Caracterización de complicaciones por otitis media aguda en el Hospital Clínico de la Pontificia Universidad Católica de Chile / Characterization of complications of acute otitis media at the Clinical Hospital of Pontificia Universidad Católica de Chile

Introducción: las complicaciones por otitis media aguda tienen una incidencia menor a un 1%. Aun así, se describe en literatura una mortalidad de un 5%. Actualmente existe escasa evidencia sobre estas complicaciones en nuestra realidad local. Objetivo: describir las de complicaciones de otitis media aguda según tipo, sexo, síntomas de ingreso, exámenes solicitados y tratamiento. Material y Métodos: estudio descriptivo retrospectivo de revisión de fichas clínicas que incluyó pacientes que ingresaron al Hospital Clínico de la Pontificia Universidad Católica de Chile con diagnóstico de otitis media aguda entre el 1 enero de 2000 hasta el 30 de julio de 2022. Resultados: se obtuvieron 71 pacientes ingresados por complicación de otitis media aguda. La edad media fue de 26,79 años, con 46 mujeres y 25 hombres. Se observaron complicaciones extracraneales, intracraneales y complicaciones simultáneas. Las complicaciones más frecuentes fueron la laberintitis y mastoiditis sin reportar casos de mortalidad. Discusión: actualmente existe escasa información sobre complicaciones de otitis media aguda y su epidemiología a nivel local. Las complicaciones extracraneales fueron más frecuentes: de ellas, la laberintitis y la mastoiditis agudas. El diagnóstico es clínico con apoyo de exámenes tanto de laboratorio, audiovestibulares e imágenes. Con respecto al tratamiento quirúrgico, se debe evaluar caso a caso y debe incluir miringotomía con o sin instalación de tubo de ventilación y mastoidectomía en casos refractarios. Es importante la sospecha y la derivación precoz

Introduction: Complications due to acute otitis media have an incidence of less than 1%. Nevertheless, it is described in the literature as having a 5% mortality rate. Currently, there is little evidence of these complications in our local reality. Objective: Describe the complications of acute otitis media based on its type, patient gender, admission symptoms, requested exams, and treatment. Material and Methods: Retrospective and descriptive study of patients' medical records admitted at the "Hospital Clínico de la Pontificia Universidad Católica de Chile" who were diagnosed with acute otitis media from January 1st, 2000, to July 30th, 2022. Results: There were 71 patients admitted due to complications of acute otitis media. On average, they were 26.29 years old; 46 were women, and 25 were men. Extracranial, intracranial, and simultaneous complications were observed. The most frequent ones were labyrinthitis and mastoiditis, without any mortality cases reported. Discussion: Currently, there is scarce information about the complications of acute otitis media and its local epidemiology. Extracranial complications were the most frequent: acute labyrinthitis and mastoiditis. The clinical diagnosis is supported by laboratory, audiovestibular, and image tests. Regarding surgical treatment, each patient must be evaluated independently. It should include myringotomy with or without a ventilation tube and mastoidectomy in refractory cases. It is crucial to detect it early and proceed with a medical referral.

Mastoiditis enmascarada: Reporte de caso en un hospital pediátrico de alta complejidad / Masked mastoiditis: case report in a high-complexity pediatric hospital

La mastoiditis enmascarada es una forma poco frecuente dentro de las complicaciones de las otitis medias, ya sean aguda o crónicas. Su principal característica es presentar poca o mínima sintomatología ótica y tener un curso larvado en el tiempo. Este diagnóstico debe ser correctamente sospechado, ya que eventualmente puede generar consecuencias otológicas graves y presentar complicaciones mayores a nivel intra o extratemporal. En este trabajo se presenta el caso clínico de una paciente pediátrica sana, a la cual se diagnostica mastoiditis enmascarada de tres meses de evolución complicada con absceso de Bezold. Se inicia desde el ingreso hospitalario esquema antibiótico bi-asociado y se realiza mastoidectomía simple, evolucionando de forma satisfactoria.

Masked mastoiditis is a rare complication of acute or chronic otitis media. Its main characteristic is to present little or minimal otic symptoms and has a slowly progressive course over time. This diagnosis must be suspected correctly because it can eventually generate serious otological consequences and present major complications at intra or extratemporal levels. We report the clinical case of a healthy pediatric patient, who was diagnosed with masked mastoiditis complicated with a Bezold's abscess. A bi-associated antibiotic scheme was started from admission and a timpanomastoidectomy was performed, with a satisfactory outcome.

MRI-based assessment of effects of radiotherapy on the onset and progression of mastoiditis in patients with nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective:To analyze the effects of radiotherapy on the onset and progression of mastoiditis in patients with nasopharyngeal carcinoma (NPC) using magnetic resonance imaging (MRI) and to explore the risk factors for the onset of mastoiditis after radiotherapy.Methods:The onset and progression of mastoiditis of 204 NPC patients 3, 12, and 24 months after radiotherapy were analyzed based on MRI images. The multi-factor logistic regression analysis was applied to explore the risk factors of the onset of mastoiditis after radiotherapy. The cross-sectional area of the tensor veli palatini muscle was measured and the relationship between the atrophy degrees of the tensor veli palatini muscle and the onset of mastoiditis was analyzed.Results:The incidence of mastoiditis before radiotherapy was 20.6% (84/408, ears), and was 41.1% (168/408, ears), 22.3% (91/408, ears), and 19.6% (80/408, ears), respectively 3, 12, and 24 months after radiotherapy. The incidence of radiotherapy-induced mastoiditis was 35.8% (116/324, ears), 18.2% (59/324, ears), and 16.4% (53/324, ears), respectively 3, 12, and 24 months after radiotherapy. The remission rate of 63 patients (83 ears) who developed mastoiditis 3 months after radiotherapy was 63.9% (53/83, ears) and 75.9% (63/83, ears), respectively 12 and 24 months after radiotherapy. The remission rate of 54 patients (60 ears) who suffered mastoiditis before radiotherapy was 43.3% (26/60, ears), 65.0% (39/60, ears), and 73.3% (44/60, ears) 3, 12, and 24 months after radiotherapy. The multivariate analysis showed that the independent risk factors for radiotherapy-induced mastoiditis included age ≥50, clinical stages Ⅲ-Ⅳ, radiotherapy dose > 70 Gy, and tumors invading pharyngeal ostium of the eustachian tube. In addition, the atrophy degree of tensor veli palatini muscle 12 and 24 months after radiotherapy correlated with the onset of mastoiditis.Conclusions:The incidence of mastoiditis significantly increased 3 months after radiotherapy and significantly decreased 12 months after radiotherapy for NPC patients. The natural remission rate of radiotherapy-induced mastoiditis 12 months after radiotherapy was over 70%. The independent risk factors for radiotherapy-induced mastoiditis include age ≥50, clinical stages Ⅲ-Ⅳ, radiotherapy dose >70 Gy, and tumor invading pharyngeal ostium of the eustachian tube. The atrophy degree of the tensor veli palatini muscle 12 and 24 months after radiotherapy correlates with the onset of mastoiditis.

Complicaciones de la otitis media con parálisis del sexto par craneal contralateral en pediatría / Cranial complications of otitis media with paralysis of the contralateral sixth cranial pair in pediatrics

Resumen. La otitis media es una infección frecuente en la infancia, la cual puede producir complicaciones, incluidas las neurológicas graves, en cuatro de cada 100 niños en países en desarrollo. Se presenta el caso de una niña de nueve años sin antecedentes de enfermedad que consultó por otitis media derecha, otorrea, síndrome de hipertensión intracraneal y parálisis del VI nervio craneal contralateral a la lesión. La tomografía computarizada de cráneo y la resonancia magnética cerebral revelaron otomastoiditis crónica, apicitis petrosa, y trombosis de los senos transverso y sigmoide, el bulbo yugular y la vena yugular interna derecha. Recibió tratamiento antibiótico y quirúrgico. Este caso refleja el espectro de complicaciones intracraneales y extracraneales asociadas con la otitis media aguda en la era antibiótica. El examen físico permite la detección precoz de la hipertensión intracraneal, con signos como el papiledema y la parálisis del VI par contralateral como hallazgo inusual.

Abstract. Otitis media is a frequent infection during childhood. Complications may be present in up to 4 of 100 children including serious neurological complications, particularly in developing countries. We report the case of a 9-year-old girl with no disease history who presented with otitis media, otorrhea, intracranial hypertension syndrome, and paralysis of the VI cranial nerve contralateral to the lesion. A computed tomography scan of the skull and a brain magnetic resonance imaging revealed chronic otomastoiditis, petrous apicitis, and thrombosis of the transverse and sigmoid sinus, the jugular bulb, and the right internal jugular vein. She received antibiotics and surgical treatment. This case shows the spectrum of intra and extracranial complications associated with acute otitis media in the antibiotic era. The physical examination allows early identification of intracranial hypertension with signs such as papilledema and sixth contralateral nerve palsy as an unusual finding.

Actinomicosis en el hueso temporal. Reporte de un caso pediátrico / Actinomycosis in temporal bone. A pediatric case report

La actinomicosis es una infección causada por un bacilo anaerobio Gram-positivo, filamentoso, ramificado, no esporulado. Integra la flora habitual de la orofaringe y coloniza transitoriamente el tracto gastrointestinal, genital femenino y el árbol bronquial. Es poco frecuente en el hueso temporal. Por su semejanza a un hongo, es difícil su reconocimiento, lo que hace necesaria la sospecha clínica para obtener los cultivos apropiados en condiciones anaeróbicas en forma prolongada. Los hallazgos microscópicos típicos incluyen necrosis con gránulos de azufre amarillento y la presencia de filamentos que se asemejan a infecciones fúngicas. El tratamiento requiere de elevadas y prolongadas dosis de antibiótico con penicilina o amoxicilina, entre 6 y 12 meses. La duración de la terapia antimicrobiana podría ser reducida en pacientes que han sido operados quirúrgicamente. Se presenta, a continuación, un caso clínico de actinomicosis en el hueso temporal en un paciente pediátrico que requirió tratamiento quirúrgico para su resolución.

Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.

Mastoiditis aguda con complicación intracraneal. Reporte de un caso pediátrico / Acute mastoiditis with intracranial complication in a pediatric patient

La mastoiditis aguda es una infección de las celdillas mastoideas, generalmente, secundaria a la progresión de una otitis media aguda. Las bacterias aisladas con más frecuencia en las mastoiditis son Streptococcus pneumoniae, Streptococcus pyogenes y Staphylococcus aureus. La infección mastoidea puede extenderse por contigüidad, afectar a estructuras vecinas y dar lugar a complicaciones intra- o extracraneales. Las más frecuentes son las intracraneales, entre las que se incluyen la meningitis, el absceso cerebeloso o del lóbulo temporal, el absceso epi- o subdural y la trombosis de senos venosos.Se presenta el caso de una niña de 4 años que desarrolló dos complicaciones intracraneales (absceso epidural y trombosis de senos venosos transverso y sigmoideo) a partir de una mastoiditis aguda producida por Streptococus pyogenes

Acute mastoiditis is an infection that affects the mastoid air-cell system, usually due to the progression of an acute otitis media. The bacteria most frequently isolated in acute mastoiditis are Streptococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus. The mastoid infection can extend affecting contiguous structures and producing intra or extracranial complications. The most frequent ones are intracranial complications, including meningitis, temporal lobe or cerebellar abscess, epidural or subdural abscess and venous sinus thrombosis.We present the case of a 4-year-old girl who developed two intracranial complications (intracranial epidural abscess and transverse and sigmoid sinus thrombosis) initiated in an acute mastoiditis produced by Streptococcus pyogenes.

Therapeutic approach to pediatric acute mastoiditis - an update / Abordagem terapêutica da mastoidite aguda pediátrica - uma atualização

Abstract Introduction: Acute mastoiditis remains the most common complication of acute otitis media. It may rarely appear also in cochlear implant patients. However, the treatment recommendations for this disease are not precisely defined or employed, and in the current literature the differences regarding both the diagnosis and management are relatively substantial. Objective: The aim of this study was to determine a standard and safe procedure to be applied in case of pediatric acute mastoiditis. Methods: A retrospective chart review of 73 patients with 83 episodes of acute mastoiditis hospitalized at our tertiary-care center between 2001 and 2016 was conducted. Bacteriology, methods of treatment, hospital course, complications, and otologic history were analyzed. Based on our experience and literature data, a protocol was established in order to standardize management of pediatric acute mastoiditis. Results: All the patients treated for acute mastoiditis were submitted to an intravenous antibiotic regimen. In the analyzed group pharmacological treatment only was applied in 11% of children, in 12% myringotomy/tympanostomy was added, and in the vast majority of patients (77%) mastoidectomy was performed. In our study recurrent mastoiditis was noted in 8% of the patients. We also experienced acute mastoiditis in a cochlear implant child, and in this case, a minimal surgical procedure, in order to protect the device, was recommended. Conclusions: The main points of the management protocol are: initiate a broad-spectrum intravenous antibiotic treatment; mastoidectomy should be performed if the infection fails to be controlled after 48 h of administering intravenous antibiotic therapy. We believe that early mastoidectomy prevents serious complications, and our initial observation is that by performing broad mastoidectomy with posterior attic and facial recess exposure, recurrence of acute mastoiditis can be prevented.

Resumo Introdução: A mastoidite aguda continua a ser a complicação mais comum da otite média aguda. Pode ocorrer também, embora raramente, em pacientes com implante coclear. Entretanto, as recomendações de tratamento para essa doença não são bem definidas ou usadas e, na literatura corrente, as diferenças em relação ao diagnóstico e ao manejo são relativamente significativas. Objetivo: O objetivo deste estudo foi determinar um procedimento padrão e seguro a ser aplicado em caso de mastoidite aguda pediátrica. Método: Foi realizada uma revisão retrospectiva de prontuários de 73 pacientes com 83 episó-dios de mastoidite aguda hospitalizados em nosso centro terciário entre os anos de 2001 a 2016. Foram analisados a bacteriologia, métodos de tratamento, evolução hospitalar, complicações e histórico otológico. Com base em nossa experiência e dados da literatura, foi estabelecido um protocolo para padronizar o tratamento da mastoidite aguda pediátrica. Resultados: Todos os pacientes tratados para mastoidite aguda foram submetidos a antibioticoterapia endovenosa. No grupo analisado, o tratamento farmacológico só foi aplicado em 11% das crianças, em 12% a miringotomia/timpanostomia foi adicionada e na maior parte dos pacientes (77%) foi feita a mastoidectomia. Em nosso estudo, mastoidite recorrente foi observada em 8% dos pacientes. Também observamos mastoidite aguda em criança usuária de implante coclear e, nesse caso, foi recomendada a minimização de procedimentos cirúrgicos, a fim de proteger o dispositivo. Conclusões: Os principais pontos do protocolo de conduta são: iniciar um tratamento antibiótico endovenoso de amplo espectro; a mastoidectomia deve ser feita caso a infecção não seja controlada após 48 horas da administração de antibioticoterapia intravenosa. Acreditamos que a mastoidectomia precoce previne complicações graves e nossa observação inicial é que, com uma mastoidectomia ampla com exposição do ático posterior e do recesso facial, a recorrência de mastoidite aguda pode ser evitada.

Influencia terapeútica en la evolución de la otitis media aguda / Therapeutic influence on the evolution of acute otitis media

Introducción: La otitis media aguda (OMA) es una de las infecciones más comunes y primera causa de administración de antibioterapia en la infancia. En ocasiones pueden tener una evolución tórpida y dar lugar a complicaciones, siendo la mastoidi-tis aguda la más frecuente. Según algunos estudios se está produciendo un aumento en la incidencia de esta patología y de su gravedad, sin saberse claramente su causa.Métodos: Se realiza un estudio retrospectivo de pacientes ingresados en el Hospital Virgen de la Salud de Toledo, durante un periodo de 64 meses, de 2012 a 2017. Los criterios de inclusión fueron pacientes que fueron diagnosticados con mastoiditis aguda y/o complicaciones derivadas de ésta. Resultados: Se identificaron un total de 22 pacientes con mastoiditis aguda, correspondiendo a una media anual de 4,125 casos/año. El 63,63% de los casos tenían entre 0-2 años. Sólo el 50% de los casos recibieron antibioterapia oral, antes del ingreso hospitalario. Se aisló el germen en el 60% de los casos, siendo el Streptococcus pneumoniae el causante más frecuente. Se detectaron un total de 4 casos de mastoiditis complicada suponiendo el 18,18% de los pacientes; todos fueron varones, y ninguno tenía supuración espontánea a su llegada a Urgencias. Conclusiones: El uso de antibioterapia oral para el tratamiento de la OMA no ha demostrado que disminuya la incidencia de mastoiditis aguda. Sin embargo, es posible que las complicaciones derivadas de una OMA con evolución tórpida sean más graves cuando no se ha empleado antibiótico sistémico para el tratamiento de la OMA.

Introduction: Acute otitis media (AOM) is one of the most common infections and the first cause of administration of antibiotic therapy in childhood. Sometimes they may have a torpid evolution and lead to complications, such as acute mastoiditis more frequently. According to some studies, there is an increase its incidence and severity, but its cause has not been well understood. Methods: A retrospective study was performed, including the patients who were admitted to the Virgen de la Salud Hospital of Toledo, during a period of 64 months, from 2012 to 2017. The inclusion criteria were patients who were diagnosed with acute mastoiditis and or compli-cations derived from it. Results: A total of 22 patients with acute mastoiditis were identified, corresponding to an annual average of 4.125 cases/year. Additionally, 63.63% of the cases were between 0-2 years old. Only 50% of the patients received oral antibiotherapy prior to hospital admission. The germ was isolated in 60% of the cases, Streptococcus Pneumoniae was the most frequent cause. A total of 4 cases of complicated mastoiditis were detected, accounting for 18.18% of the patients; all were male, and none had spontaneous suppuration upon their arrival to the Emer-gency Department. Conclusions: The use of oral antibiotic therapy for the treatment of AOM has not been shown to reduce the incidence of acute mastoiditis. However, it is possible that the complications derived from an AOM with torpid evolution are more serious when systemic antibiotic has not been used for the treatment of AOM

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)

Relato de 3 Casos de Complicações de Otite Média Aguda / Report of 3 Cases of Complications of Acute Otitis Media

Antes da introdução dos antibióticos na prática clínica, a disseminação do processo infeccioso da orelha média para as estruturas adjacentes frequentemente resultava em complicações graves, que atualmente são mais comuns nos países em desenvolvimento, como o Brasil, do que nos países desenvolvidos, e mais prevalentes nas primeiras duas décadas de vida. Este trabalho relata três casos clínicos de complicações de otite média aguda atendidos no Hospital Universitário São Francisco de Assis no ano de 2015, através das revisões dos prontuários, que foram analisados e discutidos com base na literatura atual. As complicações de otites médias agudas podem ser graves e potencialmente fatais. (AU)

Prior to the introduction of antibiotics into clinical practice, dissemination of the infectious process from the middle ear to adjacent structures often resulted in severe complications, which are currently more common in developing countries, such as Brazil, than in developed countries, and more prevalent in the first two decades of life. This paper reports three clinical cases of acute otitis media complications treated at the São Francisco de Assis University Hospital in 2015, through medical records reviews, which were analyzed and discussed based on current literature. The complications of acute otitis media can be serious and potentially fatal. (AU)

Zygomatic Mastoiditis with Extracranial Complications: An Extremely Rare Cause of Cheek Swelling / 대한이비인후과학회지

Zygomatic mastoiditis is an extremely rare cause of an inflamed, swollen cheek. We encountered a 10-year-old girl with left preauricular swelling, pain, and mild trismus. Temporal bone computed tomography revealed a zygomatic root abscess with bone defects and a scanty amount of soft tissue lesion in Prussak's space. After antibiotic therapy for 2 weeks, her pain subsided, but the swelling persisted. All inflamed air cells, including the lesion in the zygomatic root, were eradicated. The swelling subsided after the surgery. The patient has not experienced any postoperative complications or shown any evidence of relapse for more than 1 year.

ДУНД ЧИХНИЙ ИДЭЭТ ҮРЭВСЛИЙН ЧАМАРХАЙ ЯСНЫ БОЛОН ГАВАЛ ТАРХИНЫ ХҮНДРЭЛИЙН ТОХИОЛДОЛ, ОНОШИЛГОО ЭМЧИЛГЭЭ / Шинэ санаа Шинэ нээлт

@#BACKGROUND. The most complications of inflammation of the middle ear temporal bone and skull brain are otitis media, suppurative otitis media, meningitis and skull brain abscess. Aim:To diagnose otitis media, to find the complication of suppurative skull brain and to study the treatment issues as well as to decrease the complication. METHOD. We treated that the patients who was treated the otitis media and complicated with suppurative skull brain between 2014-2015, also the treatment was studied by us in department of otolaryngology surgery of Shastin Central Hospital. RESULTS. In our study, we found the following results: It was a high prevalence with chronic otitis media with effusion in 60 (28.8%) people of younger age group with 25-35 years old. It was a female preponderance with 66% by prevalence. Chronic otitis media with effusion 120 (57.6%), chronic otitis media with mastoiditis 79 (37.9%), total number of patients chronic otitis media with and without mastoiditis 199 (95.5%). It shows disease are easy to throne to the complicated stage of its disease. There was 1 case (0.48%) with intracranial complication. We manage the 8 (4%) patients by antibiotic therapy, 200 (96%) patients by combined with medical and surgical therapy with average 9-12 days of hospital bed days. During 2014-2015, there was only 1 case with intracranial complication from chronic otitis media, shows our early diagnostic level of medical service are quite well. CONCLUSION. Therefore we conclude that prevention, early diagnosis are the main way to decrease the disease. The most important issue is to manage acute otitis media as early as possible before converting it chronic form.

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.

A case series of complicated infective otitis media requiring surgery in adults

<p><b>INTRODUCTION</b>With the advent of antibiotics, complications of otitis media have become less common. It is crucial for physicians to recognise otitis media and treat its complications early. Herein, we present our institution's experience with patients who required emergency surgical intervention for complications of otitis media.</p><p><b>METHODS</b>Data on patients who underwent emergency surgery for complications of otitis media from 2004 to 2011 was retrieved from the archives of the Department of Otolaryngology, Changi General Hospital, Singapore.</p><p><b>RESULTS</b>A total of 12 patients (10 male, two female) underwent emergency surgery for complications of otitis media. The median age of the patients was 25 years. Otalgia, otorrhoea, headache and fever were the main presenting symptoms. Extracranial complications were observed in 11 patients, and six patients had associated intracranial complications. The primary otologic disease was acute otitis media in six patients, chronic otitis media without cholesteatoma in three patients and chronic otitis media with cholesteatoma in three patients. Mastoidectomy and drainage of abscess through the mastoid, with insertion of grommet tube, was the main surgical approach. Two patients required craniotomy. The mean length of hospital stay was 16.2 days and the mean follow-up period was 16.3 months. Five patients had residual conductive hearing loss; two patients with facial palsy had full recovery.</p><p><b>CONCLUSION</b>Otitis media can still result in serious complications in the post-antibiotic era. Patients with otitis media should be monitored, and prompt surgical intervention should be performed when necessary to attain good outcomes.</p>

Lipidomic Profiling of Mastoid Bone and Tissue from Patients with Chronic Otomastoiditis

Introduction Chronic otomastoiditis causes pain, otorrhea, and hearing loss resulting from the growth of tissue within the normally hollow mastoid cavity. Objectives In this report, we used a lipidomics approach to profile major mastoid bone and tissue lipids from patients with and without otomastoiditis. Methods The bone dust created during mastoidectomy, as well as the mastoid tissue, was analyzed from seven patients. Bone dust was also collected and analyzed in an additional four otologic cases (parotidectomy requiring mastoidectomy). Samples were subjected to a modified Bligh/Dyer lipid extraction, then high-performance thin-layer chromatography (HPTLC), combined gas chromatography/electron impact-mass spectrometry (GC/EI-MS), and flow-injection/electrospray ionization-tandem mass spectrometry (FI/ESI-MSMS). Data were analyzed for identification and profiling of major lipid components. Results HPTLC revealed the presence of various lipid classes, including phosphatidylcholines, cholesterol, and triacylglycerols. GC/EI-MS analysis revealed the presence of cholesterol and several fatty acids. FI/ESI-MSMS analysis revealed a host of phosphatidylcholines, phosphatidylethanolamines, and cholesteryl esters. Conclusion We used a lipidomics approach to develop an efficient (both in time and tissue amount) methodology for analysis of these tissues, identify the most abundant and common lipid species, and create a base of knowledge from which more focused endeavors in biomarker discovery can emerge. In an effort toward improved patient categorization and individualized intervention, the ultimate goal of this work is to correlate these lipid molecules to disease state and progression. This is the first reported study of its kind on these tissues. .

Intervenção fonoaudiológica precoce num paciente com paralisia facial após otomastoidite / Early speech therapy intervention in a patient with facial paralysis after otomastoiditis

De ocorrência frequente, a paralisia facial é uma patologia que acomete a face ea expressão facial. Dentre as etiologias possíveis será destacada uma de ocorrência pouco comum, a Otomastoidite. A intervenção fonoaudiológica iniciada precocemente colabora para o retorno da mobilidade e funções da musculatura reduzindo assim a atrofia muscular e surgimento de sincinesias e contraturas. O objetivo do estudo foi reabilitar um paciente acometido pela paralisia facial após otomastoidite com a intervenção fonoaudiológica precoce e descrever a aplicação de uma proposta de intervenção terapêutica diferenciada. Na metodologia optou-se por exercícios miofuncionais específicos, avaliação e acompanhamento audiológico. Nos resultados, após nove semanas de acompanhamento, observou-se melhora expressiva na simetria do sorriso, adequação das funções estomatognáticas e presença dos reflexos acústicos estapedianos.

Facial palsy is a condition of frequent occurrence which affects the face and the facial expression. Amongst the possible etiologies it will be highlighted one uncommon occurrence, Otomastoiditis. Speech-language therapy starting early collaborates for the return of mobility and function of the muscles thus preventing muscle atrophy and minimizing synkinesis and contracture. The study objective was to rehabilitate a patient affected by facial paralysis after otomastoiditis with early intervention and describe the implementation and effectiveness of a proposal for differentiated and unusual therapeutic intervention. In the methodology we chose specific miofunctional exercises, audiological assessment and monitoring. The results, after nine weeks of follow-up, showed a significant improvement in the symmetry of the smile, adequacy of stomatognathic functions and presence of acoustic stapedial reflexes.

Embryonal rhabdomyosarcoma of the middle ear presenting with aural polyp and facial nerve palsy

Rhabdomyosarcoma is a rare tumour in the middle ear and mastoid cavity in children and the diagnosis is difficult. Repeated histological examination may be essential to confirm the diagnosis. We report a 6 year old boy with a left aural polyp, otorrhoea and facial nerve palsy who was initially thought to have otitis media and mastoiditis. He had polypectomy and the tissue taken for histopathology suggested an inflammatory condition. Subsequently he had mastoidectomy. Tissue taken during mastoidectomy was however reported as rhabdomyosarcoma. The child developed a cerebral abscess and eventually succumbed. A literature review of the disease, radiological findings, immunohistochemical features and treatment options is described.

Diagnosis and treatment of otogenic deep neck abscess / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo improve the understanding and treatment of otogenic deep neck abscess.METHODSTo analyse the treatments of 2 cases retrospectively and do the literature review.RESULTS 2 cases had long history of otitis media, showed abnormal signal connection on MRI image between neck lesion and middle ear. They were cured by mastoidectomy and drainage from neck abscess to mastoid cavity.CONCLUSIONThe otogenic deep neck abscess is different from other one in the etiology, pathogenesis, pathogenic bacteria, treatment and so on. The neck MRI examination has obvious advantages in the nature of the lesion, the resolution of the soft tissue and the correlation of lesions between the neck and the mastoid, and can be used as the predominant treatment. Incision and drainage of the neck abscess is unnecessary if operated on time. Before the neck abscess is cured thoroughly, keeping drainage of the mastoid tip is very important for prevention of recurrence. Postoperative change dressing should also be strengthened.

A Case of Epidural Abscess Complicated from Acute Mastoiditis Caused by Streptococcus pneumoniae / 소아감염

Acute otitis media (AOM) is one of the most common childhood infectious diseases. Despite antibiotic treatment for AOM, AOM and its complication still continue to develop. Acute mastoiditis is a serious complication of AOM and epidural abscess constitutes the commonest of all intracranial complication of AOM. Neurological complication of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We report the rare case of acute otitis media progressing to acute mastoiditis, epidural abscess formation and lateral sinus thrombophlebitis caused by Streptococcus pneumoniae in a child. She was admitted with acute otitis media with fever. Despite proper antibiotics, acute mastodititis and epidural abscess were developed, and after surgical drainage and antibiotics therapy she was recovered without sequalae.

An Unusual Complication of Chronic Suppurative Otitis Media: Bezold Abscess Progressing to Scapular Abscess

Introduction: Suppurative otitis media is still the most common ear disease in developing countries. Otogenic complications of this disease have decreased considerably because of the advent of antibiotics, and few rare complications have been encountered. Objective: To report a case of a patient with scapular abscess and lumber cellulitis that had progressed from Bezold abscess as a complication of squamous-type chronic suppurative otitis media. Resumed Report A 14-year-old girl presented with foul-smelling, purulent, left ear discharge of 1-year duration and decreased hearing on same ear of 6-month duration. She developed painful swelling in left side of neck with restricted neck movement and high-grade fever of 3-day duration and swelling over the left scapular area of 1-day duration. The examination and investigation diagnosed squamous-type chronic suppurative otitis media with Bezold abscess progressing to scapular abscess and lumber cellulitis. Final: Comment Chronic suppurative otitis media can lead to abscess in any part of body...