Complication Of Otitis Media Research Articles

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 case series of complicated infective otitis media requiring surgery in adults.

With the advent of antibiotics, complications of otitis media have become less common. It is crucial for physicians to recognise otitis media and treat its complications early. Herein, we present our institution's experience with patients who required emergency surgical intervention for complications of otitis media. Data on patients who underwent emergency surgery for complications of otitis media from 2004 to 2011 was retrieved from the archives of the Department of Otolaryngology, Changi General Hospital, Singapore. A total of 12 patients (10 male, two female) underwent emergency surgery for complications of otitis media. The median age of the patients was 25 years. Otalgia, otorrhoea, headache and fever were the main presenting symptoms. Extracranial complications were observed in 11 patients, and six patients had associated intracranial complications. The primary otologic disease was acute otitis media in six patients, chronic otitis media without cholesteatoma in three patients and chronic otitis media with cholesteatoma in three patients. Mastoidectomy and drainage of abscess through the mastoid, with insertion of grommet tube, was the main surgical approach. Two patients required craniotomy. The mean length of hospital stay was 16.2 days and the mean follow-up period was 16.3 months. Five patients had residual conductive hearing loss; two patients with facial palsy had full recovery. Otitis media can still result in serious complications in the post-antibiotic era. Patients with otitis media should be monitored, and prompt surgical intervention should be performed when necessary to attain good outcomes.

Bezold's abscess: A case report and review of cases over 14 years

Bezold's abscess is one of the rare complications of otitis media. It was named after Friedrich Bezold in 1881, who described the pus escaping through the medial side of the mastoid process into the incisura digastrica (digastric grove) and forming an abscess. This article reports a case report of a 73-year-old male who presented with right otitis media complicated with Bezold's abscess. The diagnosis is confirmed radiologically by magnetic resonance imaging. The patient was managed by intravenous antibiotic, drainage of abscess, and cortical mastoidectomy. Then, we conducted a literature review for all the cases reported between 2000 and 2014. We found around 17 cases in the literature, and additional eight reported cases but we have excluded them because some are not in English language and the others are not registered in PubMed. We think that because of the evolution in imaging technology, these cases are easier to be diagnosed nowadays. Bezold's abscesses case reports were seen more in adults (10 of 18, 55.6%) than in pediatric of 18 years old and below (8 of 18, 44.4%). It is found more in males (11 of 18, 61%) than in females (7 of 18, 39%). In this review, the time latency between the presentation of the patient and the diagnosis of Bezold's abscess is ranging between 2 days and 2 weeks. The pattern of mastoid pneumatization is the main factor behind developing Bezold's abscess. Since this review confirms that the most common organisms are Gram-positive organisms, it is wise to choose the antibiotic directed against Gram-positive organisms. Finally, we conclude that the surgical treatment can be tailored according to the pneumatization of the mastoid bone and the extension of neck abscess.

Acute mastoiditis in children with a cochlear implant

ObjectivesCochlear implantation is performed at a young age, when children are prone to acute otitis media. Acute mastoiditis is the most common complication of otitis media, but data on its management in the presence of a cochlear implant are sparse. The objective of this study was to assess the characteristics, treatment, and outcome of acute mastoiditis in children with a cochlear implant. MethodsThe medical files of all children who underwent cochlear implantation at a pediatric tertiary medical center in 2000–2014 were retrospectively reviewed. Those diagnosed with acute mastoiditis after implantation were identified, and data were collected on demographics, history, presentation, method of treatment, complications, association with untreated otitis media with effusion, and long-term middle-ear sequelae. ResultsOf the 370 children (490 ears) who underwent cochlear implantation, 13 (3.5%) were treated for acute mastoiditis (median age at acute mastoiditis, 32 months). Nine had a pre-implantation history of chronic secretory or acute recurrent otitis media, and 5 had been previously treated with ventilation tubes. In all 9 children who had unilateral cochlear implant, the acute mastoiditis episode occurred in the implanted ear. The time from implantation to mastoiditis was 5–61 months. The same treatment protocol as for normal-hearing children was followed, with special attention to the risk of central nervous system complications. Primary treatment consisted of myringotomy with intravenous administration of wide-spectrum antibiotics. Surgical drainage was performed in 8 out of 13 patients, with (n=7) or without (n=1) ventilation-tube insertion, to treat subperiosteal abscess or because of lack of symptomatic improvement. There were no cases of intracranial complications or implant involvement or need for a wider surgical approach. No middle-ear pathology was documented during the average 3.8-year follow-up. ConclusionsThe relatively high rate of acute mastoiditis and subperiosteal abscess in children with a cochlear implant, predominantly involving the implanted ear, supports the suggestion that recent mastoidectomy may be a risk factor for these complications. Despite the frequent need for drainage, more extensive surgery is usually unnecessary, and recovery is complete and rapid. As infections can occur even years after cochlear implantation, children with otitis media should be closely followed, with possible re-introduction of ventilation tubes.

Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management

ObjectivesOtogenic lateral sinus thrombosis (LST) is a rare intracranial complication of acute otitis media (AOM), which can lead to severe neurological sequelae and death. The aim of this study was to analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations. MethodsAt a tertiary Italian hospital, a retrospective review was conducted on the medical records of eight patients diagnosed with otogenic LST over a 3-year period. Four children were males and mean age was 4.7 years. ResultsAll patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy±trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus (p=0.029). ConclusionLST is a severe condition occurring even in absence of otological signs, and despite adequate antibiotic therapy for AOM, which should be ruled out and promptly treated. A dominant neurological presentation is associated in our series with anatomical variations of cerebral sinus venous drainage patterns. This should be carefully evaluated and considered in diagnosis, treatment planning and prognosis.

Complications of otitis media – a potentially lethal problem still present

IntroductionIt is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. ObjectiveThis paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM). MethodsRetrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. Results80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. ConclusionICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.

Challenges in the management of acute mastoiditis in children.

Acute mastoiditis (AM) is a rare but serious complication of otitis media. Recent studies consolidated the role of Streptococcus pyogenes as the second most important etiologic agent of AM and suggested an increased involvement of a relatively new pathogen (Fusobacterium necrophorum). The recently accumulated evidence on AM epidemiology in children is conflicting and not convincing in demonstrating clear trends during the last years. While a significant decrease was recorded in the incidence of pneumococcal invasive disease and complicated AOM following the introduction of the pneumococcal conjugate vaccines, data on the efficacy of these vaccines in the prevention of AM are limited and did not show any remarkable changes in the dynamics of disease caused by Streptococcus pneumoniae. The clinical findings in AM may differ according to the causative pathogen and different patient age subgroups. Together with computerized tomography, magnetic resonance imaging became frequently used, particularly in the diagnosis of AM complications. Simple mastoidectomy remains the most reliable and effective surgical intervention for the treatment of subperiosteal abscesses.

Otitis Media Extratemporal Complication

Introduction: The negligence in middle-ear chronic infections without significant symptomatology may result in devastating complications, irreversible sequelae, or even death. Although subperiosteal abscess is a common complication of otitis media, parotitis and abscess of the temporozygomatic are rarely found. Comorbidities and neglect to the treatment are variables related to the onset of complications.

Canine aural cholesteatoma: A histological and immunohistochemical study

Canine aural cholesteatoma is an epidermoid cyst that forms in the middle ear cavity as a rare complication of otitis media but the aetiopathogenesis remains controversial. In the present study, 13 cases of canine aural cholesteatoma were investigated histologically and immunohistochemically and compared with cases of chronic otitis. The immunohistochemical investigation was performed using the following monoclonal antibodies: anti-cytokeratins (CK) 14, 16, 8/18, and 19, and anti-Ki67. The proliferative indexes (PIs) of cholesteatomata and otitis epithelium were calculated as the percentage of Ki67 positive nuclei/total nuclei. Histologically, the cholesteatomata were composed of a hyperplastic, hyperkeratotic epithelium (matrix) resting on a fibrous perimatrix, infiltrated by inflammatory cells and devoid of cutaneous adnexa. Immunohistochemically, the cholesteatoma epithelium was CK14- and CK16-positive, and CK8/18- and CK19-negative. A similar pattern of CK expression was found in otitis externa. In otitis media, ciliated epithelium stained CK8/18- and CK19-positive in all layers, CK14-positive in the basal layers, and CK16-negative. The mean PIs in cholesteatomata and otitides were 18.8 and 17.8, respectively. The immunohistochemical pattern of CK expression in cholesteatomata, when compared with chronic otitis, was suggestive of hyperproliferative epithelium, but its origin could not be demonstrated. Comparable PI values were obtained in cholesteatoma and in chronic otitis, which confirmed that Ki67 is a valuable indicator of a hyperproliferative state, but not a predictor of aggressiveness.

Otogenic lateral sinus thrombosis: Case series and controversies

ObjectivesThe aim of this study is to (1) report the clinical presentation, treatment, and sequelae in a series of pediatric patients with otogenic lateral sinus thrombosis and (2) to review the most controversial aspects of management of this rare intracranial complication of otitis media. MethodsRetrospective chart review of inpatients treated for central venous thrombosis at a tertiary care facility between 1996 and 2012. ResultsFive pediatric patients (four male, one female) were identified with otogenic lateral sinus thrombosis. Age at presentation ranged from 13 months to 15 years. All underwent a surgical procedure, ranging from a simple myringotomy with tympanostomy tube placement to tympanomastoidectomy and internal jugular vein ligation or craniotomy. Three were anticoagulated with unfractionated heparin with subsequent transition to low molecular weight heparin of variable duration. One patient developed a non-life-threatening intracranial hemorrhage while on long-term anticoagulation. Follow-up imaging, when available, did not directly correlate complete thrombus resolution with use of anticoagulation or with persistent symptoms. ConclusionsOtogenic lateral sinus thrombosis is a rare intracranial complication of otitis media with significantly reduced morbidity and mortality in the modern era of antibiotic treatment, surgical intervention, and anticoagulation therapy. Due to the rarity of this condition today, the recommended extent of surgical intervention and need for routine anticoagulation are unclear, and requires further data to determine definitively.

Acute mastoiditis in children in the State of Qatar

Background:Acute mastoiditis is a serious complication of otitis media. Its diagnosis and treatment carry a great importance due to its potentially serious consequences. This study was designed to evaluate recent clinical experiences with pediatric acute mastoiditis in the State of Qatar. Our objectives were to highlight the importance of this disease and its possible complications, which emphasize the necessity of early diagnosis and proper treatment. We also assessed the commonality of this condition compared to some other countries as well as explored their experience in this regard.Materials and Methods:This is a retrospective study of all children ≤ 14 years presenting to the pediatric emergency centers (PEC) in the State of Qatar between January 2005 and December 2008, with a clinical diagnosis of acute mastoiditis supported by CT scan findings.Results:Twenty-seven patients were diagnosed with acute mastoiditis during the study period, with a mean age of 5.4 years. Only four children were diagnosed with otitis media and started on antibiotics a few days prior to presentation. The following signs and symptoms recorded on presentation were: fever in 77%, ear pain in 51%, ear discharge in 40%, postauricular swelling in 100%. The most frequent pathogen cultured by ear swab wasPseudomonas aeruginosa(in six out of sixteen patients who presented with ear discharge). One patient needed surgical intervention for mastoid abscess. There were two recorded complications of mastoid abscess in one patient that needed drainage and facial palsy in three patients. No mortality was reported during the study period.Conclusions:Acute mastoiditis in children is not uncommon in the State of Qatar. Full recovery with conservative treatment is noticed in most cases.Pseudomonas aeruginosais a common pathogen which indicates the need for broader systemic coverage in early diagnosis. Moreover, in order to promote adequate management and prevent inherently severe complications, great care is required from clinicians to reach early diagnosis. Involvement of the otolaryngology physician from the beginning is very significant.

A Trial of Treatment for Acute Otorrhea in Children with Tympanostomy Tubes

BackgroundRecent guidance for the management of acute otorrhea in children with tympanostomy tubes is based on limited evidence from trials comparing oral antibiotic agents with topical antibiotics.MethodsIn this open-label, pragmatic trial, we randomly assigned 230 children, 1 to 10 years of age, who had acute tympanostomy-tube otorrhea to receive hydrocortisone–bacitracin–colistin eardrops (76 children) or oral amoxicillin–clavulanate suspension (77) or to undergo initial observation (77). The primary outcome was the presence of otorrhea, as assessed otoscopically, 2 weeks after study-group assignment. Secondary outcomes were the duration of the initial otorrhea episode, the total number of days of otorrhea and the number of otorrhea recurrences during 6 months of follow-up, quality of life, complications, and treatment-related adverse events.ResultsAntibiotic–glucocorticoid eardrops were superior to oral antibiotics and initial observation for all outcomes. At 2 weeks, 5% of children treated with antibiotic–glucocorticoid eardrops had otorrhea, as compared with 44% of those treated with oral antibiotics (risk difference, −39 percentage points; 95% confidence interval [CI], −51 to −26) and 55% of those treated with initial observation (risk difference, −49 percentage points; 95% CI, −62 to −37). The median duration of the initial episode of otorrhea was 4 days for children treated with antibiotic–glucocorticoid eardrops versus 5 days for those treated with oral antibiotics (P<0.001) and 12 days for those who were assigned to initial observation (P<0.001). Treatment-related adverse events were mild, and no complications of otitis media, including local cellulitis, perichondritis, mastoiditis, and intracranial complications, were reported at 2 weeks.ConclusionsAntibiotic–glucocorticoid eardrops were more effective than oral antibiotics and initial observation in children with tympanostomy tubes who had uncomplicated acute otorrhea. (Funded by the Netherlands Organization for Health Research and Development; Netherlands Trial Register number, NTR1481.)

English

Complication of otitis media is defined as a spread of infection beyond the pneumatised area of temporal bone and associated mucosa. Though introduction of antibiotics has decreased the incidence of intracranial complications, they still occur in unrecognized, poorly managed or resistant cases which lead to morbidity and mortality. Here we report a case of chronic otitis media with recurrent temporal lobe abscess leading to mortality.

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.

Nocardia mastoiditis in an African child

A previously well, human immunodeficiency virus (HIV)-positive boy, presented with features of chronic mastoiditis with no intracranial complications. Intraoperative findings revealed a chronic granulomatous infection. Culture of pus swabs grew Nocardia asteroides, sensitive to trimethoprim and sulphamethoxazole. The child completed 12 months of treatment. There are very few case reports on N. mastoiditis in the literature, and the incidence of this as a complication of otitis media is unknown. To the best of our knowledge, this is the first case report of N. mastoiditis from Africa.

Lateral sinus, Transverse Sinus and Jugular Vein Thrombosis as a Rare Complication of Chronic Mastoiditis

Lateral sinus, Transverse Sinus and Jugular Vein Thrombosis as a Rare Complication of Chronic Mastoiditis Transverse sinus, lateral sinus and jugularvein thrombosis is a rare disease and their early treatment is important for decreasing the morbidity and mortality. The involvement of lateral sinus and transverse sinus during the course of ear infection were a wellknown complication in preantibiotic days, but lateral and transverse sinus thrombosis is an uncommon cranial complication of otitis media nowadays. Contrast-enhanced computed tomography scan and magnetic resonance imaging plays a major role in diagnosis and management. The advance of non-invasive diagnostic techniques and broad-spectrum antibiotics has dramatically decreased the mortality and altered the diagnostic and treatment paradigm. Surgical exploration and debridement of the infected thrombosed sinus seems to be effective. Recently, anti-coagulant treatment has also been proposed. We want to present a case with lateral sinus, transverse sinus and jugular vein thrombosis which were treated successfully to call attention to a rare, but possibly fatal complication of chronic suppurative otitis media.

Otitis Media in Children: Review Article

Otitis media is one of the most common infectious diseases of childhood. It is not uncommon for clinicians to miss the diagnosis of the acute form especially in younger children. Late and missed diagnoses result in poor management and increased risk of complications. This review highlights the epidemiology, presenting features, diagnosis, treatment and complications of otitis media.

Petrositis With Bilateral Abducens Nerve Palsies complicated by Acute Otitis Media

Petrous apicitis is a rare but fatal complication of otitis media. An infection within the middle ear can extend within the temporal bone into the air cells of the petrous apex. With only the thin dura mater separating the trigeminal ganglion and the 6th cranial nerve from the bony petrous apex, they are vulnerable to inflammatory processes, resulting in deep facial pain, lateral rectus muscle paralysis, and diplopia. In 1904, Gradenigo described a triad of symptoms related to petrous apicitis, including acute suppurative otitis media, deep facial pain resulting from trigeminal involvement, and abducens nerve palsy. It has traditionally been treated with surgery, but recent advances in imaging, with improved antibiotic treatment, allow conservative management. In this case report, we describe a clinical and neuroradiological evolution of a child with a petrous apicitis after acute otitis media, which was managed medically with a positive outcome.

Outcomes of tympanostomy tube placement in children with Down syndrome—A retrospective review

ObjectivesTympanostomy tubes are commonly used for treatment of chronic otitis media with effusion (COME) or recurrent acute otitis media (RAOM) in patients with Down syndrome, but hearing outcomes in this population have been mixed, and complications appear to be common. We aim to characterize outcomes and complications associated with tympanostomy tube placement in this population. MethodsRetrospective review. All patients with Down syndrome presenting to a tertiary academic pediatric otolaryngology practice over a ten year period from 2002 to 2012 who received tympanostomy tubes for COME, RAOM, or hearing loss were reviewed. ResultsLong term follow up data was obtained in 102 patients, with average follow up 4.7 years. COME was the primary indication for tube placement in 100/102 (98%). Less than half of these patients (44%) initially failed their newborn hearing screen. Post operative hearing was found to be normal or near normal for the better hearing ear in 85/99 (85.9%), and normal to near normal in bilateral ears in 71/99 (71%). A majority (63.7%) of patients required two or more sets of tubes during the follow up period. Long term complications were common and were significantly increased if the patient required three or more sets of tubes, including chronic perforation (36.6% vs 8.2%, p<0.001), atelectasis (29.3% vs 1.6%, p<0.0001), and cholesteatoma (14.6% vs 0%, p=0.003). ConclusionsCOME is a frequent problem in Down syndrome, and the majority of patients will require two or more sets of tubes during their childhood and achieve normal postoperative hearing. Long term complications of otitis media appear to be more common in this population and appear to correlate with increasing number of tubes placed. More investigation is required to determine optimal treatment strategies for COME in patients with Down syndrome.

Antibiothérapie des infections ORL sévères du nourrisson et de l’enfant : mastoïdites aiguës

In children, acute mastoiditis is a classic but rare complication of otitis media. Primary treatment of mastoiditis is mainly medical with intravenous antibiotics. Surgical procedures may be necessary for complicated forms of the disease. Though, the adequacy of the initial empiric antibiotic therapy with the susceptibility of the suspected bacteria germs is essential to avoid potentially serious complications. We perform a review of the literature to provide supportive arguments for the therapeutic approach of acute mastoiditis in children worked out by the French Group for Pædiatric Infectious Diseases.