoidectomy at a tertiary-care university hospital from January 2012 to June 2023.Objectives: We aimed to evaluate AM incidence during pre-COVID, COVID, and post-COVID periods; assess complications; and analyze the microbial spectrum.Data Analysis: Incidence and complication rates were compared between periods, along with the microbial spectrum. Population: 75 children were included (median age, 3.3 yr).Incidence: Significant increases in AM cases occurred in the post-COVID period compared to pre-COVID and COVID periods. No significant difference was observed between pre-COVID and COVID periods.Complications: Complication rates increased notably in the post-COVID period compared to pre-COVID and COVID periods with respect to more sensitive imaging methods being used in the post-COVID period. No significant difference was observed between pre-COVID and COVID periods.Spectrum of Pathogens: No significant differences were found in pathogen distribution between periods. Streptococcus pyogenes and Streptococcus pneumoniae were common throughout. The study highlights a substantial rise in AM cases and complications after COVID-19 restrictions were lifted in Germany. This underscores the importance of monitoring infectious diseases and their complications during health crises. Additionally, the study highlights the importance of contrast-enhanced imaging. Further research is needed to explore the mechanisms behind this trend. The study reveals a significant increase in pediatric AM cases and complications following the COVID-19 pandemic in Germany. Adequate computed tomographic or magnetic resonance imaging, including contrast enhancement, is shown to be a very important parameter beside clinical symptoms in deciding for the right therapy. Thus, surgical treatment became more important. Continuous monitoring and adaptive healthcare strategies during health crises are vital for optimal patient care. Further research is warranted to understand the reasons behind these trends and to inform future pandemic preparedness efforts.

Zapalenie zatok żylnych w przebiegu zapaleń uszu

Mastoiditis is an infection of mastoid process, the portion of the temporal bone of the skull which is behind the ear and contains open air-containing spaces. With possible extra cranial and intracranial complications, acute mastoiditis is the leading complication of acute otitis media (AOM). The goal of this review was to assess the clinical features, pathogens, complications and management of acute and chronic mastoiditis. Retrospective systematic review of studies and articles on acute and chronic mastoiditis between 1983 and 2010 in pubmed, include clinical, epidemiological, microbiological, treatment and outcome data. In 10 studies, the average age was 16, ranging from 6 months to 70 years, with 55% from 0 to 5 years. Most common symptom was otalgia (84 %), 58% of patients had history of past AOM and 61% were under antibiotic therapy during admission. 74% presented with retroauricular swelling and erythema, 58% had a displaced pinna. In general, the prevalence of organisms causing mastoiditis varies greatly between studies, among countries and according to the age of the patient. Reported pathogens were as follows: Streptococcus pneumoniae, most frequently isolated pathogen in acute mastoiditis, prevalence of approximately 25% Group A beta-hemolytic streptococci, Staphylococcus aureus, Moraxella catarrhalis, Haemophilus influenzae, Pseudomonas aeruginosa, Mycobacterium species, Aspergillus fumigatus and other fungi, Nocardia asteroides. Extension of the infectious process beyond the mastoid system can lead to a variety of intracranial and extracranial complications, including meningitis, cerebral abscess, epidural, subdural and intraparenchymal abscesses, vascular thrombosis, osteomyelitis, and abscesses deep within the neck. Permanent damage of the ear leads to hearing loss, vertigo and sometimes facial weakness. The Cochrane review found that antibiotic treatment of otitis media may play an important role in reducing the risk of mastoiditis in populations where it is more common. Despite the use of antibiotics, acute mastoiditis still remains a threat to patients with AOM, especially children under 5 years of age. On the basis of the clinical features and imaging findings, the disease is managed conservatively with intravenously administered antibiotics or treated with mastoidectomy and drainage plus antibiotic therapy. Great care is required by clinicians to make an early diagnosis in order to promote adequate management and prevent complications. Key words: Mastoiditis, otitis media, childhood.

Mastoiditis is an infection of mastoid process, the portion of the temporal bone of the skull which is behind the ear and contains open air-containing spaces. With possible extra cranial and intracranial complications, acute mastoiditis is the leading complication of acute otitis media (AOM). The goal of this review was to assess the clinical features, pathogens, complications and management of acute and chronic mastoiditis. Retrospective systematic review of studies and articles on acute and chronic mastoiditis between 1983 and 2010 in pubmed, include clinical, epidemiological, microbiological, treatment and outcome data. In 10 studies, the average age was 16, ranging from 6 months to 70 years, with 55% from 0 to 5 years. Most common symptom was otalgia (84 %), 58% of patients had history of past AOM and 61% were under antibiotic therapy during admission. 74% presented with retroauricular swelling and erythema, 58% had a displaced pinna. In general, the prevalence of organisms causing mastoiditis varies greatly between studies, among countries and according to the age of the patient. Reported pathogens were as follows: Streptococcus pneumoniae, most frequently isolated pathogen in acute mastoiditis, prevalence of approximately 25% Group A beta-hemolytic streptococci, Staphylococcus aureus, Moraxella catarrhalis, Haemophilus influenzae, Pseudomonas aeruginosa, Mycobacterium species, Aspergillus fumigatus and other fungi, Nocardia asteroides. Extension of the infectious process beyond the mastoid system can lead to a variety of intracranial and extracranial complications, including meningitis, cerebral abscess, epidural, subdural and intraparenchymal abscesses, vascular thrombosis, osteomyelitis, and abscesses deep within the neck. Permanent damage of the ear leads to hearing loss, vertigo and sometimes facial weakness. The Cochrane review found that antibiotic treatment of otitis media may play an important role in reducing the risk of mastoiditis in populations where it is more common. Despite the use of antibiotics, acute mastoiditis still remains a threat to patients with AOM, especially children under 5 years of age. On the basis of the clinical features and imaging findings, the disease is managed conservatively with intravenously administered antibiotics or treated with mastoidectomy and drainage plus antibiotic therapy. Great care is required by clinicians to make an early diagnosis in order to promote adequate management and prevent complications.

Acute mastoiditis in infancy: the “Soroka” experience: 1990–2000

Acute and chronic mastoiditis and chronic suppurative otitis media

Rationale: Acute otitis media is a common disease in early childhood, and is usually caused by Streptococcus pneumoniae (S. pneumoniae). Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone (acute coalescent mastoiditis). In addition, the infection can extend through the surrounding bones or the emissary veins beyond the mastoid's air cells, leading to subperiosteal abscesses. Patient's Concern: A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis (swelling and redness of the skin). Diagnosis: Bilateral acute coalescent mastoiditis caused by S. pneumoniae infection. The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides. Interventions: The patient underwent intravenous antibiotic therapy and surgical treatment. Outcomes: The patient was discharged 14 days after hospitalization with an improved condition. Lessons: Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications, sometimes serious and even life-threatening. Complications are prevalent in children under 2 years, in whom the disease progresses more rapidly and severely. The vaccination with a 13-valent vaccine may not result in sufficient immunity against S. pneumoniae, a predominant pathogen in children affected by acute coalescent mastoiditis.

Acute mastoiditis in children under 15 years of age in Southern Israel following the introduction of pneumococcal conjugate vaccines: A 4-year retrospective study (2009–2012)

Objectives: To find out different etio-pathological factors of the disease and also to rise awareness among all levels of medical practitioners and thus decrease missing of diagnosis by early referral, appropriate surgical intervention, and thereby reduce morbidity and mortality of the patient. Methods: A total of 100 patients with chronic suppurative otitis media (CSOM) were collected from the department of Otolaryngology - Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College and Mitford Hospital Dhaka from January 2003 to February 2004. Patients having CSOM with definitive cholesteatoma with or without complications were included in this study in different age & sex belong to different socioeconomic conditions. Results: One hundred patients of CSOM with cholesteatoma had been included in this study to see the various aspects of the disease with particular attention to know the etiopathology of CSOM with cholesteatoma with or without complications in our perspective. One hundred patients of different age and sex belonging to different socioeconomic conditions were examined meticulously under magnification and investigated as per protocol. The study shows poverty, illiteracy, overcrowding, living in slum with kuntcha floor, bathing in ponds and river with the habit of swimming are the main etiological factors. The study also shows ignorance about primary health care and grave consequences of the disease, nonavailability of trained doctors in the vicinity are also responsible for the development of disease and its complications. Conclusion: The study concluded that by avoiding etiological factors, improving socioeconomic condition & literacy status and by providing trained doctors in the rural areas, the development of the disease & its complications can be reduced and thus saves thousands of lives with early referral and early surgical intervention. Key words: Chronic Suppurative Otitis Media; Cholesteatoma. DOI: 10.3329/bjo.v17i1.7627 Bangladesh J Otorhinolaryngol 2011; 17(1): 42-47

Objective: To describe cases of complicated middle ear infections in children with cochlear implants (CI), i.e., episodes of acute otitis media (AOM) and acute mastoiditis (AM), resulting in hospitalization.Methods: A total of 206 children under 16 years (300 implantations) were implanted between 1 January 2008 and 31 December 2014 at the West Danish CI Center, Department of Otorhinolaryngology Head and Neck Surgery, Aarhus, Denmark. By means of two prospective local databases, episodes of AOM or AM and demographics were retrieved including biochemistry, microbiology, length of follow- up, and variable treatment modalities (intravenous (IV) antibiotics, revision mastoidectomy, and insertion of ventilation tubes).Results: Overall rate of AOM and/or AM was 9.2% (AOM: 9%, AM: 1.9%). Mean age at CI was 46 months. Mean follow-up was 45 months. Mean time from CI operation to AOM or AM was 3 and 4 months, respectively. Children younger than 2 years were at highest risk of AOM and/or AM. All had antibiotics prescribed before admittance, and two- thirds of infected ears had already ventilation tubes inserted. Bacteria could not be detected in more than half of cases. The most frequently isolated strains were pneumococci and nontypable Haemophilus influenzae. The majority of patients were successfully treated with IV cefuroxime (64% of cases) and insertion of ventilation tubes. None of the children developed facial nerve paralysis, intracranial infections, or septicemia.Discussion: Almost 10% of CI children required at least one hospitalization due to AOM and/or AM compared with 0.1 per thousand of non-CI children. This discrepancy can be explained by a low threshold for active treatment of otitis media in CI children and hence referral to a CI center. The results suggest that benzylpenicillin might be an appropriate initial treatment of AOM and AM. However, cephalosporin was the most preferred antibiotic. Most CI children were already treated with ventilation tubes at admission and almost all children without ventilation tubes, had a tube inserted during admission. Insertion of ventilation tubes is still much debated and more research in this field is needed.Conclusion: AOM and/or AM were seen in Danish children with CI as often as in other western countries. Treatment of complicated middle ear infections was sufficient with IV cephalosporin and ventilation tube insertion. Special attention should be paid to children younger than 4 years and the associated microbiology including serotyping should be monitored.

Objective:To explore the distribution of pathogenic bacteria and drug sensitivity among patients with chronic suppurative otitis media. Methods:Patients with chronic suppurative otitis media who were hospitalized in the Department of Otolaryngology, People's Hospital, Peking University for surgery from January 1, 2019 to May 1, 2021 were enrolled as the subjects, then take the deep secretions of the external auditory canal for bacterial culture. Finally, the distribution and drug sensitivity of the pathogenic bacteria are analyzed. Results:A total of 126 patients were enrolled, of which 53 were culture-positive, and 57 strains of bacteria were isolated, including 47 strains of Gram-positive cocci, 10 strains of Gram-negative bacilli. Among Gram-positive cocci, 24 methicillin-sensitive staphylococcus aureus（MSSA） strains, 7 methicillin-resistant staphylococcus aureus（MRSA） strains, 14 coagulase-negative staphylococcus strains, 1 strain enterococcus faecium, and 1 strain otitis Zurich. 4 strains（4/10） of pseudomonas aeruginosa among Gram-negative bacilli. Among them, MSSA has a high resistance rate to levofloxacin, moxifloxacin, clindamycin, and gentamicin, and high sensitivity to oxacillin, vancomycin, linezolid, and rifampin. MRSA is highly resistant to common antibiotics except vancomycin, rifampicin, and linezolid. The Gram-negative bacilli have higher resistance rates to levofloxacin, aztreonam, ciprofloxacin, ceftazidime, and piperacillin/tazobactam, and to meropenem, imipenem, amika star, cefepoxime, cefoperazone/sulbactam, and tobramycin are more sensitive. The results of univariable and multivariable analysis showed that age and bacterial infection were independent factors related to dry ears, and the duration of the disease history was a non-independent factor. Conclusion:The main pathogenic bacteria infections in patients with chronic suppurative otitis media are MSSA, MRSA, and pseudomonas aeruginosa. Whether it is combined with bacterial infection and age are independent factors related to whether patients with chronic suppurative otitis media could have dry ears. Therefore, patients with chronic suppurative otitis media should be treated with specific antibiotics or surgical interventions as soon as possible in combination with drug sensitivity results to avoid prolonging disease course or causing serious infectious complications.

To evaluate the impact of the COVID-19 pandemic on acute otitis media (AOM) and acute mastoiditis (AM) by analyzing longitudinal changes in disease incidence, clinical presentations, complications, and microbial patterns across pre-pandemic, pandemic, and post-pandemic periods. A retrospective cohort study examining pediatric AOM and AM cases (age ≤ 15 years) at a tertiary medical center between March 2015 and February 2024. Cases were categorized into three periods: pre-COVID (March 2015-February 2020), lockdown (March 2020-February 2021), and post-lockdown (March 2021-February 2024). We assessed disease incidence, microbiology, complications, and clinical outcomes. Among 6,673 patients (6,221 AOM, 452 AM), AOM cases significantly decreased during lockdown (301/year) vs. pre-COVID (658/year) (p = 0.041) but returned to baseline in post-lockdown (758/year). AM showed similar trends without statistical significance. Complications of AM per case were highest during lockdown (0.52) vs. pre-COVID (0.39), with increased mastoidectomy rates (28% vs. 18.4%). Positive culture rates increased post-COVID (52.7-73.7%), and mean hospitalization duration was longest during lockdown (8.56 days vs. 7.96 pre-COVID, p = 0.005). The COVID-19 pandemic induced a significant temporary reduction in acute otitis media and acute mastoiditis cases, primarily during lockdown periods. Despite the initial decrease, disease incidence returned to pre-pandemic baseline levels post-lockdown. Notably, the lockdown period showed higher complication rates and longer hospitalization durations, suggesting potential delays in medical care, but overall disease patterns remained fundamentally unchanged.