Management of otogene extracranial complications in children and adolescents: report of 35 cases over 10 years.

OBJECTIVE: Medical management of exocranial otogenic complications represents a challenge for a medical system of a country in general, especially for ENT services. The goal of this study is to find some answers on demographic data, clinical symptoms and signs, diagnostics, and especially therapy for these complications in young patients. METHOD: The study is retrospective, performed in the ENT clinic of the University Clinical Center of Kosova in Prishtina and covers 10 years (from 01.06.2000 to 01.06.2010) and includes all young aged patients (1-18 years) hospitalized because of exocranial otogenic complications. RESULTS: From a total of 35 patients, male were 22 (63%) and females 13 (37%). The commonest complications were: mastoiditis in 18 (51.4%) and subperiosteal mastoidal abscess in 12 cases (34%) than rarest complications were: Bezold's abscess in 2 cases, facial nerve paresis, labyrinthitis, and combined complication one case each. Diagnostics of these cases were based on the clinical appearance, laboratory analyses, and clinical imaging. Treatment of these patients was surgical, medical, and combined: 3 of the medical therapy only (intravenous antibiotics), and 32 others were treated surgically: cortical mastoidectomy in 16 (45%) of cases, mastoidectomy and aeration tube insertion in 6 (17%) and antrotomy in 3 (8.5%) of cases. None of these series of patients died and none of them had permanent sequels. CONCLUSION: Timely diagnostics and adequate treatment of exocranial otogenic complications made it possible that our results can be comparable with the results of other referent centers cited in the recent literature.

Post-operative clinical course in children undergoing mastoidectomy due to complicated acute mastoiditis.

PURPOSE: To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment. METHODS: A retrospective chart review of children diagnosed with CAM who underwent mastoid surgery during 2012-2019 in a tertiary care university hospital. 33 patients, divided into 2 groups: 17 patients with sub-periosteal abscess (SPA) alone-single complication group (SCG) and 16 patients with SPA and additional complications: sigmoid sinus thrombosis (SST), peri-sinus fluid/abscess, epidural/subdural abscess, and acute meningitis-multiple complications group (MCG). RESULTS: 33 patients belong to the SCG 17(51%) and 16(49%) belonged to the MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P = 0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P = 0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings; a total of 18 positive cultures were reported. Fusobacterium necrophorum counted for 8/18(44.5%) of all positive cultures, 7/9(77.8%) in the MCG vs. 1/9(11.1%) in the SCG, P = 0.004. Streptococcus pneumoniae was reported only in SCG (5/9, 55.5%, vs. 0/9, P = 0.008). CONCLUSION: Post-mastoidectomy fever due to CAM is not unusual and seems to be a benign condition for the first 5-6 days, following surgery. MCG patients are more prone to develop POF. F. necrophorum is more likely to be associated with MCG, and S. pneumoniae is common in SCG patients.

Preparing the surgical area for non-shaved ear surgery: a clinical assessment.

OBJECTIVE: To review the clinical experience for non-shaved middle ear/mastoid surgery and evaluate the proper method of preparing the postauricular surgical field. METHODS: This retrospective study reviewed medical records of cases where the non-shaved surgical procedure was carried out for middle ear/mastoid diseases. In all cases, middle ear and mastoid surgery was performed by one otologic surgeon without hair shaving to treat chronic perforation of tympanic membrane, as well as chronic suppurative otitis media, with or without mastoiditis during two years. The prevalence of surgical site infection (SSI) and bacterial culture of the surgical field was assessed just before the skin incision. RESULTS: In this review of 106 cases, the SSI rate was 1.6% for the non-shaved ear surgery. Bacterial colonisation was found on the prepared surgical field in 8.5% of cases and these bacteria was different from true pathogens. SSI of the skin incision occurred in two cases, although no bacterial colonisation of the non-shaved surgical field was found. The surgical exposure of postauricular area was enough to do tympanoplasty or tympanomastoidectomy, even though in cases where a hairline was close to postauricular sulcus. CONCLUSION: This study showed that when preparing the non-shaved ear surgery, the surgeons should not have to worry about skin contamination by hair. We suggest that the non-shaved ear surgery would appear to be preferable for the postauricular approach.

Surgical intervention for acute mastoiditis: 10 years experience in a tertiary children hospital.

PURPOSE: To evaluate the clinical course of children with acute mastoiditis (AM) who required surgical intervention. MATERIAL AND METHODS: Clinical and biochemical characteristics at the moment of hospital admission were reviewed for patients who required surgery for AM. Children who were successfully managed conservatively during the last 3 years of study were chosen as a comparison group. RESULTS: During 2008-2017, 570 children were admitted with AM: 82(14%) underwent cortical mastoidectomy, including 31(38%) with decompression of epidural space and sigmoid sinus. The comparison group consisted of 167 children with AM who did not require surgery. The surgical group had a higher rate of acute otitis media before admission. At the time of hospital admission, the surgical group had a higher rate of prolonged fever, otorrhea, and sub-periosteal abscess. Their average temperature, WBC, neutrophil count, and CRP were significantly higher (39.2 vs. 37.9°. C, 20 K vs. 16.5 K, 67 vs. 55.8 percent, 17 vs. 8.8, respectively, p = 0.0001). Fusobacterium necrophorum was the most common pathogen in the surgical group (50%), and group A streptococcus in the comparison group (22%). Sub-periosteal abscess, sinus venous thrombosis, and epidural involvement were diagnosed in 95, 35, and 38 percent of patients, respectively. Average length of IV antibiotic treatment was 20 days in operated children, compared to 5.6 days in the comparison group (p = 0.0001). Since 2013, a significantly higher percentage of children were diagnosed with Fusobacterium mastoiditis (p = 0.0001) who required surgery (p = 0.008). CONCLUSION: In children with AM presenting with, high fever, leukocytosis, elevated CRP, and sub-periosteal abscess, early CT and surgical intervention were frequently required. The increase in Fusobacterium infection might be an explanation for the increase in complicated AM requiring surgery.

Management of Pediatric Acute Mastoiditis in Israel: Nationwide Survey Among Otorhinolaryngologists and Emergency Pediatricians.

INTRODUCTION: Acute mastoiditis (AM) is a medical emergency that mandates prompt diagnosis and treatment. Nevertheless, its management often differs between otorhinolaryngologists (ORLs) and pediatricians (PEDs) working in emergency departments. We sought to characterize the similarities and differences between management protocols of these 2 disciplines. METHODS: A voluntary electronic questionnaire, including 17 items pertaining to pediatric AM management, was sent to all the 20 otorhinolaryngology and their corresponding pediatric emergency departments nationwide. Each department sent 1 filled out questionnaire. The response rate was 100%. RESULTS: Eighteen (90%) ORLs are notified when a child with suspected AM arrives. Medical history collected by both disciplines was similar-previous otologic history (100%), previous antibiotic use (100%), and pneumococcal conjugate vaccination status (60%)-whereas acute otitis media risk factors were more important to PEDs (13 [65%] PEDs, 10 [50%] ORLs). According to 85% to 90% of ORLs and PEDs, imaging was not mandatory upon admission. According to 14 (70%) PEDs and 16 (80%) ORLs, imaging was overall performed in less than 50% of patients during hospitalization. Intravenous ceftriaxone and cefuroxime were the most common first-line antibiotic treatments (8 [40%] ORLs, 10 [50%] PEDs), with a mean treatment duration of 7 to 10 days. Eighteen (90%) of the ORLs, compared with 15 (75%) PEDs, reported that myringotomy (with or without ventilating tube insertion) was performed upon diagnosis (P = 0.05). CONCLUSIONS: The management of pediatric AM is generally similar by both disciplines. The use of imaging studies is mild-moderate. We call for a national registry and encourage the publication of guidelines.

Otomastoiditis caused by Candida auris: Case report and literature review.

Fungal otomastoiditis is a rare disease, but can be fatal for immunocompromised patients. Recently, there have been increasing cases of otologic infection caused by Candida auris. Candida auris can be easily misdiagnosed for other species and treatment is difficult due to multidrug resistance. Clinician should be aware of this rare pathogen, and it should be treated with appropriate antifungal agent with surgical debridement.

[Lateral Sinus Thrombosis--A Rare Complication of an Acute Mastoiditis or Infected Cholesteatoma]. / Die Sinusvenenthrombose--eine seltene Komplikation der akuten Mastoiditis und des Cholesteatoms.

BACKGROUND: Lateral sinus thrombosis (LST) is a rare but threatening complication of an acute mastoiditis or infected cholesteatoma. Currently only very few papers are available in the literature dealing with the systematic investigation of patients with suspected LST. The purpose of the present study was to evaluate the clinical, intraoperative and therapeutic findings of patients with particular disease. PATIENTS AND METHODS: For this retrospective study the clinical records of 7 patients which were admitted for a suspected LST were evaluated. All patients underwent mastoidectomy with exposition of the lateral sinus and investigating of its blood flow. RESULTS: A LST was confirmed in 4 patients, 3 patients had a phlebitis. Patients with a LST presented additional symptoms beside otalgia, i. e., dizziness, cephalgia, meningism, deafness of the affected ear, and facial nerve paresis. Postoperative MRI scans revealed a recanalization of the sinus in all cases. Although immediate surgery, 2 patients developed a 2-staged brain abscess in the cerebellum. CONCLUSION: Clinical symptoms of the SVT are unspecific. In cases of an acute mastoiditis, neurological signs might be pathognomonic and can direct to a LST. Therapeutic concepts comprise intravenous antibiotics and operative elimination of disease. The exposition of the lateral sinus should be performed in any mastoidectomy for a LST in order to scrutinize its blood flow. In case of a thrombosis additional anticoagulative therapy might be indicated. To exclude a 2-staged brain abscess control MRI scans 7 through 14 days postoperatively are recommended.

[Sinonasal fungal infections are not exclusively due to mucorales and Aspergillus!]. / Les infections fongiques nasosinusiennes ne sont pas uniquement liées aux mucorales et aux Aspergillus !

Rhino-sinusal infections are serious diseases and possibly lethal. When they are invasive, we easily discuss apergilloses and mucormycoses. The confirmation of the diagnosis of mucormycosis need an extensive surgery for precise histopathological and mycological evaluation. The pathologist may be faced to other rare mycoses such as phaeohyphomycoses, which present different morphological features than mucormycoses and Aspergillus. Once the diagnosis is established, an appropriate antifungal treatment is quickly started. The aim of our work is to report two observations of phaeohyphomycoses, to describe their histopathological features, to discuss complementary diagnostic methods and to present the main differential diagnoses.

[Acute mastoiditis with retroauricular abscess - a report of two cases]. / Ostre zapalenie wyrostka sutkowego z ropniem zamalzowinowym ­ opis dwóch przypadków.

Otogenic complications may occur as a result of both acute and chronic otitis media. The purpose of the diagnostic process and treatment of patients with otogenic complications is to identify and eliminate focal points of the infection. Due to general application of antibiotics, these complications are rarely observed. Retroauricular abscess may be the first symptom associated with the development of acute mastoiditis in patients with communication disturbances. Intravenous antibiotics and surgery have been successfully used for treatment in the two described cases. First case: 9 years old girl suffering from hydrocephalus, mental retardation. Retroauricular abscess occured as a result of the left ear acute otitis media. Second case: 17 years old girl with multiple congenital defects, mental retardation. Four surgery because of epidural abscess, meningitis, external auditory canal atresia, granulation and cholesteatoma during two years. Retroauricular abscess occured in the course of the right ear chronic otitis media.

Toxic inner ear lesion following otitis media with effusion: a comparative CT-study regarding the morphology of the inner ear.

Viral infections of the upper respiratory airways can lead to a delayed viral otitis media (VOM) caused by a diffusion of viruses/virus particles through the round window membrane and resulting in sensorineural hearing loss. The treatment of choice is immediate paracentesis, evacuation of all fluids from the middle ear cavity, and haemorrheological infusions. However, in some cases, persistent symptoms may be an indication for a surgical approach using mastoidectomy. In high-resolution computed tomography, an extended small-sized pneumatisation of the mastoid cells with complete shading was found in these non-responsive cases. Therefore, a direct means of inner ear affliction through weak parts of the labyrinthine bone may be hypothesised. Patients suffering from a toxic inner ear lesion (TIEL) following a common cold, treated over a 10-year period in a Tertiary Care Centre (N = 52, 57 ears), were identified and the morphological characteristics of the temporal bones of affected patients were examined by means of high-resolution computed tomography (hrCT). The findings were compared with a matched control group of 64 normal ears (CONT). Measurements included the grade of pneumatisation, distances within the temporal bones and Hounsfield units (HU) at defined anatomical structures. In the TIEL group, we found a small-sized pneumatisation in 79.4 % and a medium-sized pneumatisation in 10.9 %, thus differing from the CONT group and the literature data. Thickness of the bone wall of the lateral semicircular canal (LSC) and distances within the aditus ad antrum were significantly reduced in the TIEL group. HU's were markedly lower in the TIEL group at the precochlea, the LSC, and dorsolateral to the promentia of the LSC. There was a correlation between the HU's at the prominentia of the LSC and the hearing loss (p = 0.002). Persisting interosseous globuli, as described in 1897 by Paul Manasse, form an osseochondral network within the otic capsule and may be responsible for a direct means of toxic inner ear infection. The CT-morphometric results support this thesis. In the group of these patients (TIEL) a CT-scan and in non-responders to conservative treatment a surgical approach by mastoidectomy is recommended.

[Comparative evaluation of mastoidoplasty results in application of various plastic materials].

The results of surgical treatment of 62 patients, suffering chronic purulent middle otitis, were analyzed. The structure of mastoid processus and attic constitutes a base for choice of middle ear surgical sanation. Sanation operation with preservation or reconstruction of external acoustical meatus posterior wall was finished with combined mastoidoplasty using autobone, spongioid bone bioimplant Tutoplast or bioceramic material "Sintekost". Achievement of a steady sanating effect have promoted in late postoperative period a trustworthy lowering of the perception threshold of the bone--conducted sounds as on vocal, and also on high frequencies, while of the air--conducted sounds--on vocal frequencies. This permits in perspective to perform a hearing--improving operations with good functional result.

Tympanomastoidectomy for cholesteatoma among Nigerians.

The incidence of cholesteatoma among Nigerians is not well documented, as is the outcome of surgical treatment. A descriptive analysis of prospectively collected data of cases of cholesteatoma managed with tympanomastoidectomy at National Hospital Abuja between September 2005 and April 2012 is presented. Cases were analyzed for age, sex, type of cholesteatoma, intra-operative findings, and post-operative outcome after 6 months of follow up. A total of 28 ears from 25 cases of cholesteatoma had tympanomastoidectomy. Age range was 6-73 years (mean = 34.4, SD = 18.67). There were 13 females and 12 males. Primary acquired cholesteatoma was seen in 18 cases (20 ears), secondary acquired in 5 cases (six ears), and external auditory canal cholesteatoma was seen in 2 cases (two ears). The sites involved in middle ear cholesteatoma was attic, sinus and mesotympanum pars tensa (16/26), attic, sinus, antrum and mastoid cavity (5/26), attic, sinus, mesotympanum and mastoid antrum (4/26), and attic only (3/26).21/25 of cases (24 ears) managed had single stage intact canal wall (ICW) tympanomastoidectomy, while 4/25 (4 ears) had two-stage surgery with canal wall down tympanomastoidectomy in two of these, and revision surgery done within 12 months of first surgeries. 2/25 cases (in the two stage revision group) had postoperative persistent mastoid cutaneous fistula and were treated with post-auricular advancement flap. The commonest cholesteatoma type seen at National Hospital Abuja, Nigeria was primary acquired type, and involved the attic, sinus and mesotympanum pars tensa mainly, and most can be managed by single stage tympanomastoidectomy.

[Diseases of the middle ear in childhood]. / Erkrankungen des Mittelohres im Kindesalter.

Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA® and the active partially implantable device Vibrant Soundbridge® could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of -these implantable hearing aids.

[Certain peculiarities of the clinical picture of mastoiditis in the children].

The objective of the present study was to analyse the cases of acute otitis media complicated by mastoiditis in the children given the surgical treatment during the period from 2009 till 2012. A total of 46 patients underwent antromastoidotomy. The main clinical variants of the disease, their incidence, the age composition of the affected children, and the principal etiological factors were determined.

[Destructive mastoiditis with thrombosis of the sigmoid sinus in a 8 year-old child presenting with concomitant chicken pox].

The specific clinical feature of mastoidities that developed in a patient presenting with chicken pox was the rapid progress in temporal bone destruction with partial thrombosis of the sigmoid sinusis in the absence of typical manifestations of mastoiditis. The pronounced destructive changes found in a series of CT images were regarded as the indications for urgent antromastoidotomy with the puncture of the sigmoid sinusis.

Acute mastoiditis in cochlear implanted children: A single-centre experience.

BACKGROUND: Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant. Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies. PATIENTS AND METHODS: Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases. RESULTS: AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3-30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series. CONCLUSIONS: Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1-4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.

Chronic otitis media with multiple complications.

Chronic otitis media (COM) is defined as persistent infection or inflammation of the middle ear and mastoid air cells. The proximity of the middle ear cleft and mastoid air cells to the intratemporal and intracranial compartments places structures located in these areas at increased risk of infectious complications. The complications of COM are divided into intracranial and extracranial complications. The development and appropriate use of antibiotics have led to a decrease in these potentially devastating complications. However, they continue to occur, and clinical vigilance is required for early detection and treatment. We reported a case with multiple complications, both intracranial and extracranial secondary to COM.

[Peculiar features of mastoiditis in a brest-fed infant with the "exposed" facial nerve].

This paper reports the clinical case of mastoiditis in a 5-month old child in whom an unusual localization of the totally "naked" facial nerve outside of the bone canal in the mastoid part was discovered intraoperatively. This finding was quite unexpected because nerves are not visible on CT scanograms. The author emphasizes that the clinical course of otitis media in the breast- fed infants and young children is characterized by a number of peculiarities due to specific anatomical, physiological, and immunological features of the child's organism. She also notes that the number of antromastoidotomies for the treatment of mastoiditis has increased in Tatarstan during the recent years.

Analysis of Prognostic Factors Impacting Pediatric Acute Mastoiditis Outcomes.

BACKGROUND: This study aimed to investigate the outcomes of pediatric patients with acute mastoiditis while examining the role of intravenous steroid therapy, patient demographics, and serum inflammatory values as prognostic factors. METHODS: This study is a single-center retrospective observational study including 73 consecutive patients treated for acute mastoiditis in the course of the 10-year study period (January 2010 to December 2019). RESULTS: Data analysis showed that patients requiring surgical treatment (14%) had a 3-fold higher C-reactive protein value at admission compared to those treated conservatively (P < .001). Receiver operating characteristic analysis revealed that a C-reactive protein cut-off of ≥98.7 had a sensitivity and specificity of 100% and 74.6%, respectively, for predicting the need for surgery (area under the curve=0.927, P < .001). The duration of symptoms before hospitalization was nearly 2 days shorter in male patients (P=.031), and the use of intravenous steroid therapy significantly shortened the length of hospitalization (P=.023), by 1.4 days on average. CONCLUSION: Intravenous steroid therapy may be useful in decreasing the length of hospital stay. Mastoiditis tends to present more severely in male patients, and monitoring C-reactive protein values during treatment correlated well with the need for surgery.