Emerging Clinical Features of Acute Mastoiditis in Israel: A Registry Based Cohort.

BACKGROUND AND OBJECTIVES: Acute mastoiditis (AM) is a severe infection in the young population, with possible life-threatening complications. This study aimed to characterize AM presentation, symptoms and signs, complications, and management, over a period of 10 years. METHODS: This large-scale population-based cohort studied "Clalit Health Care" records, to include patients <18 years diagnosed with AM, hospitalized between the years 2008-2018. After validation, we investigated clinical symptoms and signs, pneumococcal vaccination status, complications, laboratory and microbiological parameters, imaging, antibiotic treatment and surgical interventions. RESULTS: AM was diagnosed in 1189 patients, mean age of 2.71 years and 591 (49.71%) were female. Most presented with protrusion of pinna (83.1%), retro auricular redness (73.5%) and fever (71.8%). Patients <2 years of age had more symptoms (3.8 ± 1.4, opposed to 3.6 ± 1.5, P = 0.006) and showed higher white blood cell count and C-reactive protein values. Local and intracranial complications occurred in 233 (20.8%) and 75 (6.5%) patients, respectively. Complications were associated with increased white blood cell count and C-reactive protein and related to bacterial type, specifically Fusobacterium necrophorum (P < 0.0001), for which 50% had an intracranial complication. Between the years 2008-2018, Streptococcus pneumoniae-positive cultures decreased (30.9% to 10.3%, P > 0.0001) as opposed to group-A Streptococcus (10.9% to 30.9%, P = 0.002). CONCLUSIONS: This study shows a difference in AM appearance in the <2 years population and the association between white blood cell count, C-reactive protein and microbiology results with the occurrence of a complication. This may play a role in the management process, such as imaging and intervention needs. Although performed during the pneumococcal vaccine era, the disease microbiology was shown to change significantly throughout the study.

Risk factors for recurrent acute mastoiditis in pediatric patients: a registry-based cohort study.

OBJECTIVE: To describe characteristics of pediatric patients with recurrent acute mastoiditis, and to identify risk factors for this condition. STUDY DESIGN: A retrospective cohort study. SETTING: Data based on electronic medical records of the largest Health Maintenance Organization in Israel. METHODS: Children hospitalized due to acute mastoiditis during the years 2008-2018 were identified, and their diagnosis was verified. Patients with recurrent acute mastoiditis were identified and grouped, and their characteristics were outlined and compared to those of the original group to identify risk factors for recurrence. RESULTS: During the 11-year period, a total of 1115 cases of children hospitalized due to acute mastoiditis were identified with a weighted incidence rate of 7.8/100,000. Of this group, 57 patients were diagnosed with recurrence following a full clinical recovery. The incidence proportion of recurrent acute mastoiditis was 5.1% (57/1115), male-to-female ratio was 27:30, 73.4% were younger than 24 months, the median period from the first episode was 3.4 months (IQR 2.0;10.0), and 82.5% of the patients (n = 47) had a single recurrence, whereas 18.5% (n = 10) had two recurrences or more. Mastoidectomy and swelling over the mastoid area during the first episode were identified as the main risk factors for recurrent mastoiditis HR = 4.7 [(2.7-8.2), p < 0.001] and HR = 2.55 [(1.4-4.8), p = 0.003], respectively. Mastoidectomy was the only independent significant risk factor for recurrence in a multivariate analysis. CONCLUSIONS: Mastoidectomy and swelling over the mastoid area during the first episode of acute mastoiditis were found strongly related independent risk factor for future recurrent episodes of acute mastoiditis.

Epidemiology of pediatric acute mastoiditis in Israel: A National Registry 10-year perspective.

Background and Objectives: Previous small studies have proposed a higher incidence of acute mastoiditis in Israeli pediatric patients than in other Western countries. The aim of this study was to describe the incidence of acute mastoiditis and its epidemiological features over a decade, in order to identify variables that could possibly affect the incidence. Methods: All admitted patients aged <18 years diagnosed with acute mastoiditis between 2008 and 2018 at Clalit Healthcare Services were identified and a database was generated. Results: A total of 1189 and 1115 patients met the inclusion criteria, respectively. Acute mastoiditis diagnosis was confirmed in 95.2% of the patients. The incidence was 7.78 cases per 100,000 children-years but was significantly higher in children under 2 years of age (average of 38.31 per 100,000 children-years). No specific pattern was observed in the annualized incidence rate during the study period. Acute mastoiditis was significantly more common in children of Jewish descent than non-Jewish (10.4 vs. 3.03 per 100,000 children-years, P < 0.001) and of high socioeconomic status and is more common in the winter. The prevalence of household parental smoking (52%) was more than double that previously reported in the Israeli population. Conclusions: A higher incidence of acute mastoiditis was observed in the Israeli population than in other reports. The age-dependent rate was identified along with unique epidemiological features such as seasonality, higher incidence in patients of Jewish descent, or high socioeconomic status. Related parental smoking habits lend further support against the exposure of young children to household smoking.Level of evidence: Individual retrospective cohort study.

[EARLY LARYNGEAL CANCER - TREATMENT OUTCOMES OF TRANSORAL LASER MICROSURGERY].

AIMS: To evaluate predictive factors for local control, larynx preservation and overall survival in patients with early laryngeal cancer, who were treated with endoscopic transoral CO2 laser microsurgery. BACKGROUND: Transoral laser microsurgery (TLM) is the treatment of choice for early laryngeal cancer. The current study aimed to assess the outcomes and validity of carbon dioxide (CO2) laser microsurgery in patients with early larynx cancer and to determine predictors for outcomes. METHODS: A retrospective study included all patients who were treated with laser microsurgery, in the Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa, between the years 2009-2016. We evaluated outcomes according to local control, margin status, larynx preservation, and overall survival. Cordectomy types I-V were classified by the European Laryngological Society (ELS). RESULTS: Laser microsurgery was performed in 74 patients with early laryngeal cancer, mean age 68.2±10.4 years, M: F 65:9, mean follow-up 58±28 months. Seventy-three percent (73%) were smokers. Primary tumor location was glottic in 68 patients (92%), supraglottic (5 patients - 7%), and subglottic (1 patient - 1%). Tumor stage was as follows: Tis: 18 patients (24%), T1a: 35 patients (47%), T1b:10 patients (14%) and T2: 11 patients (15%). In 72 patients (97%), margins were taken from the patient side, 64% (46 patients) had negative margins, whereas 26 patients (36%) had positive margins. Patients with positive margins had either further laser surgery (19%), or radiotherapy (14%). Two patients were not treated for positive margins, both had recurrent disease in a mean follow-up of 26 months, and both had total laryngectomy. Five years local control rate (LCR) stratified by stage was as follows: Tis-81.5%, T1a- 88%, T1b-100% and T2 - 58% (NS). Overall 5-year local control rate (LCR) was 83%, with no significant difference between patients with positive or negative margins. Overall 5-year survival was 87% and organ preservation rate was 93. CONCLUSIONS: Laser microsurgery provides an excellent rate of disease free/overall survival for early laryngeal cancer and has a valuable role in organ preservation. No significant differences were found in LRC and overall survival between patients with positive margins compared to patients with negative margins, most probably due to immediate further intervention in patients with positive margins.