Aspectos clínicos y bacteriológicos de las mastoiditis agudas como complicación de otitis media aguda y crónica en pediatría, Experiencia en 10 años / Clinical and bacteriological features of acute mastoiditis as a complication of acute and chronic otitis media in pediatrics. A 10-years experience

Antecedentes. Cualquier paciente pediátrico o adulto que presente otitis media aguda (OMA) u otitis media crónica (OMC), particularmente colesteatomatosa, puede desarrollar complicaciones intratemporales y endocraneales, especialmente mastoiditis aguda (MA). Objetivo. Describir las características clínicas y bacteriología de los pacientes asistidos por MA como complicación de OMA y OMC. Lugar de aplicación: Servicio de Otorrinolaringología. Hospital de Pediatría Juan P. Garrahan. Diseño. Descriptivo, retrospectivo, transversal y observacional. Población. Pacientes con mastoiditis aguda por OMA y por OMC asistidos en el Servicio de ORL durante 10 años. Material y métodos. Revisión de historias clínicas de todos los pacientes tratados entre enero de 1999 y diciembre de 2008. Resultados. Se estudiaron 57 pacientes con MA, 40/57 por OMA y 17/57 por OMC. Hubo 40 niños hospitalizados con signos y síntomas de MA por OMA. Se diagnosticó complicación endocraneal en el 12,5% (5/40) de los casos. Los aislamientos bacterianos más frecuentes fueron Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae y Turicella otitidis. Se registraron 17 casos de niños hospitalizados con diagnóstico de MA y OMC. Ocurrieron complicaciones supurativas intracraneales en el 35,3% (6/17) de los casos. Los aislamientos bacterianos más frecuentes fueron las enterobacterias, P. aeruginosa y los gérmenes anaerobios. Conclusión. El diagnóstico de tipo y estadio de otitis media previa o coexistente a la complicación es fundamental para encarar el tratamiento antimicrobiano empírico inicial, sospechar complicaciones endocraneales asociadas y proponer procedimientos quirúrgicos menores, medianos o mayores oportunamente (AU)

Background. Any pediatric or adult patient presenting with acute otitis media (AOM) or chronic otitis media (COM), especially cholesteatomatous, may develop intratemporal and intracranial complications, mainly acute mastoiditis (AM). Objective. To describe the clinical and bacteriological features of patients seen for AM as a complication of AOM and COM. Setting: Department of Otolaryngology, Hospital de Pediatría Juan P. Garrahan. Design. A descriptive, retrospective, cross-sectional, observational study. Population. Patients with AM because of AOM and COM seen at the Department of Otolaryngology over a 10-year period. Material and methods. Review of the clinical charts of all patients treated between January 1999 and December 2008. Results. 57 Patients with AM, 40/57 due to AOM and 17/57 due to COM, were evaluated. Forty children were admitted to hospital with signs and symptoms of AOM-related AM. Intracranial complications were observed in 12.5% (5/40) of the patients. The most frequently isolated pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae, and Turicella Otitidis. Seventeen children were hospitalized because of COM-related AM. Suppurative intracranial complications occurred in 35.3% (6/17) of the cases. The most frequently isolated pathogens were Enterobacteriaceae, P. aeruginosa, and anaerobic bacteria. Conclusion. The diagnosis of type and stage of otitis media prior to or coexisting with the complication is essential to address the initial empirical antimicrobial treatment, associated intracranial complications should be suspected and minor, intermediate, or major surgical procedures should be proposed at the appropriate time (AU)

Doenças inflamatórias da orelha média / Inflammatory diseases of the middle ear

OBJETIVO: Determinar as alterações tomográficas mais frequentes na doença inflamatória da orelha média e comparar os achados da tomografia computadorizada e da ressonância magnética com os dados otológicos e cirúrgicos. MATERIAL E MÉTODO: Foram comparados os resultados dos examesde imagem, clínico e cirúrgico de 95 pacientes (95 tomografias computadorizadas e uma ressonânciamagnética). RESULTADOS: Em 52 casos os resultados dos exames de imagem foram normais. Dos 43 pacientes com alterações radiológicas, a comparação com os achados dos exames de imagem, otolaringológico e histopatológico demonstrou: otomastoidite aguda em 2 (4,6%) pacientes, otomastoidite crônica unilateral em 9 (21,0%), otomastoidite crônica bilateral em 2 (4,6%), colesteatoma unilateral em 26 (60,5%) e colesteatoma bilateral em 4 (9,3%). CONCLUSÃO: A tomografia computadorizada foi capaz de definir as características das lesões e as complicações existentes na maioria dos casos e foi necessário o uso da ressonância magnética em um dos 43 pacientes com alterações radiológicas, para definir o tipo de material presente na orelha média. O conhecimento dos dados clínicos e do exame otológico permitiu a interpretação dos achados de imagem mais apropriada para cada caso.

OBJECTIVE: To determine the aspects and frequency of middle ear alterations at computed tomography and magnetic resonance imaging in patients with clinical suspicion for middle ear inflammatory disease. MATERIAL AND METHOD: Imaging examination resultsof 95 patients (95 computed tomography and 1 magnetic resonanceimaging) were compared with the results of otology, imaging and surgical findings. RESULTS: Fifty-two patients had normal imaging results. Forty-three patients had radiologic alterations compared to the physical, otology and hystopathologic exams: acute otomastoiditis in 2 patients (4.6%), unilateral chronic otomastoiditis in 9(21.0%), bilateral chronic otomastoiditis in 2 (4.6%), unilateral cholesteatoma in 26 (60.5%), and bilateral cholesteatoma in 4 (9.3%).CONCLUSION: Computed tomography was able to demonstrate the characteristics of the lesions and found complications in majority of the cases. Magnetic resonance imaging was used only in one patient to rule out scar and cholesteatoma. The knowledge of theclinical and otologic data enables the radiologist to elaborate a more appropriate interpretation of the imaging findings.