Otogenic Infections Research Articles

Controversies in the management of subdural empyema

Forty one cases of subdural empyema treated between 1977 and 1988 at the Postgraduate Institute of Medical Education and Research. Chandigarh, have been analysed. The patients ranged from 9 days to 80 years of age. There were 22 children, including 11 infants. Fever, altered sensorium and seizures were the most common symptoms present for 1 day to 6 months. Otogenic infection was the commonest aetiological factor followed by postoperative and posttraumatic causes. Thirty seven patients had supratentorial empyemas, including 4 with parafalcine collections, three had infratentorial empyemas, and in one there was extension of the empyema from the supratentorial to the infratentorial compartment. Therapeutic modalities used included percutaneous needle aspirations in infants and burr hole evacuation and craniotomies in adults. A wide spectrum of organisms was detected. Mortality in this series was 24%, which was mainly attributable to the deteriorated neurological status prior to treatment. A detailed review of the literature has been given, highlighting various controversies in the management of SDE. Important prognostic factors and a treatment plan are suggested.

Intracranial abscesses in adults: an analysis of 54 consecutive cases.

A retrospective analysis was performed of 54 consecutive adult patients with intracranial abscesses hospitalized between 1973 and 1985. Clinical signs and symptoms were varying and no single symptom was found in more than 48% of the patients. Also the laboratory findings were of limited diagnostic value. The etiology of the infections varied with the sources and could be identified in 42 of the patients. In patients with postoperative abscesses or infections after penetrating head injuries Staphylococcus aureus was the most commonly found causative agent. In patients with abscesses originating from sinus, dental or otogenic infections, anaerobic bacteria dominated and most patients had multiple bacterial isolates. A majority of patients (33/47) with diagnosed abscesses were treated with both surgical drainage and systemic antibiotics. 14 patients received antibiotics only, due to inoperable abscesses or spontaneous regression without surgery. 17 of the patients (31.5%) died from their intracranial infections and only 9 survived without sequelae. Important prognostic factors were missed diagnosis and presence of multiple or ruptured abscesses. One patient died of acute brain stem herniation after lumbar puncture, a procedure which was found to be of limited diagnostic value and which seems to be contraindicated in patients with intracranial abscesses.

Head and Neck Surgery: Indications, Techniques, Pitfalls, vol 3: Ear

This superbly illustrated book by 13 mostly European authors will be a necessity for any student or practitioner of ear surgery. The volume carries an excellent translation by P. M. Stell of Liverpool, England. The material on preoperative diagnostic procedures and indications for surgery and the references are adequate, but the book in general suffers from a short, telegraphic style. Helpful to the student of surgery are the various descriptions and illustrations of new and standard instruments of otologic surgery, a mundane topic frequently overlooked. I particularly enjoyed the text by Marguth on neurosurgical procedures of interest to the otologist. The chapters on otogenic infections, intracranial complications, and basal skull surgery are excellent, while chapters on foreign body removal, malignant external otitis, and radical mastoid surgery are brief and weak. Important otologic concepts, such as intact canal wall techniques, surgery for Bell's palsy, and mastoid surgery, are too briefly and

A review of 50 cases of intracranial complications from otogenic infection between 1961 and 1977.

The records of 50 patients with intracranial complications of middle ear disease treated over the past 16 years have been reviewed. Virtually all the known intracranial consequences of middle ear infection have been encountered, and include cerebral abscess, cerebellar abscess, meningitis, lateral sinus thrombosis, otitic hydrocephalus and cortical thrombophlebitis. The clinical features, neurological signs and investigative data for each group have been compared and contrasted. Treatment in the past has consisted of radical and modified radical mastoidectomy. It is proposed that these techniques will continue to be preferred for the management of chronic otitis media in the presence of a condition as serious as an intracranial complication. It is concluded that with a quoted incidence of postoperative cholesteatoma as high as 40% intact canal wall techniques are not justified in these patients at present.

A NEWER CONCEPT OF THE MANAGEMENT OF OTOGENIC INFECTION

IN THE temperate zones otologic practice can be divided generally into two distinct seasonal phases. One is the summer phase, during which conditions are essentially the same both indoors and out as regards temperature and humidity. During the second, or winter, phase people live in different environments, the dry, warm indoors and the variable, cold outdoors. During this phase the human economy is subject to great fluctuations of temperature and humidity over relatively short periods. As a result, people have fall, winter and spring colds, with the ensuing complications, not the least of which are otogenic infections, such as otitis media and mastoiditis. During the summer phase otologists see relatively few infections of this type but a greatly increased number of external otogenic infections. In addition, they frequently encounter exacerbations of chronic otogenic infections, which have been artificially activated by swimming, excessive sweating and bathing, with consequent pathologic aural changes.

LOCAL USE OF SULFANILAMIDE IN OTOGENIC INFECTIONS

Chemotherapy has become an important means for the effective combating of infections, which previously depended on less specific agents. Sulfanilamide, which was one of the first drugs synthesized, has been used with success against otogenic infections. Many operations for acute mastoiditis have been avoided by early use of this drug. Investigative studies have shown that under certain in vitro conditions sulfanilamide is effective in its bacteriostatic property in a dilution of 1:10,000. In higher concentrations, however, the bactericidal and bacteriostatic influences may be augmented considerably. Clinically, a blood concentration of free sulfanilamide up to 10 to 20 mg. per hundred cubic centimeters can be obtained. The solubility of sulfanilamide at body temperature is about 0.8 per cent. It has been demonstrated that many substances, including peptone, may interfere with the action of sulfanilamide on micro-organisms. In an active focus of infection to which the blood supply is impaired, because of

BACILLUS PROTEUS IN OTOGENIC INFECTIONS, SECONDARY MASTOIDITIS, THROMBOSIS OF THE LATERAL SINUS AND BACTEREMIA

The infrequency of the occurrence of Bacillus proteus in otogenic infections and the high mortality which it causes make it of sufficient interest to justify reporting the present case. Since 1912 only 9 cases have been reported in the literature. Seven of the patients gave a history of chronic otitis; all were operated on and 4 had the lateral sinus obliterated and the internal jugular vein ligated. The blood cultures were positive in all but 1 case, and that was the only case in which the patient recovered. The mortality was 89 per cent; 3 patients died of meningitis and 5 of the overwhelming bacteremia. REVIEW OF THE LITERATURE Ross1in 1912 reported the case of a boy aged 9 months who died after an illness of about six days. There had been typical signs and symptoms of meningitis. From the spinal fluid organisms were isolated. Both ears contained pus.