ABSTRACT
Introducción: Los abscesos retro y parafaríngeos son procesos infrecuentes aunque asociados con morbilidad significativa y potencial mortalidad. El objetivo del estudio es revisar nuestra experiencia en el manejo diagnóstico y terapéutico de los abscesos retro y parafaríngeos y comparar el resultado entre los pacientes tratados con antibioterapia exclusiva con aquellos que requirieron drenaje quirúrgico. Pacientes y métodos: Estudio retrospectivo de pacientes diagnosticados de abscesos retro y parafaríngeos en nuestro hospital terciario durante el periodo 2000-2009. Resultados: Treinta y un casos fueron identificados. Diecisiete presentaron absceso retrofaríngeo, 11 abscesos parafaríngeos y 3 ambos. Encontramos un incremento de la frecuencia media anual (1,4 casos/años en el periodo 2000-2004 versus 4,8 casos/año en el periodo 2005-2009, p=0,006). La mediana de edad fue 3 años (rango 1-10). Dieciocho (58%) pacientes recibieron antibioterapia por vía oral previa al ingreso (betalactámicos 84%). La clínica de presentación fue: fiebre (93%), linfadenopatías cervicales (93%), dolor cervical (90%), tortícolis (74%), odinofagia (64%), trismus (32%), sialorrea (22%) y estridor (6%). En 13 niños se realizó drenaje quirúrgico, siendo positivo el cultivo microbiológico en 8 casos; Streptococcus pyogenes fue el germen más frecuente (n=4). Todos los pacientes recibieron antibioterapia por vía intravenosa. No hubo diferencias en la estancia hospitalaria, complicaciones o recurrencias al comparar los tratados con antibioterapia exclusiva y los tratados con cirugía. Conclusiones: La frecuencia media anual de casos se incrementó durante la segunda mitad del periodo de estudio. La mayoría de niños fueron tratados satisfactoriamente con manejo conservador. La indicación quirúrgica debe basarse en la presentación clínica y la respuesta al tratamiento antibiótico (AU)
Introduction: Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention. Material and methods: A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre. Results: Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P=0.006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n=4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention. Conclusions: Retro- and parapharyngeal abscesses were increasingly observed during the 2nd part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy (AU)
Subject(s)
Humans , Male , Female , Child , Retropharyngeal Abscess/complications , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/drug therapy , Anti-Bacterial Agents/therapeutic use , Retropharyngeal Abscess/physiopathology , Retropharyngeal Abscess/surgery , Retropharyngeal Abscess , Retrospective Studies , Streptococcus pyogenes/isolation & purification , Antibiotic ProphylaxisABSTRACT
INTRODUCTION: Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention. MATERIAL AND METHODS: A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre. RESULTS: Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P=.006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n=4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention. CONCLUSIONS: Retro- and parapharyngeal abscesses were increasingly observed during the 2(nd) part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy.
Subject(s)
Abscess , Pharyngeal Diseases , Retropharyngeal Abscess , Abscess/diagnosis , Abscess/therapy , Child , Child, Preschool , Female , Humans , Infant , Male , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/therapy , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/therapy , Retrospective Studies , Spain , Time FactorsABSTRACT
INTRODUCTION: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. MATERIAL AND METHOD: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. RESULTS: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. CONCLUSIONS: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events.
Subject(s)
Brain Diseases/epidemiology , Brain Diseases/etiology , Otitis Media/complications , Acute Disease , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
Introducción: las complicaciones intracraneales (CI) secundarias a otitis media son procesos infrecuentes aunque potencialmente graves. Recientemente hemos encontrado una frecuencia inusualmente elevada, cuyas características clínicas y epidemiológicas describimos. Material y método: estudio descriptivo retrospectivo de pacientes con complicaciones intracraneales secundarias a otitis media ingresados en nuestro hospital terciario durante el periodo abril de 2004-noviembre de 2007. Resultados: 8 pacientes han presentado CI: trombosis de seno sigmoideo (4), trombosis de seno lateral (1), meningitis (2), absceso epidural (1) e hidrocefalia otítica (1); 4 de los pacientes presentaban otomastoiditis. El 87,5% de los pacientes había recibido antibioterapia oral previa a la complicación. Los síntomas más frecuentes fueron fiebre, otalgia, cefalea, parálisis del VI par y parálisis facial. Se aisló el germen causal en 3 pacientes: Streptococcus pyogenes (2) y Proteus mirabillis (1). Los demás pacientes tuvieron cultivos negativos. Se realizó mastoidectomía radical en 2 pacientes y tratamiento médico con antibioterapia intravenosa de amplio espectro en todos los pacientes. Se produjo la curación sin secuelas en 6 casos y ninguna muerte. Conclusiones: hemos detectado un incremento en la frecuencia de CI secundarias a otitis media aguda. Para confirmarlo se requieren estudios prospectivos multicéntricos a fin de valorar si se ha producido un cambio epidemiológico en la incidencia de este tipo de complicaciones (AU)
Introduction: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. Material and method: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. Results: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. Conclusions: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events (AU)
