Crisis febril como manifestación inicial de COVID-19 / Febrile crisis as initial manifestation of COVID-19

Introducción: La COVID-19 es una enfermedad que ha mostrado una baja morbilidad y mortalidad en pediatría. Las crisis febriles constituyen una de las causas más frecuentes de admisión en los servicios de urgencia y de interconsultas con el neuropediatra. Objetivo: Interpretar la presencia de crisis febril simple en pacientes admitidos en servicios de urgencia pediátricos como manifestación inicial de COVID-19. Presentación del caso: Paciente femenina de un año de edad, con antecedentes de salud anterior que acude al cuerpo de guardia con fiebre de 38 ℃; y crisis motora, de inicio generalizada, tónico-clónica, que cedió con medidas antitérmicas. Por protocolo se realiza punción lumbar la cual resulta negativa. Se ingresa, 24 horas después comienza con manifestaciones catarrales, se hace otoscopia y se diagnostica una otitis media aguda, por lo que se inicia tratamiento antibiótico. Se realiza la prueba de reacción en cadena de la polimerasa para la COVID-19 con resultado positivo, por lo que se remite para el Hospital Pediátrico San Miguel del Padrón. Conclusiones: Se debe sospechar la presencia de COVID-19 ante paciente que acude a servicio de urgencias por una crisis febril, como único problema de salud. LA COVID-19 es una enfermedad que ha demostrado que se puede presentar de diversas formas(AU)

Introduction: COVID-19 is a disease that has shown low morbidity and mortality in pediatrics. Febrile crises are one of the most common causes of admission to emergency services and consultations with the neuropediatrician. Objective: Interpret the presence of simple febrile crisis in patients admitted to pediatric emergency services as an initial manifestation of COVID-19. Case presentation: One-year-old female patient, with a previous health history, who is attended in the emergency service with a fever of 38 ℃; and motor crisis, of widespread onset, with tonic-clonic seizures, which yielded with antypiretic measures. By protocol, lumbar puncture is performed which is negative. She was admitted, and 24 hours later there is an onset of catarrhal manifestations; an otoscopy is performed and acute otitis media is diagnosed, so antibiotic treatment is initiated. The polymerase chain reaction test for COVID-19 (PCR) is performed with a positive result, so, the patient is referred to the San Miguel del Padrón Pediatric Hospital. Conclusions: COVID-19 should be suspected in patients who attend to the emergency services due to a febrile crisis as the only health problem. COVID-19 is a disease that has been shown to occur in a variety of ways(AU)

Research on computer aided diagnosis of otitis media based on faster region convolutional neural network / 生物医学工程学杂志

Otitis media is one of the common ear diseases, and its accurate diagnosis can prevent the deterioration of conductive hearing loss and avoid the overuse of antibiotics. At present, the diagnosis of otitis media mainly relies on the doctor's visual inspection based on the images fed back by the otoscope equipment. Due to the quality of otoscope equipment pictures and the doctor's diagnosis experience, this subjective examination has a relatively high rate of misdiagnosis. In response to this problem, this paper proposes the use of faster region convolutional neural networks to analyze clinically collected digital otoscope pictures. First, through image data enhancement and preprocessing, the number of samples in the clinical otoscope dataset was expanded. Then, according to the characteristics of the otoscope picture, the convolutional neural network was selected for feature extraction, and the feature pyramid network was added for multi-scale feature extraction to enhance the detection ability. Finally, a faster region convolutional neural network with anchor size optimization and hyperparameter adjustment was used for identification, and the effectiveness of the method was tested through a randomly selected test set. The results showed that the overall recognition accuracy of otoscope pictures in the test samples reached 91.43%. The above studies show that the proposed method effectively improves the accuracy of otoscope picture classification, and is expected to assist clinical diagnosis.

Translation, validation and cultural adaptation of "The Eustachian Tube Dysfunction Questionnaire-7" (ETDQ-7) to Brazilian Portuguese (BR) / Tradução, validação e adaptação cultural do questionário "The Eustachian Tube Dysfunction Questionnaire-7" (ETDQ-7) para o português brasileiro (BR)

Abstract Introduction: Chronic Eustachian tube dysfunction can cause several symptoms and middle ear conditions that can impact patient quality of life. It is estimated to be relatively frequent, affecting approximately 5% of adults. The diagnostic tools for this condition are still inadequate. In 2012, McCoul et al. published a questionnaire for the evaluation of Eustachian tube dysfunction named ETDQ-7. They established its replicability and validity. The cutoff point for the diagnosis of chronic Eustachian tube dysfunction was equal to or greater than 14.5, with 100% sensitivity and 100% specificity. Objective: To translate, adapt and validate the ETDQ-7 questionnaire to Brazilian Portuguese. Methods: We translated the questionnaire into Brazilian Portuguese and applied it to 50 patients, 20 of whom had chronic Eustachian tube dysfunction, and 30 controls. Results: The results obtained with the North-American questionnaire were confirmed in its Brazilian version. The cut-off point for the diagnosis of chronic Eustachian tube dysfunction was ≥14, also exhibiting high sensitivity and specificity, very similar to that of ETDQ-7. Conclusion: It is recommended that ETDQ-7 be used to complement the clinical history of patients with chronic Eustachian tube dysfunction; it can also be used as an important tool for diagnosis, patient follow-up and treatment management.

Resumo Introdução: A disfunção crônica da tuba auditiva pode causar diversos sintomas e doenças de orelha média e impactar a qualidade de vida dos pacientes. Estima-se que é uma morbidade relativamente frequente, acomete cerca de 5% dos adultos. Os instrumentos diagnósticos para essa afecção ainda são insuficientes. Em 2012 McCoul et al. publicaram um questionário para a avaliação da disfunção da tuba auditiva denominado ETDQ-7. Eles demonstraram sua reprodutibilidade e validade. O ponto de corte para o diagnóstico de disfunção de disfunção crônica da tuba auditiva foi de maior ou igual a 14,5 com 100% de sensibilidade e 100% de especificidade. Objetivo: Traduzir, adaptar e validar o questionário ETDQ-7 para o português brasileiro. Método: Traduzimos o questionário para o português do Brasil e o aplicamos em 50 pacientes, 20 com disfunção crônica da tuba auditiva e 30 controles. Resultados: Os resultados obtidos no questionário americano foram confirmados na versão brasileira. O ponto de corte para o diagnóstico de disfunção crônica da tuba auditiva foi maior ou igual a 14, também com alta sensibilidade e especificidade, muito semelhante ao ETDQ-7. Conclusão: Recomenda-se que o ETDQ-7 seja usado como um complemento na história clínica do paciente com disfunção crônica da tuba auditiva e pode ser usado também como uma importante ferramenta para fins de diagnóstico, seguimento de pacientes e manejos no tratamento.

Enfermedad neumocócica en pacientes menores de 5 años / Pneumoccocal disease in a patient under 5 years

Introducción: La enfermedad neumocócica afecta prioritariamente a las personas en las edades extremas de la vida. En este sentido, el Hospital Docente Infantil Sur Dr. Antonio María Béguez César constituye un sitio de vigilancia centinela del Proyecto Nacional Neumococo, lo cual sirvió de motivación para desarrollar la presente investigación sobre esta enfermedad. Objetivo: Describir las características epidemiológicas, clínicas, microbiológicas e imagenológicas en pacientes menores de 5 años ingresados por presentar enfermedad neumocócica. Métodos: Se realizó un estudio observacional, descriptivo y prospectivo de 170 pacientes menores de 5 años de edad, ingresados en el mencionado centro hospitalario en el período 2014-2016 por presentar enfermedad neumocócica. Resultados: En la serie predominaron la supresión precoz de la lactancia materna (52,3 %) y la existencia de fumadores convivientes (44,7 %) como principales factores de riesgo, además de la fiebre (100,0 %), la tos (96,0 %), el tiraje (74,1%) y la polipnea (70,0 %) como síntomas más frecuentes; mientras que la neumonía se presentó en 82,3 % y hubo 10,0 % de positividad al neumococo, por serotipos 19A, 19F, 14 y 6A, con 66,6 % de colonización en lactantes. Por su parte, la letalidad y la mortalidad proporcional por neumonía fueron de 2,85 y 8,0 %, respectivamente, sin decesos por neumococo. Conclusiones: El aislamiento de neumococo resultó bajo, con predominio en lactantes colonizados y con indicadores de mortalidad por neumonía no neumocócica, lo cual sugiere que la corta edad es un riesgo de deceso por dicha causa.

Introduction: Pneumococcal disease affects mainly people in the extreme ages of life. In this sense, Dr. Antonio María Béguez Caesar Southern Teaching Pediatric Hospital constitutes a place of centinel surveillance of the Pneumococcus National Project, which served as motivation to develop the present investigation on this disease. Objective: To describe the epidemiological, clinical, microbiological and imaging characteristics in patients younger than 5 years admitted due to a pneumoccocical disease. Methods: An observational, descriptive and prospective study of 170 patients younger than 5 years admitted to the above mentioned hospital in the period 2014-2016 was carried out, for presenting pneumoccocal disease. Results: The early suppression of the maternal feeding (52.3 %) and the presence of coexisting smokers (44.7 %) as main risk factors, besides fever (100.0 %), cough (96.0 %), chest indrawing (74.1 %) and polypnea (70.0 %) as the most frequent symptoms prevailed in the series; while the pneumonia was presented in 82.3 % and there was 10.0 % positiveness to pneumoccocus, by serotypes 19A, 19F, 14 and 6A, with 66.6 % colonization in infants. On the other hand, lethality and proportional mortality for pneumonia were of 2.85 and 8.0 %, respectively, without deaths due to pneumoccocus. Conclusions: Pneumoccocus isolation was low, with prevalence in colonized infants and with mortality indicators due to non pneumoccocal pneumonia, which suggests that the short age is a death risk due to this cause.

Pólipo y/o granuloma aural en niños. Estudio prospectivo en 75 casos / Aural polyp and/or granuloma in children. A prospective study of 75 cases

En otorrinolaringología (ORL) infantil es habitual el hallazgo de pólipos y granulomas de oído en niños que consultan especialmente por otorrea de evolución prolongada. El pólipo y/o granuloma aural es una masa de carácter inflamatorio, que ocupa parte de la luz del conducto auditivo externo, generalmente pediculado, de aspecto congestivo, a veces friable y fácilmente sangrante, cuyo origen generalmente es a nivel de la mucosa del oído medio. Con el objetivo de describir las características clínicas, otológicas, bacteriológicas e histopatológicas de los pólipos y granulomas de oído diagnosticados en un servicio de ORL pediátrico se realizó un estudio prospectivo, descriptivo, observacional y longitudinal. Se estudió a la población pediátrica con diagnóstico de pólipo y/o granuloma aural en su primera consulta en el servicio de ORL del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". Se incluyeron 75 pacientes en el estudio, evaluados consecutivamente desde el 02 de diciembre 2013 y hasta 30 enero del 2015, con una edad media: 93 meses (rango 2­180). Se realizó otomicroscopía y, en los casos de granulomas y pólipos accesibles, se realizó toma de muestra para estudio bacteriológico e histopatológico y evaluaciones audiológicas y radiológicas con tomografía computarizada (TC) en los casos necesarios. Se indicó el tratamiento médico o quirúrgico adecuado a cada patología. El motivo de consulta principal fue la otorrea como único síntoma en el 81,33% de los casos y, en menor porcentaje, asociada a otros síntomas. Tiempo medio de evolución de los síntomas: 13,5 meses (rango 1-96). No se pudo extraer material en el 20% de los pacientes. Se tomaron muestras para estudio de 60/75 granulomas óticos accesibles. El informe anatomo-patológico fue: granuloma o pólipo inflamatorio en el 50%, tejido epidermoide compatible con colesteatoma en el 41,7%, tuberculosis (TBC) en 3,3%, granuloma por cuerpo extraño en 1,7%, histiocitosis de células de Langerhans (HCL) en 3,3% muestras de pólipos. Se realizó estudio bacteriológico en 57/75 casos. Se desarrollaron gérmenes en 52/57 cultivos. El 32,7% (17/52) fueron cultivos polimicrobianos. Dos casos desarrollaron Mycobacterium tuberculosis. Se observó velamiento de caja, ático o mastoides con erosión ósea en el 46,2% (24/52) de los casos evaluados con TC. Diagnóstico final: colesteatoma 39 pacientes, OMA con pólipo de Scheibe o complicada con mastoiditis 16, OMC simple granulomatosa 13, TBC 2, HCL 2, otitis externa y celulitis en conducto auditivo externo 2 y granuloma a cuerpo extraño 1. Conclusiones: es importante obtener el diagnóstico histológico y microbiológico de los pólipos aurales en niños precozmente para excluir neoplasia u otras enfermedades granulomatosas específicas y evitar cirugías que pueden provocar secuelas al no estar indicadas en el tratamiento adecuado de ciertos tumores e infecciones (AU)

In pediatric otolaryngology (ENT) ear polyps and granulomas are a common finding in children who consult especially for prolonged otorrhea. The aural polyp and/or granuloma is an inflammatory mass occupying part of the lumen of the external auditory canal. It is usually pedunculated, congestive, sometimes friable, and may bleed easily. Its origin is usually at the level of the mucosa of the middle ear. With the aim to describe the clinical, otological, bacteriological, and histopathological features of ear polyps and granulomas diagnosed in a Department of pediatric ENT, a longitudinal, prospective, descriptive, observational study was conducted. Pediatric patients diagnosed with an aural polyp and/or granuloma at the first visit at the Department of ENT of Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" were studied. Seventy-five patients were included in the study, evaluated consecutively from December 2, 2013 to January 30, 2015; Mean age was 93 months (range 2 ­ 180). Otomicroscopy was performed and, in cases of accessible granulomas and polyps, a sample was taken for bacteriological and histopathological study. Audiological and radiological evaluations with computed tomography (CT scan) were performed when necessary. Appropriate medical or surgical treatment was indicated accordingly. The main reason for the consultation was otorrhea as the only symptom in 81.33% of cases and, in a lesser percentage, associated with other symptoms. Mean time from symptom onset to diagnosis: 13.5 months (range 1-96). No sample could be harvested in 20% of patients. Samples were taken for study of 60/75 accessible ear granulomas. Pathology report was: Inflammatory granuloma or polyp in 50%, epidermoid tissue compatible with cholesteatoma in 41.7%, tuberculosis (TBC) in 3.3%, granuloma due to a foreign body in 1.7%, and Langerhans cell histiocytosis (LHC) in 3.3% of the samples of polyps. Bacterial cultures, performed in 57/75 cases, were positive in 52/57. Polymicrobial microorganisms were found in 32.7% (17/52). Mycobacterium tuberculosis was found in two cases. Opacification of the antrum, attic, and mastoid cavities with bone erosion was observed in 46.2% (24/52) of the cases evaluated with CT. Final diagnosis: Cholesteatoma in 39 patients, OMA with a Scheibe polyp or complicated with mastoiditis in 16, simple granulomatous OMC in 13, TBC in 2, LHC in 2, external otitis and cellulitis in the external ear canal in 2, and granuloma due to a foreign body in 1. Conclusions: Histological and microbiological diagnosis of aural polyps in children should be obtained early to rule out neoplasia other granulomatous diseases to avoid surgery that may cause sequelae and is not the adequate management of certain tumors and infections (AU)

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)

Síndrome de Münchausen por poder en otorrinolaringología / Münchausen syndrome by proxy in otorhinolaryngology

El síndrome de Münchausen por poder es una forma de maltrato infantil, con graves consecuencias para el niño afectado. El diagnóstico de esta afección constituye un desafío para los médicos por su heterogeneidad en los síntomas y signos de presentación. Variadas manifestaciones otorrinolaringológicas están descritas en esta patología. En este artículo se presenta un caso clínico de otitis media crónica con otorragia en un paciente de 2 años, donde se logró establecer el diagnóstico de síndrome de Münchausen por poder a través de la identificación de elementos incongruentes en la historia clínica y finalmente por la detección in fraganti de la agresión por parte de la madre. En esta revisión se concluye que es necesario un alto índice de sospecha para identificar esta patología, la que debe ser una preocupación habitual del equipo de salud para evitar asi consecuencias graves en estos pacientes, tales como secuelas psiquiátricas o incluso la muerte.

Münchausen's syndrome by proxy is a form of child abuse with severe consequences for the affected child. The diagnosis of this condition is a challenge for physicians due to the heterogeneity of the presentation symptoms. A lot of otorhinolaryngological manifestations have been described in this syndrome. We present a case of a 2 year old patient with chronic otitis media and otorrhagia, where we could establish the diagnosis of Münchausen's syndrome by proxy through the identifications of incongruent elements on the clinical history and finally the direct visualization of mother's aggression. In this should be a common concern for health workers to avoid severe consequences in these patients like psychiatric diseases or even death.

Microbiology of Chronic Suppurative Otitis Media at Queen Elizabeth Central Hospital; Blantyre; Malawi: A Cross-Sectional Descriptive Study

Background.Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore; it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment; avoid complications; and provide records for future reference. Aim. The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre; Malawi; and establish their relationship signs and symptoms; and with the demographic pattern of the study.Methods.This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM; who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS version 20.The study found that Proteus mirabilis; Pseudomonas aeruginosa; and Staphylococcus aureus were the most prevalent aerobic bacteria; while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOM-causing microorganisms were-significantly more so than the others-characteristically associated with each of the following clinical features: quantity of pus drainage; mode of onset; otalgia; hearing loss; location of tympanic membrane perforation; and mucosal appearance

Alterações auditivas em crianças portadoras de fissuras labiopalatinas / Hearing loss in children with cleft of the lip and palate

As fissuras labiopalatinas são malformações congênitas que têm como características deformidade estética facial, alterações de fala e disacusia condutiva ocasionada pela disfunção crônica da tuba auditiva. Existem protocolos de tratamento para a reparação do lábio e do palato, que habitualmente são realizados aos três e aos 18 meses de idade, respectivamente. A reparação do palato tem como funções restabelecer a anatomia do palato e assoalho da cavidade nasal, bem como promover o funcionamento adequado da tuba auditiva. A correta inserção dos músculos tensor e elevador do véu palatino no palato duro pode promover abertura mais eficiente da tuba auditiva durante a deglutição, mantendo a aeração da orelha média, minimizando o risco do desenvolvimento da otite média com efusão. Se, por um lado, os protocolos são claros em relação ao momento da palatoplastia, não existe consenso para o tratamento da disfunção da tuba auditiva. Estudos têm surgido com a intenção de orientar equipes de tratamento a definir o melhor momento para a resolução dessa doença, que indicam timpanotomia com colocação de tubos de ventilação como tratamento de escolha. Alguns pesquisadoresrecomendam a timpanotomia precocemente, aos quatro meses de idade, outros são mais conservadores e aguardam o surgimento dos sintomas para intervir cirurgicamente. Neste trabalho verificou-se o que existe de mais atual no tratamento das otites médias com efusão, os estudos com modelos computacionais, a história natural das alterações auditivas em pacientes com fissuras labiopalatinas não operadas e o resultado das introduções de tubos de ventilação no desenvolvimento auditivo e de fala dessa população...

The cleft lip and palate are congenital malformations characterized by esthetic facial deformation, delays in speech, conductive hearing loss caused by cronical disfunction of Eustachian tube. There are treatment protocols for lip and palate reparation that, usually, are made at 3 and at 18 months-old, respectively. The palate restauration have the function of restabilish the palate anatomy and nasal cavity floor, as well promote the correct operation of Eustaquian tube. The rigth insertion of tensor and levator velli palatini muscle on the hard palate can promote this opening onthe Eustaquian tube more eficiently during swallowing, keeping midle ear aeration, minimizing the risk of otitis media with effusion development. The protocols are clear in respect of the palatoplasty time, but there is not a consensus about the treatment of Eustachian tube disfunction. Studies have emerge with the intention of orientation for the treatment teams to define the best resolution for this patology, wich indicates tympanotomywith grommet insertion for the chosen treatment. Some reserchers indicatetympanotomy earlier, at 4 months-old, some others are more conservatives and wait for the symptoms to appear for a surgical intervention. In this study we verify what is the current treatment of otitis media with effusion, the studies with computation models, the natural history of hearing loss in patients with unrepared cleft palate and the results of grommets introduction on speech and hearing development of this population...

Trombosis de seno lateral como complicación de otitis media aguda en niños: Reporte de un caso y revisión de la literatura / Lateral sinus thrombosis as a complication of acute otitis media in children: A case report and literature review

La otitis media aguda es frecuente en niños y generalmente de evolución benigna. Durante las últimas décadas, con el uso de antibióticos y tratamientos quirúrgicos asociados, la incidencia de las complicaciones de la otitis media aguda ha disminuido hasta 10 veces junto con la mortalidad de éstas (menor al 10%). Las complicaciones se pueden clasificar según su localización en intratemporales o intracraneales. Dentro de las complicaciones intracraneales más frecuentes, se encuentra la trombosis del seno lateral. En el presente estudio se reporta el caso de un preescolar de 5 años que fue derivado al Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau por otitis media aguda complicada con mastoiditis y absceso subperióstico que fue drenado junto con una mastoidectomía. Cuatro días posterior a la cirugía se agrega cefalea, vómitos no explosivos y edema de papila por lo que se realiza una resonancia nuclear magnética en fase venosa que muestra trombosis del seno lateral. Se realiza una revisión de la literatura sobre el manejo de la trombosis del seno lateral y, basado en la evidencia existente, se propone un algoritmo de manejo para esta patología ya que aún no existe un consenso para su tratamiento.

Acute otitis media is a common disease in children and generally has a benign course. During recent decades, the use of antibiotics and associated surgical treatments has decreased the incidence of the complications of acute otitis media in 10 times, as well as the mortality which currently is less than 10%. According to their location, the complications can be classified in intratemporal or intracranial. Lateral sinus thrombosis is one of the most common intracranial complications of acute otitis media. The present study reports the case of a 5 year old child who was referred to our Department of Otolaryngology for acute otitis media complicated with mastoiditis and subperiosteal abscess. He underwent a mastoidectomy and the abscess was drained. Four days after surgery the child presented headache, nonexplosive vomiting and papilledema. Lateral sinus thrombosis was identified by magnetic resonance venography. We present a literature review on the management of this pathology, and, based on existing evidence, we propose an algorithm for the management of this condition because there is still no consensus for its treatment.

Otoscopia: exame da orelha / Otoscopy: examination of ear

Otoscopia é o exame que permite ao médico avaliar o conduto auditivo e a membrana timpânica, além de diagnosticar enfermidades da orelha externa e da orelha média. A otoscopia, uma boa anamnese e um exame físico completo são fundamentais para o estudo das doenças da orelha. O presente trabalho faz uma revisão da otoscopia e de suas principais afecções.

Otoscopy is the examination of the external auditory meatus and the tympa nic membrane. It is used for the purpose of diagnosing diseases of the external and middle ear. The anmanesis and the clinical examination associated with ear examination (otoscopy) are essential in ear diaseases. The purpose of this study is to review the examination of the ear (otoscopy) and principal disease of the ear.

Korean Clinical Practice Guidelines: Otitis Media in Children

Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media.

Eosinophilic Otitis Media: CT and MRI Findings and Literature Review

Eosinophilic otitis media (EOM) is a relatively rare, intractable, middle ear disease with extremely viscous mucoid effusion containing eosinophils. EOM is associated with adult bronchial asthma and nasal allergies. Conventional treatments for otitis media with effusion (OME) or for chronic otitis media (COM), like tympanoplasty or mastoidectomy, when performed for the treatment of EOM, can induce severe complications such as deafness. Therefore, it should be differentiated from the usual type of OME or COM. To our knowledge, the clinical and imaging findings of EOM of temporal bone are not well-known to radiologists. We report here the CT and MRI findings of two EOM cases and review the clinical and histopathologic findings of this recently described disease entity.

Oitite média aguda em crianças: avaliação dos diagnósticos e das condutas / Acute oititis in children: evaluation of diagnoses and of conduct

A otite média aguda é uma patologia de alta prevalência nos consultórios de pediatria. Para um diagnóstico clínico correto é necessário observar a presença de secreção em ouvido médio e que esta secreção esteja inflamada. O tratamento pode ser somente de observaçãoi ou utilização de antibióticos específicos. Outros medicamentos não tem eficácia comprovada. Foram avaliadas todas as crianças atendidas no Instituto Curitiba de Saúde, no período de um ano, com diagnóstico de otite média aguda, através de prontuário eletrônico. De um total de 585 diagnósticos de otite média aguda consideramos como diagnóstico e terapia corretos 290 casos (49,6 por cento). A maioria dos diagnósticos incorretos foi com a presença somente de hiperemia sem efusão (35 por cento). Do tratamento inadequado em 15 por cento a duração da antibioticoterapia foi incorreta e em 8,5 por cento utilizaram-se antibióticos ineficazes para o tratamento de otite. Em metade dos casos diagnosticados como otite média aguda o diagnóstico e o tratamento foram considerados corretos.

Otitis media aguda / Acute otitis media

La Otitis Media Aguda, (OMA), es una inflamación aguda del espacio del oído medio. Se caracteriza por la acumulación de líquido o secreción purulenta. Es la enfermedad más frecuente en niños, para la cual se usan antibióticos. Se presenta la revisión de la mejor evidencia disponible relacionada con la epidemiología, etiología, diagnóstico clínico y el tratamiento médico y quirúrgico.

The Acute Otitis Media, (AOM), is an acute inflammation of the space of the middle ear. It is characterized by the accumulation of serous or purulent secretion. It is the most frequent disease in children for which antibiotics are used. This is a revision of the best evidence available related to epidemiology, aetiology, clinical diagnosis and the medical and surgical treatment.

Otimizando o diagnóstico para o tratamento adequado das principais infecções agudas em otorrinopediatria: tonsilite, sinusite e otite média: [revisão] / Optimizing the management of the main acute infections in pediatric ORL: tonsillitis, sinusitis, otitis media: [review]

As sinusites, otites médias agudas e tonsilites são muito freqüentes em crianças. A maioria dessas infecções é causada por vírus, mas em geral, elas são tratadas com antibióticos. O uso inapropriado de antibióticos favorece a seleção, crescimento e disseminação de bactérias resistentes que colonizam as vias respiratórias, atingindo toda a comunidade. A emergência de bactérias resistentes dificulta os tratamentos das infecções respiratórias, sendo essencial desenvolver estratégias efetivas para restringir o uso de antibióticos sem prejudicar as crianças que realmente precisam desses medicamentos. OBJETIVO: Analisar os resultados de estudos randomizados e controlados sobre critérios clínicos e laboratoriais utilizados para diagnóstico e tratamento das tonsilites, sinusites e otites. MÉTODOS: Levantamento dos estudos randomizados e controlados sobre o tema, publicados no MEDLINE e SCIELO, de 2000 a 2006. CONCLUSÕES: Como a maioria dessas infecções evolui bem sem antibióticos, deve-se evitar o uso desses medicamentos a menos que a criança pertença aos grupos de alto risco para complicações ou apresente persistência ou piora dos sintomas com tratamento sintomático. É necessário que os médicos e leigos conheçam melhor a evolução natural das infecções respiratórias agudas e que seja garantido o acesso das crianças a serviços médicos de boa qualidade para orientação e reavaliação, quando necessária.

Sinusitis, acute otitis media and tonsillitis are very frequent in children. Most of these infections are caused by viruses, but are generally treated with antibiotics. Inappropriate use of antibiotics favors the selection, growth and spread of resistant bacteria; these bacteria colonize the airways and affect the entire community. With the emergence of antibiotic-resistant bacteria, respiratory infections have become more difficult to treat. Effective strategies are needed to restrict the use of antibiotics without harming children that truly need these drugs. AIM: to present a critical analysis of the results of randomized and controlled studies on clinical and laboratory criteria used in diagnosing and treating tonsillitis, sinusitis and otitis. METHODS: a review of randomized and controlled studies about these conditions published in MEDLINE and SCIELO from 2000 to 2006. CONCLUSIONS: Given that most of these infections progress favorably without antibiotics, the use of these drugs should be avoided unless the child belongs to a high risk group for complications, or symptoms persist or worsen with despite symptomatic treatment. Physicians and laypersons should have better knowledge about the natural evolution of acute respiratory infections.