Foreign body aspiration in Israeli children during the COVID-19 pandemic.

BACKGROUND: Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, there has been a decline in pediatric emergency department visits. Our aim was to assess the pattern of pediatric foreign body aspiration (FBA) during the first year of the COVID-19 pandemic, in comparison to the prior years. METHODS: In this retrospective multicenter study, we compared the number of children who presented with FBA during the COVID-19 year (March 1, 2020 to February 28, 2021) to the annual average of the years 2016-2019. We also compared the lockdown periods to the postlockdown periods, and the percentage of missed FBA, proven FBA, and flexible bronchoscopy as the removal procedure. RESULTS: A total of 345 children with FBA from six centers were included, 276 in the pre-COVID-19 years (average 69 per year) and 69 in the COVID-19 year. There was no difference in the prevalence of FBA between the COVID-19 year and any of the prior 4 years. Examining the lockdown effect, the monthly incidence of FBA dropped from a pre-COVID-19 average of 5.75 cases to 5.1 cases during lockdown periods and increased to 6.3 cases in postlockdown periods. No difference in the percentage of missed FB or proven FB was observed. There was a significant rise in the usage of flexible bronchoscopy as the removal procedure (average of 15.4% vs. 30.4%, p = 0.001). CONCLUSION: There were fewer cases of pediatric FBA during lockdown periods, compared to post-lockdown periods, presumably related to better parental supervision, with no difference in the prevalence of FBA during the COVID-19 year.

Diabetes and glycemic control in necrotizing otitis externa (NOE).

PURPOSE: Although the association between necrotizing otitis externa (NOE) and diabetes mellitus (DM) is well known, there is little knowledge in regards to the effects of DM and glycemic control on the outcome of NOE. The aim of the study was to determine the effects of DM duration and glycemic control, and in-hospital glycemic control on NOE severity. METHODS: A retrospective case series analysis, including all patients hospitalized between 1990 and 2018 due to NOE were included. Data collected included NOE disease characteristics, duration of DM, DM-associated comorbidities, glycated hemoglobin (HbA1c), urine microalbumin and in-hospital blood glucose measurements. Disease severity was defined based on duration of hospitalization (above or below 20 days) and need for surgery. RESULTS: Eighty-nine patients were included in the study. Eighty-three patients (94.3%) had DM. Preadmission HbA1c was 8.13% (5.8-12.6%). Forty-nine patients (65.5%) had mean blood glucose of ≥ 140 mg/dL and 26 (34.5%) had ≤ 140 mg/dL. DM duration was 157.88 months among NOE patients who required surgery, and 127.6 months among patients who were treated conservatively (p value 0.25). HbA1c in patients hospitalized < 20 days was 7.6%, and 8.7% among NOE hospitalized ≥ 20 days (p value 0.027). Seven patients with mean blood glucose of ≤ 140 mg/dL had Pseudomonas Aeruginosa (PA-NOE) (26.7%), in comparison to 25 (51.0%) with mean blood glucose measurement of ≥ 140 mg/dL (p = 0.045). CONCLUSIONS: HbA1c at admission is associated with longer hospitalization duration among NOE patients. Mean blood glucose during hospitalization was associated with a higher likelihood of PA infection, however, it had no effect on disease outcome.

Computer tomography findings in necrotizing otitis externa based on the offending pathogens.

PURPOSE: High-resolution temporal bone computer tomography (HRTBCT) is the most common initial radiological modality used for the assessment of necrotizing otitis externa (NOE). OBJECTIVES: (1) To compare the extension of disease, as seen on HRTBCT, in patients with NOE caused by different pathogens and (2) assess whether radiological findings may suggest the offending pathogen in cases of sterile-NOE. METHODS: All NOE patients were hospitalized between 1990 and 2018. All patients underwent HRTBCT at admission. Three groups (fungus-NOE, PA-NOE and sterile-NOE) comprising of ten patients each were randomly selected. HRTBCT was reevaluated by a senior radiologist. Thirteen radiological subsites were selected for reevaluation. RESULTS: All patients in the fungal-NOE group complained of otalgia, compared to nine in the sterile-NOE and six in the PA-NOE groups (p value = 0.044). External ear canal edema and granulation tissue were the most common findings in all groups. Surgery was performed in five patients in the fungal-NOE and PA-NOE and three in the sterile-NOE group (p value = > 0.05). Radiological findings indicating severe bone erosion within the EEC was seen in all patients but 3 (p value = > 0.05). Severe TMJ erosion was seen in one patient within the fungal-NOE and PA-NOE group (p value = > 0.05). When mild and severe involvement were combined, TMJ bone erosion was seen in four patients in the fungal-NOE and only in one patient in the PA-NOE (p = 0.04). CONCLUSIONS: TMJ involvement may be more common in fungal disease, suggesting a different spreading pathway, as opposed to PA-NOE. Accordingly, TMJ involvement on HRTBCT may justify antifungal treatment in sterile culture-NOE.

Surgery for necrotizing otitis externa-indications and surgical findings.

PURPOSE: Treatment for necrotizing otitis externa (NOE) includes long term antibiotic and surgery in selected cases. Indications and extent of surgery, however, are still not defined. The aims of this study were: (1) present our experience in surgery for NOE (2) compare high-resolution computer tomography and perioperative findings (3) suggest recommendations for indications and extent of surgery. METHODS: A retrospective case series study was conducted in a tertiary referral center. Patients hospitalized due to NOE between the years 1990-2015 and underwent surgery were included. RESULTS: Twenty patients were included in the study. HRTBCT was performed in 17 patients. Most common radiological findings included mastoid fullness (n = 13, 76.4%) and edema of external ear canal (n = 12, 70.5%). Surgical indications included lack of response to treatment (n = 18) and facial nerve palsy (n = 2). Seven patients underwent local debridement. Most common operative findings included soft tissue necrosis (n = 4, 57.1%) and gross bony destruction of the external ear canal (n = 2, 28.5%). Thirteen patients underwent tympanomastoid surgery. Most common operative findings included granulation tissue in the mastoid (n = 7, 53.8%) and mastoid bony erosion (n = 4, 30.7%). Facial canal involvement was seen in four patients (30.7%). CONCLUSION: This is the first study to describe a large group of surgically treated NOE. Initial surgical approach should be based on clinical and HRTBCT findings. Minimal HRTBCT findings may be addressed with local debridement. Severe HRTBCT findings should be addressed with canal wall up mastoidectomy as the minimal surgical procedure. Further extent should be decided based on perioperative findings.

Necrotizing Otitis Externa-Analysis of 83 Cases: Clinical Findings and Course of Disease.

OBJECTIVES: Evaluate the relationship between clinical findings and course of disease among patients with necrotizing otitis externa (NOE). STUDY DESIGN: Retrospective case series review. SETTING: Tertiary referral center. PATIENTS: Adult patients with no previous history of chronic ear disease, hospitalized due to NOE between the years 1990 to 2015. MAIN OUTCOME MEASURES: 1) Duration of hospitalization and 2) necessity for surgery. RESULTS: Eighty-one patients were included in the study, corresponding to 83 effected ears. Thirty-two patients (38.5%) were hospitalized longer than 20 days and 20 patients (24.0%) underwent surgery. Otalgia was the most common complaint (n = 71, 85.5%). Pseudomonas Aeruginosa (PA) was the most common isolated bacteria (n = 40, 48.1%). Shifting incidence of culture results was noted, as rates of PA NOE decreased and rates of sterile culture and fungal NOE increased. Duration of complaints and presence of aural discharge at admission were associated with prolonged hospitalization (p = 0.010, p = 0.011, respectively). Advanced age, duration of hospitalization, and rates of readmission were associated with surgery (p = 0.037, p < 0.001, p < 0.001 respectively). CONCLUSIONS: Duration of complaints and presence of aural discharge may indicate advanced NOE and require longer in-hospital treatment. Elderly patients are at increased risk for conservative treatment failure and are more likely to require surgery. With shifting incidence of pathogens, a wider empirical treatment covering nontraditional pathogens should be considered.