Acute Otitis Media Complication Research Articles

An Unusual Acute Otitis Media Complication: Luc’s Abscess

An Unusual Acute Otitis Media Complication: Luc’s Abscess

Neuraminidase inhibitors are effective and safe in reducing influenza complications: meta-analysis of randomized controlled trials.

BackgroundThere is scarce evidence verifying the impact of neuraminidase inhibitors (NAIs) in reducing influenza complications. The aim was to evaluate the available evidence from randomized-controlled trials (RCT) regarding the efficacy and safety of NAIs in reducing influenza complications. MethodsA systematic search of the literature was performed in the Cochrane Library, PubMed and Web of Science databases (2006–2019). Eligibility criteria were RCT that enrolled patients of any age or clinical severity with seasonal influenza (H1N1, H3N2, or B) or influenza-like syndrome and receiving NAIs comparing to placebo therapy. ResultsEighteen RCTs (9004 patients) were included: nine focused on oral oseltamivir, six on inhaled zanamivir, and three on intravenous peramivir. Administration of NAIs therapy significantly decreased the time to clinical resolution (median difference: -17.7 hours; and total influenza-related complications (OR: 0.64, 95%CI: 0.51–0.82). In addition, NAIs significantly decreased acute otitis media complication (OR: 0.50, 95%CI: 0.31–0.82) and need for antibiotic treatment (OR: 0.64, 95%CI: 0.46–0.90); and showed a trend towards a reduced occurrence of pneumonia (OR: 0.44, 95%CI: 0.10–2.00), bronchitis (OR: 0.80, 95%CI: 0.43–1.48), sinusitis (OR: 0.73, 95%CI: 0.40–1.32), asthma exacerbations (OR: 0.57, 95%CI: 0.28–1.16), and hospitalizations (OR: 0.57, 95%CI: 0.24–1.38). The overall proportion of AEs tend to increase with NAIs treatment (OR: 1.16, 95%CI: 0.92–1.47). Use of NAIs was associated with a significant increase of nausea and vomiting (OR: 1.61, 95%CI: 1.04–2.50) and a decrease on diarrhea (OR: 0.81, 95%CI: 0.65–1.00). ConclusionsNAIs are effective in reducing time to clinical resolution, total influenza-related complications, otitis media, and need of antibiotic administration. Reductions on mortality, pneumonia, asthma exacerbations or hospitalization rates only did demonstrate a trend benefit in favor of NAIs. The only significant AE is the increased occurrence of nausea and vomiting.

BEZOLD ABSCESS: A RARE COMPLICATION OF ACUTE OTITIS MEDIA

To the Editor: We read with interest the recent study from Ren et al. (1) on acute otitis media (AOM) complications; the authors considering 5,811,127 Emergency Department visits for AOM, found 15,243 (0.26%) patients who presented with a complication (1). The authors reported serious AOM complications including sigmoid sinus thrombosis, epidural or intracerebral abscess, meningitis, petrous apicitis, and otic hydrocephalus (1). In our opinion, the authors forgot to mention a rare but severe complication of otitis media, Bezold abscess (2). Bezold abscess is a complication of AOM with mastoiditis presenting as a laterocervical abscess (2). It is caused by a suppurative process eroding the mastoid cortex along the digastric ridge and spreading between the digastric and sternocleidomastoid muscles. Bezold's abscess was associated with lateral sinus thrombosis, that may be caused by compression or thrombosis of an internal jugular vein or because of phlebitis of the emissary veins (3). Bezold abscess treatment includes broad-spectrum antibiotic therapy and early surgery to establish drainage of the mastoid cells and neck space (4). AOM is one of the most common childhood infections that affects approximately 50 to 85% of children before the age of 3 (5). Ren et al. (1) did not found any Bezold abscess in their large cases series. Nevertheless, we think it is important to remember this rare AOM complication because in small children aural signs and symptoms could be absent (6,7). Children under the age of 5 with Bezold abscess could fail to report otalgia and otorrhea may be absent (7). It is fundamental in children with fever and neck swelling to perform an otoscopy and verify if AOM is present. If Bezold abscess is suspected, a computed tomography has to be performed to identify the abscesses in the neck and involvement of the mastoid process and enables the surgeon to carefully plan the intervention (7). Brain imaging could also detect other intracranial complications of AOM that could be associated to Bezold abscess (3).

Symptomatic and Asymptomatic Respiratory Viral Infections in the First Year of Life: Association With Acute Otitis Media Development

Sensitive diagnostic assays have increased the detection of viruses in asymptomatic individuals. The clinical significance of asymptomatic respiratory viral infection in infants is unknown. High-throughput, quantitative polymerase chain reaction assays were used to detect 13 common respiratory viruses from nasopharyngeal specimens collected during 2028 visits from 362 infants followed from near birth up to 12 months of age. Specimens were collected at monthly interval (months 1-6 and month 9) and during upper respiratory tract infection (URTI) episodes. Subjects were followed closely for acute otitis media (AOM) development. Viruses were detected in 76% of 394 URTI specimens and 27% of asymptomatic monthly specimens. Rhinovirus was detected most often; multiple viruses were detected in 29% of the specimens. Generalized mixed-model analyses associated symptoms with increasing age and female sex; detection of respiratory syncytial virus (RSV), influenza, rhinovirus, metapneumovirus, and adenovirus was highly associated with symptoms. Increasing age was also associated with multiple virus detection. Overall, 403 asymptomatic viral infections in 237 infants were identified. Viral load was significantly higher in URTI specimens than asymptomatic specimens but did not differentiate cases of URTI with and without AOM complication. The rate of AOM complicating URTI was 27%; no AOM occurred following asymptomatic viral infections. AOM development was associated with increasing age and infection with RSV, rhinovirus, enterovirus, adenovirus, and bocavirus. Compared to symptomatic infection, asymptomatic viral infection in infants is associated with young age, male sex, low viral load, specific viruses, and single virus detection. Asymptomatic viral infection did not result in AOM.

Role of Human Bocavirus in Upper Respiratory Tract Infections and Acute Otitis Media.

BackgroundHuman bocavirus (HBoV) is a newly described parvovirus. HBoV1 has been associated with respiratory infections, including acute otitis media (AOM), but the knowledge on the significance of HBoV1 in upper respiratory tract infections (URI) and AOM in relation to other respiratory viruses is limited. The objective of this study was to compare the rate of detection of HBoV1 to that of other respiratory viruses in specimens from children with URI, with and without AOM complication.MethodsNasopharyngeal secretions (NPS) were collected during URI from healthy children (6–35 months) followed prospectively for 1 year; specimens have been previously analyzed for broad spectrum of respiratory viruses. Archived NPS were analyzed for HBoV1 using a high-throughput, quantitative polymerase chain reaction method.ResultsSeven hundred and seven NPS samples collected during URI episodes from 201 children were studied for HBoV1. A total of 94 (47%) children tested positive for HBoV1 DNA during 172 (24%) URI episodes; HBoV1 was present as the only virus in 44 (6%) URI episodes. Overall, 37% of URI episodes were complicated by AOM. Of URI associated with single virus (n = 303), the rate of AOM complicating URI associated with HBoV1 only was 52% (23 of 44); this was a higher AOM rate, compared to that of other respiratory viruses.ConclusionsAmong URI associated with single respiratory virus, HBoV1-URI was commonly associated with AOM complication. The important role of HBoV1 on AOM pathogenesis needs to be studied further.

Lactate dehydrogenase as a marker of nasopharyngeal inflammatory injury during viral upper respiratory infection: implications for acute otitis media

Background:Acute otitis media (AOM) is a frequent complication of viral upper respiratory tract infection (URI). We hypothesized that the severity of nasopharyngeal cellular injury during URI, as measured by lactate dehydrogenase (LDH) concentrations in nasopharyngeal secretions (NPSs), is related to AOM complication.Methods:LDH concentrations were determined in NPS samples (n = 594) that were collected at the initial visit for URI from 183 children who were followed for the development of AOM. A subset of NPS samples (n = 134) was analyzed for interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α concentrations.Results:AOM complication was independently predicted by LDH concentrations (median mU/ml with AOM = 2,438 vs. without AOM = 1,573; estimate = 0.276; P = 0.02). LDH effect on AOM development was highest during the first 4 d of URI. LDH concentrations were higher in URIs due to adenoviruses, bocaviruses, and rhinoviruses as compared with virus-negative samples (P < 0.05). There was a positive correlation between concentrations of LDH and all cytokines (P < 0.001).Conclusion:LDH concentrations in NPS are positively associated with AOM risk, suggesting that the severity of nasopharyngeal inflammatory injury during URI contributes to the development of AOM and that reduction of inflammatory injury may reduce the risk for AOM.

Viral Load and Acute Otitis Media Development After Human Metapneumovirus Upper Respiratory Tract Infection

The role of human metapneumovirus (hMPV) in acute otitis media complicating upper respiratory tract infection (URI) was studied. Nasopharyngeal specimens from 700 URI episodes in 200 children were evaluated; 47 (7%) were positive for hMPV, 25 (3.6%) with hMPV as the only virus. Overall, 24% of URI episodes with hMPV only were complicated by acute otitis media, which was the lowest rate compared with other respiratory viruses. hMPV viral load was significantly higher in children with fever, but there was no difference in viral load in children with hMPV-positive URI with or without acute otitis media complication.

Nasopharyngeal acute phase cytokines in viral upper respiratory infection: impact on acute otitis media in children.

The role of acute phase cytokines generated in the nasopharynx during viral upper respiratory infection (URI) in subsequent development of acute otitis media (AOM) has not been examined. We studied 326 virus-positive URI episodes in 151 children aged 6-36 months. Nasopharyngeal secretions collected within 1 to 7 days of URI onset were studied for viruses by conventional and molecular techniques, and for concentrations of IL-1beta, IL-6, and TNFalpha by multiplex enzyme-linked immunosorbent assay. Children were followed up for 28 days to document AOM complication. IL-1beta, IL-6, and TNFalpha concentrations correlated positively with each other (P<0.001). IL-6 and TNFalpha concentrations were higher in males than in females (P=0.01 and 0.02). IL-6 and TNFalpha concentrations were inversely correlated with age (P=0.02 and 0.05). IL-6 concentrations correlated positively with duration of fever (P=0.006) and correlated negatively with the number of days of URI symptoms (P=0.026). Furthermore, IL-6 concentrations were significantly higher during adenovirus and influenza virus URIs as compared with enterovirus and rhinovirus URIs (P<0.01). IL-1beta concentrations were higher during URI episodes with AOM than those without AOM (P<0.001). We found IL-6 nasopharyngeal secretions concentrations to be higher with adenovirus and influenza infection, and in children with systemic febrile response during URI. However, IL-1beta was found to play a more important role in the development of AOM after URI. Additional studies are needed to further define the role of acute phase cytokines in virus-induced AOM.

P167: Acute Otitis Media Complication in Children: 66 Cases

P167: Acute Otitis Media Complication in Children: 66 Cases

Zygomatic abscess with temporal myositis — a rare extracranial complication of acute otitis media

Acute mastoiditis is the most common complication of acute otitis media (AOM) and its early recognition and management still poses a challenge due to potentially serious consequences. The incidences of extracranial and intracranial suppurative complications of AOM in children have decreased significantly, yet they remain a serious clinical problem, especially when caused by bacteria resistant to antibiotics. The authors presented a case of rare AOM complication - zygomatic abscess with temporal myositis. A 6-year-old boy was admitted to the ENT Department with 4 weeks of ear pain, treated for AOM with cefuroxime axetyl and amoxicilline, with acute mastoiditis and subsequent abscess formation in zygomatic and preauricular region. The inflammatory process spread through anterior air cells to the zygomatic cells leading to a fistula formation in the zygomatic bone and breakthrough into the temporal muscle. The surgical procedures applied were: myringotomy with drainage, cortical mastoidectomy and revision of zygomatic area and treatment with antibiotics (ceftriaxon). Enterococcus faecalis and Streptococcus viridans were found in the culture of middle ear and mastoid effusion. After half a year of follow-up the child had a normal hearing. Severe complications of AOM are rare today. An early diagnosis in order to promote adequate management and prevent inherently suppurative complications is essential.