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)

Diagnostic and Surgical Treatment Outcome of Acute Mastoiditis in Pediatric Age Group.

Background: The incidence of Acute Mastoiditis in children has diminished, but it is not uncommon in clinical practice. Clinical presentation includes a history of otorrhea, pain in the ear, post aural swelling, a shift in pinna position and tenderness over the mastoid. The etiology includes acute and chronic suppurative otitis media, trauma and rarely hematogenous infection. Otoscopy is difficult in this age group due to edema of the EAM skin, pain and non-cooperation. Temporal bone CT scan is very useful in evaluating the pathology in the middle ear cleft such as cortical necrosis, Ossicular erosion and Cholesteatoma. Conservative medical management is useful in tiding over the crisis but surgical exploration of middle ear cleft, eradication of the disease and Tympanoplasty alone leads to cure prevents recurrence. The study aimed at analyzing retrospectively clinical and etio-pathological characteristics of pediatric acute mastoiditis and mastoid abscess in 62 children and to plan a strategy for the management in our Hospital. Methods: Retrospective evaluation of the medical records of 62 children aged below 14 years was scrutinized to record demographic data, history, investigations, etiological factors and treatment outcomes to establish a treatment protocol for future adaptation. Results: 62 patient records were taken up in the present study; patients mean age was 9± 2.4 years. In 18 children (29.03%) previous history of CSOM was reported. All children had clear evidence of post-auricular inflammation. Other clinical features like shift in pinna position, otorrhea, fever and otalgia were noted. Increase in WBC count in 69.35% of the cases, anemia with Hb less than 8 gms% was noted in 19 (30.64%) patients. Total cell count more than 11000 was observed in 69.35% of the patients. C T scan temporal bones in the present study showed 11 (17.74%) children showed signs of Cholesteatoma, clouding of mastoid air cells was noted in 17 (27.41%) and 7 (11.29%) children presented intracranial complications. Immediate medical treatment with 3rd generation parenteral Cephalosporins, NSAIDS was initiated. Abscess drainage was done in 18 (29.03%) children. Cortical Mastoidectomy and/or MRM with Tympanoplasty were performed in 39 (62.90%) of the children. Conclusion: Surgical exploration of the middle ear cleft after initial stabilization of the child with medical treatment gave statistical significant cure rate with low recurrence rate. CT scan was significant in accurately diagnosing the mastoid involvement correlated per operatively in 71.79% of CSOM and 100% of ASOM in children undergoing surgical exploration. Surgical approach is required in cases of complications or failure of medical treatment. Watchful clinical monitoring to rule out intracranial complications is always essential in all patients with Acute Mastoiditis.

Otitis media crónica complicada en un adolescente con malformación auditiva / Complicated chronic otitis media in an adolescent with auditory malformation

Se describe el caso clínico de un adolescente de 17 años de edad, multimalformado, con agenesia del pabellón auricular, así como en el oído externo y medio, quien presentó otitis media crónica complicada. Fue ingresado en el Servicio de Otorrinolaringología del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" y se le indicó antibioticoterapia triple. Posteriormente se realizó una incisión en la región mastoidea del lado izquierdo, se drenó abundante pus, se colocó drenaje y se mantuvo la medicación con antibióticos. El paciente evolucionó favorablemente y egresó a los 10 días. Se concluyó el caso como una otitis media crónica con mastoiditis aguda.

The case report of a 17 year-old adolescent, with multiple malformations, agenesia of pinna as well as of the external and middle ear who presented with complicated chronic otitis media is described. He was admitted to the Otorhinolaryngology Service of "Saturnino Lora Torres" Clinical Surgical Teaching Provincial Hospital and he was indicated triple antibiotic therapy. Later an incision in the mastoid region of his left side was carried out, abundant pus was drained, drainage was placed and the medication with antibiotics was maintained. The patient had a favorable clinical course and he was discharged 10 days later. It was concluded that the case was a chronic otitis media with acute mastoiditis.

A Case of Acute Mastoiditis Complicated with Epidural Abscess / 대한이비인후과학회지

Epidural abscess is the most common intracranial complication of acute mastoiditis and may lead to a life-threatening condition if an appropriate treatment is not performed. The treatment of choice is a surgical eradication of lesion, drainage of the abscess, and intravenous antibiotic therapy. We report a case of acute mastoiditis followed by an epidural abscess in the posterior cranial fossa in a 32-month male patient.

Two Cases of Acute Mastoiditis with Subperiosteal Abscess

The incidence of mastoiditis in pediatric age has consistently increased over the last two decades due to increase of antibiotic-resistant bacteria. Compared to young patients, occurrence of acute otitis media complications such as acute mastoiditis and subperiosteal abscess is relatively low in adults. Various treatments for acute mastoiditis with subperiosteal abscess such as tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage have avoided the morbidity and necessity of mastoid surgery. Recently, many studies have indicated mastoidectomy only in cases of severe complications or failure of disease improvement after antibiotic treatment and myringotomy. In this report, we present two cases of successful treatment of subperiosteal abscess and discuss the management of acute mastoiditis with subperiosteal abscess in both child and adult.

Acute Mastoiditis Cases Mandating Simple Mastoidectomy

Acute mastoiditis continues to be a potentially dangerous infection in the antibiotic era. Despite use of antibiotics to treat suppurative acute otitis media in children, the incidence of subsequent development of acute mastoiditis and its complications, including periauricular subperiosteal abscess, facial paralysis, meningitis, and brain abscess has not plunged down below a certain level. Mastoidectomy has been the routine procedure for treating acute mastoiditis with subperiosteal abscess but recently many authors suggest that subperiosteal abscess complicating acute coalescent mastoiditis can be successfully treated by broad-spectrum antibiotics, myringotomy, and minor surgical procedures such as incision and drainage, not necessarily requiring simple mastoidectomy. Contrary to the recent trend shift from a surgical disease to a medical disease, we report two consecutive acute mastoiditis cases definitely mandating simple mastoidectomy to emphasize the role of surgical intervention even in the recent trend shift from a surgical to a medical disease.

Clinical Experience of Acute Mastoiditis in Recent 10 Years / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute mastoiditis is an acute inflammatory disease of the mastoid process but it has declined dramatically in the postantibiotic era. However, contrary to the benefits of broad-spectrum antibiotics, resistant and unusual pathogens may cause this disease entity. Recently, in our hospital, antibiotic resistant and atypical pathogens such as Actinomyces, Mycobacterium tuberculosis were on the increase. In this paper we would like to discuss optimal diagnosis and treatment for acute mastoiditis. PATIENTS AND METHODS: Thirteen patients with mastoititis were treated in our hospital in the last 10 years. All of them were reviewedretrospectively. RESULTS: Eight patients recovered after treating with intravenous antibiotics with or without myringotomy and the rest were managed surgically. Among the 5 who received surgical treatments, one developed chronic otitis media and one developed cholesteatoma 3 years later. CONCLUSION: Surgical intervention was indicated for cases that accompanied complications. It would be important to be aware of any unusual pathogens in the management of acute mastoiditis which does not respond to empirical antibiotics therapy.