Intratemporal Complications Research Articles

Langerhans Cell Histiocytosis Mimicking Otitis Media

Langerhans cell histiocytosis (LCH) is a spectrum of disease characterised by proliferation of Langerhans cells causing local or systemic manifestations. We report a two-year old boy who presented with a two-month history of progressive painless swelling over the right zygomatic region with ipsilateral otorrhea. Radiological investigation revealed an expansile hypodense lesion within the temporal bone with erosion of surrounding structures and meningeal enhancement. An ultrasound-guided biopsy of the lesion confirmed the diagnosis of LCH. LCH of the temporal bone may masquerade as otitis media with intra-temporal complications. A high index of suspicion is essential to avoid delay in diagnosis and management.

Surgical management of mastoiditis with intratemporal and intracranial complications in children. Outcome, complications, and predictive factors.

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. 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. 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%. 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 20mm, 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.

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

Introduction. Beta-hemolytic streptococcus is one of the most common causes of out-of-hospital infections. It can cause local or general infections of varying severity, most commonly in the throat, paranasal sinuses, ear and skin. Some infections are invasive in nature. In the last months of 2022, an alarming increase in infections caused by Streptococcus pyogenes, including invasive infections, has been observed in many countries in Europe and around the world compared to previous years. Aim. The purpose of this study was to compare the number of hospitalized patients with acute otitis media and acute mastoiditis of S. pyogenes etiology in the first six months of 2023 with hospitalizations for the same reason in the previous 5 years, and to assess the correlation with the observed worldwide trend of an increase in the number of observed beta-hemolytic streptococcus type A infections. Material and methods. A retrospective analysis of the data of patients diagnosed with acute otitis media and acute mastoiditis of S. pyogenes etiology hospitalized in the Department of Pediatric Otolaryngology in the first six months of 2023 was carried out, and their number was compared with patients hospitalized for the same reason in the previous 5 years. Results. Between January 2023 and the end of June 2023, 15 patients with acute otitis media were hospitalized in the Department of Pediatric Otolaryngology, in which S. pyogenes was isolated by bacteriological examination. Purulent leakage from the ear was observed in 10 patients. Isolated otitis media was diagnosed in 4 patients. In 10 children, AOM was complicated by acute mastoiditis, which was confirmed by CT scan. The most severe complication was sepsis of GAS etiology. Intravenous antibiotic therapy and surgical treatment were implemented in all patients, achieving a cure. From 2018 to 2022, the number of patients hospitalized for the same reason was significantly lower each year. Conclusions. The number of patients hospitalized in the Department of Otolaryngology in the last two months of 2022 and in the first six months of 2023 due to AOM, as well as AOM complicated by mastoiditis, in which the etiologic agent turned out to be S. pyogenes confirmed the observed worldwide trend towards an increase in the incidence of GAS. GAS-induced AOM is characterized by greater local aggressiveness, manifested by a higher incidence of tympanic membrane perforation, as well as mastoiditis with bone destruction. The primary antibiotic used to treat GAS infections is penicillin, with sensitivity to penicillin also implying sensitivity to all beta-lactam antibiotics. The treatment of GAS with intratemporal complications in the form of acute mastoiditis caused by S. pyogenes, especially progressing with bone destruction, requires combined antimicrobal therapy with surgical treatment.

Acute Otitis Media with Intracranial and Intratemporal Complications: A Case Study.

Acute otitis media continues to be one of the most common infections today and a major cause of the prescription of antibiotics in the pediatric age group. Complications of this condition are rare, especially when antibiotic therapy is started early; however, complications related to acute otitis media cause dramatic morbidity. This report provides a review related to a case of acute otitis media with bilateral intracranial and intratemporal complications.

Management of Acute Complicated Mastoiditis: A Systematic Review and Meta-analysis.

The objective of our study was to evaluate the efficacy of treatment options for the most frequently reported complications of acute mastoiditis in the English literature. PubMed, EMBASE, and The Cochrane Library were searched from database inception through March 29, 2019. Two independent reviewers (M.R.K., K.S.) evaluated search results for study inclusion. References cited in publications meeting inclusion criteria were reviewed. Twenty-three included studies were published from 1998 through 2018. Treatment efficacy was determined by comparing the change in number of complication subtypes in each treatment subgroup (medical, conservative, or surgical) from admission to discharge (range: 5-30 days) or postdischarge follow-up (range: 1-27.5 months) with a random effects model. Among 733 identified articles, 23 met inclusion criteria. Of the 883 included patients, 203 were managed medically (23%), 300 conservatively (34%) and 380 surgically (43%). Conservative patients had more extracranial complications (ECC, P = 0.04) and intratemporal complications (IT, P = 0.04) at follow-up compared with medical patients. Medical patients had more total number of complications (TNC, P = 0.03), ECC (P = 0.02), and IT (P = 0.01) at discharge compared with surgical patients. Conservative patients had more of all complications except intracranial/extracranial abscess and "other" at discharge and follow-up compared with surgical patients. There were larger reductions in TNC, ECC, and IT at discharge and follow-up among surgical patients compared with medical and conservative patients. There were greater reductions in TNC, ECC, IT, intracranial complications, subperiosteal abscess and lateral sinus thrombosis at discharge and follow-up among surgical patients compared with conservative patients.

LABYRINTHINE FISTULA IN CHOLESTEATOMA AND ITS MANAGEMENT-A RETROSPECTIVE STUDY

Introduction- Labyrinthine fistula is one of the most common intra-temporal complications of cholesteatoma. Objective of study is (1) to evaluate the role of CT Scan in detecting labyrinthine fistulas, (2)to establish fact that fistula grade and location have no correlation with surgical approaches(CWU Vs CWD mastoidectomy approach),(3) to study the impact on hearing after treatment of labyrinthine fistula and(4) establish a management protocol to deal with labyrinthine fistula.

A systematic review of complications of attico-antral type of chronic suppurative otitis media in our region

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is a very common disease that should be carefully treated, as severe complications can develop. Despite the significantly decrease incidence of CSOM-related complications since the introduction of antibiotics, this clinical problem has not been eliminated.</p><p class="abstract"><strong>Methods:</strong> This was an observational study conducted including 60 cases of attico-antral type of CSOM and its complications. Detailed study of determinants of attico-antral type of CSOM and its complications were studied. The various options in the management of disease and its complications with their outcomes were studied. </p><p class="abstract"><strong>Results:</strong> Majority of study participants belonged to lower socio-economic group. intra-temporal complications were most common complications and most of the patients required canal wall down surgery. Majority patients had complete recovery of the disease without recurrence during 3 months of follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Our study concluded majority of the patients belonged to the low socioeconomic status. It was also clear from the study that timely intervention in the form of early diagnosis and administration of proper treatment resulted in complete recovery of majority of patients.</p>

English

Petrositis is a rare complication of chronic otitis media. It is known to cause variety of intratemporal and intracranial complications, if not managed timely. Traditionally, surgery was advocated, but with better antibiotics availability, focus is now more on conservative treatment. We hereby present a rare case of petrositis, without full triad of Gradenigo’s syndrome and being managed by intravenous antibiotic only. This highlights importance of early diagnosis and treatment. A 19-year-old male presented with discharge from left ear and left sided headache, (becoming holocranial) for 2 years, with increased severity since a month. Discharge was scanty and yellowish; blood tinged occasionally and was often foul smelling. The headache was insidious, gradually worsening, aggravated by cold food intake and exposure to cold weather. He also gave history of mild hearing loss from left ear. There was history of some improvement with oral antibiotics, prescribed by local practitioners, but the relief was incomplete and lasted shortly. He had no complain of trauma to head or ear, double vision, vomiting, fever or facial weakness. Physical examination was normal especially with respect to extra ocular muscles (Fig.1) and muscles of facial expression.

Gambaran Komplikasi Otitis Media Supuratif Kronis Tipe Bahaya di RSUP Dr. M. Djamil Padang Tahun 2017-2019

Background. Atticoantral type of Chronic Suppurative Otitis Media (CSOM) becomes a major health problem in developing countries. This condition has potential to be hard becaused complications that occur. Objective. This objectives of this study was to decribe atticoantral type complications CSOM at Dr M Djamil Hospital Padang years 2017-2019. Methode: This was a descriptive study using secondary data from medical record of patients diagnosed with atticoantral type CSOM at Dr M Djamil Hospital Padang periode 2017-2019. This study involved outpatients and inpatient with total subject 242 who qualify inclusion criteria. Sampling technic used total sampling technic Results. There are 242 cases atticoantral CSOM with the most age group years ˃10-20 and more men than woman. The Incidence of complications was founded to be 9,1% with the most intracranial complications age group years ˃20-30, while the most age group in intratemporal complications were years ˃10-20 and more experienced by men than women. Mortality rate was found 9,1% in intrakranial complications and no cases mortality rate in intratemporal complication. Conclusion. The incidence of compliations CSOM atticoantral type in RSUP Dr M Djamil still quite high.

Postauricular Cutaneous Mastoid Fistula Closure with Combination of Bilobed Flap and Fibro-Muscular-Periosteal Flap

Chronic suppurative otitis media (CSOM) with cholesteatoma can present with intratemporal complications such as postauricular subperiosteal abscess with or without fistula. In some postauricular cutaneous mastoid fistula cases, direct closure of the wound is not possible due to skin tension, leading to skin necrosis and postoperative recurrent cutaneous fistula. Here, we describe a surgical technique using a combination of a bilobed flap and a fibro-muscular-periosteal flap for fistula closure on a 31-year-old and a 35-year-old female with postauricular cutaneous mastoid fistula due to CSOM. All patients were successfully managed with no fistula recurrence.

Case study on patient with CSOM with intracranial and intratemporal complications managed with craniotomy and facial nerve decompression

<p class="abstract">Facial nerve palsy, together with the intracranial abscess and labyrinthitis is a representative complication of advanced middle ear cholesteatoma. It is rare now a day due to ready access to medical care and antibiotics. Facial palsy is not life threatening but impairs facial movement and markedly affects patient’s social life and causes serious psychological damage. Appropriate management of this complication is necessary to ensure healing without sequelae. We present a case of CSOM with intracranial and intratemporal complications. The patient had undergone craniotomy for intracranial abscess drainage and underwent facial nerve decompression by transmastoid approach.</p>

Clinical and diagnostic observations of a complicated course of chronic otitis media, cholesteatoma in children

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.

Gradenigo’s Syndrome and Labyrinthitis: Conservative versus Surgical Treatment

Background Extracranial intratemporal complications of chronic suppurative otitis media (CSOM) are extremely rare. Gradenigo's syndrome is defined as a clinical triad of otitis media, severe pain originating from the trigeminal nerve, and ipsilateral sixth cranial nerve palsy. Case Report A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus. Conclusion Although there is little evidence to support the use of conservative treatment in the treatment of Gradenigo's syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo's syndrome.

Acute Otitis Media Complications

Objective: Acute otitis media is the result of viral or bacterial infections in the middle ear. Despite the frequent use of antibiotics for different reasons, it can still be present with serious complications. Although acute otitis media is most common between ages 3 months - 3 years, it can be seen in adults and even it may result in serious complications too. Patients and Methods: Our study was carried out by retrospectively screening patients who were admitted to Dumlupinar University Evliya Celebi Training and Research Hospital between January 2013 and June 2015 for acute otitis media. During these years, hospital data of patients who have referred to our hospital have been reviewed for intracranial and intratemporal complications. Results: A total of 2475 patients with acute otitis media were included. Intracranial and intratemporal complications were observed in 16 patients. The most frequent complications were mastoiditis (in 4 patients), subperiosteal abscess, facial nerve palsy and meningitis (each in three patients). Acute labyrhintitis developed in two patients and petrositis in one. Conclusion: Despite the current preventive and therapeutic approaches, patients with acute otitis media can still present with complications.

Current opinions in the management of otitis media complications

Introduction . The aim of this study was to determine the frequency and management of complications of AOM and COM over a period of 15 years in E.N.T Clinic “Iuliu Haţieganu”, University of Medicine and Pharmacy Cluj-Napoca, and to discuss the new concept in their treatment. Methods . Between January 2001 to December 2015, patients admitted to E.N.T. Department, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, with the diagnosis of otitis media and an associated intratemporal or intracranian complication were analyzed retrospectively. The overall incidence of all complications and of each complication individually was determined. Results . A total of 930 patients were diagnosed with otitis media. Complications of otitis media were diagnosed in 35 patients; thus, the incidence of complications was 3.37%. We identified 27 (2.9%) intratemporal complications and 8 (0.86%) intracranial complications. The most frequent complication was labyrinthine fistula in 13 (1.39%) patients. Conclusion . The incidence of otitis complications remains significant in our department. Chronic otitis media with cholesteatoma is the most frequent etiology of complications. Labyrinthine fistula is the most common complication of otitis media.

A clinical study on complications of chronic suppurative otitis media and level of awareness in patients admitted at tertiary care hospital in central India

Background: Chronic suppurative otitis media (CSOM) is a common public health problem in India. Though there is decline in the incidence of complications but they are still frequent due to poor socio-economic conditions, lack of awareness about health care and availability of trained specialist in rural settings. The objective was to study the complications of CSOM and level of awareness in patients admitted at Department of E.N.T. N.S.C.B. Medical College & Hospital Jabalpur M.P. India. Methods: The present study comprises of 52 patients with complications secondary to CSOM admitted to the Dept. of E.N.T., N.S.C.B. Medical College Hospital Jabalpur M.P. India. An analysis was made regarding the demographic profile, clinical features, complications, awareness and the outcome of the study. Data was analysed with the help of Microsoft office excel. Results: The total no. of 52 patients with complication of CSOM was included in the study. The most common age for complication was first three decade of life. Most of the patients belong to rural area and lower socioeconomic status. Majority of the patients presented with the history of ear discharge, headache, decreased hearing, ear ache, swelling behind the ear, fever, facial weakness & signs of raised intracranial tension. Intratemporal complications was seen in 46 (88.46%) of the patients while only 6 (11.53%) belongs to intracranial complications. Overall awareness was poor. Self-medication was used in 23 (44.23%) of cases and match stick with or without cotton was used in 31 (59.61%) of patients for cleaning practice. Conclusions: Complications of CSOM pose a great challenge in clinical practice & Public health. Early intervention & awareness is required to decrease morbidity and mortality of the patients.

Congenital Cholesteatoma of Inner Ear: Still a dilemma

Congenital cholesteatoma is an intriguing entity with 71% cases being detected on the basis of clinical examination in the age group of 4 to 5 years. We present an extensive case of inner ear congenital cholesteatoma in an adult male who presented with multiple intratemporal and intracranial complications.

Intratemporal Complications of Acute Otitis Media in a Patient with Mannose-Binding Lectin Deficiency and IgG3 Subclass Deficiency

Intratemporal Complications of Acute Otitis Media in a Patient with Mannose-Binding Lectin Deficiency and IgG3 Subclass Deficiency

Epidemiology of intratemporal complications of otitis media.

Introduction Despite the advent of antibiotics and immunizations in the last century, complications of otitis media remain quite frequent, have high morbidity and mortality rates, and pose a challenge to the otorhinolaryngologist. Objective To establish the annual incidence of intratemporal complications of otitis media and prospectively evaluate patients via an analysis of epidemiologic and clinical aspects. Methods Prospective, observational study. Between February 2010 and January 2011, patients admitted to a tertiary care, university-based otology practice with diagnosis of otitis media and an associated intratemporal complication (ITC) were included in the study. The following data were evaluated: age, sex, type of ITC, treatment, imaging tests findings, type and degree of hearing loss, and clinical outcome. The overall incidence of all complications and of each complication individually was determined. Results A total of 1,816 patients were diagnosed with otitis media. For 592 (33%) individuals, the diagnosis was chronic otitis media; for 1,224 (67%), the diagnosis was acute otitis media. ITCs of otitis media were diagnosed in 15 patients; thus, the annual incidence of intratemporal complications was 0.8%. We identified 19 ITC diagnoses in 15 patients (3 patients had more than one diagnosis). Labyrinthine fistulae were diagnosed in 7 (36.8%) individuals, mastoiditis in 5 (26.3%), facial palsy in 4 (21.1%), and labyrinthitis in 3 (15.8%). Conclusion The incidence of intratemporal complications in Brazil remains significant when compared with developed countries. Chronic otitis media with cholesteatoma is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

Uszkodzenia ścian kostnych ucha środkowego u chorych operowanych z powodu schorzeń ucha w Klinice Otolaryngologii CM UJ w latach 2008–2012

BackgroundWe perform the middle ear operation to remove pathological tissue and in the next step present ossicular chain reconstruction. Otosurgeon has to also identify bone dehiscences, as a potential way to develop otogenic intracranial and intratemporal complications. AimWe analyzed the patients with bone defects in the middle and/or posterior cranial fossa who present also defects of the bony wall of the facial nerve canal and lateral semicircular canal. Material and methodsWe observed 537 patients who were operated on middle ear for the first time in the Department of Otolaryngology at the Jagiellonian University of Cracow from 2008 to 2012. We used a special questionnaire that includes diagnostics of the ear's disease, method of the operation and short- and long-term effects. ResultsWe discuss 45 patients with the skull base defects in the middle and/or posterior cranial fossa. Dehiscence of the bony wall of the facial nerve canal was present in 7 patients. In 4 cases semicircular canal fistula coexisted.The most common cause of bone dehiscence was granulation tissue, less frequently cholesteatoma. Conclusions1.Apart from skull base defects in the middle and/or posterior cranial fossa, frequency of bony dehiscence of the facial nerve and semicircular canal fistula is the same as in all population operated on ear.2.Defects of the bony wall of the facial nerve and semicircular canal fistula are observed more frequently in granulomatous chronic otitis media than in cholesteatoma chronic otitis media.3.We observe the same frequency of intracranial complication in population of patients with defects of the bony wall of the facial nerve canal and horizontal semicircular canal than in all groups with skull base defects.