Adult Otogenic Meningitis in the Pneumococcal Conjugated Vaccines Era

Abstract Introduction Streptococcus pneumoniae is a major pathogen of otogenic meningitis (OgM), the most commonly reported intra-cranial complication of otitis media (OM). Objectives To study the changes in adult OgM patients in the pneumococcal conjugated vaccines (PCVs) era. Methods Retrospective cohort of adults presenting with concurrent OM and meningitis in a secondary medical care center between 2005 and 2015. Data collected included demographics, OM-related symptoms, cerebrospinal fluid (CSF) and ear culture results, pre- and during hospitalization antibiotic treatment, imaging findings, and complications. We compared the pre-PCV years (2005-2009) with the post-PCV years (2010-2015). Outcomes were 1) incidence of all-cause adult OgM from the total meningitis cases; 2) impact of PCVs on the clinical presentation of OgM and bacteriology. Results Otogenic meningitis was diagnosed in 26 out of 45 (58%) cases of all-cause meningitis admissions. Of those, 10 (38%) were male, with a mean age of 62.4 years old. Ear-related signs and symptoms were documented in 70% of the patients, and OgM was diagnosed following imaging studies in 6 out of 26 (23%) patients. All of the patients received intravenous antibiotic therapy, and 7 (27%) patients required surgical interventions: 6 required myringotomy and 1 required mastoidectomy. There were 12 (46%) patients in the pre-PCV years and 14 (56%) in the post-PCV years. The positive pneumococcal CSF and ear culture rates remained high and unchanged (~ 75%). There were no significant changes in the clinical presentation or mortality rates. Conclusion Micro-otoscopy should be included in the routine work-up of any suspected adult meningitis, because OgM is underdiagnosed. Unlike their impact on pediatric otitismedia, PCVs did not change the epidemiology and bacteriology of OgM.

Fish Bone Foreign Body: The Role of Imaging

Abstract Introduction Fish bone foreign body (FFB) impaction in the upper aerodigestive tract is a common cause for emergency department referral. Its management varies in both diagnosis and treatment paradigms. Fish bone foreign bodies are more commonly found in the oropharynx in cases of patients < 40 years old, and in the esophagus in cases of patients > 40 years old. Symptoms are typically non-indicative for the location of the FFB, with the exception of foreign body sensation at/superior to the cervical esophagus. A lack of findings during the physical examination is routinely followed by imaging, with computed tomography (CT) being the preferred modality. In practice, many patients undergo unnecessary imaging studies, including CT scans. Objectives To identify patients with suspected fish bone impaction who do not require CT imaging and can be safely discharged. Data Synthesis We have searched the PubMed database for the following medical subject headings (MeSH) terms: fish bone, fish foreign body AND oropharynx, hypopharynx, esophagus, flexible esophagoscopy, and rigid esophagoscopy. Our search in the English language yielded 32 papers. Case reports were included, since they highlighted rare and serious complications. Conclusion In patients > 40 years old suspected of fish bone impaction, noncontrast CT is recommended and should be urgently performed, even in the presence of ambiguous symptoms. However, in patients < 40 years old presenting within 24 hours from ingestion, imaging has little diagnostic value due to the low probability of esophageal fish bones. For this specific subgroup, in the absence of clinical findings, discharge without imaging studies may be considered safe. (AU)

What are the Sources for Health Information among Patients Attending Otolaryngology Outpatient Clinics in Israel? A Questionnaire Survey.

Aim: Sources for health information are continually growing and become easily accessible to the public. The aim of the study was to investigate the sources of health information and the satisfaction level with the sources among patients attending otolaryngology (ENT) outpatient clinics in Israel. Study Design: A structured questionnaire was given to patients attending ENT clinics at a tertiary medical center. Place and Duration of Study: Department of Otolaryngology, Soroka university medical center during the years 2011-2012. Methodology: We included adult patients attending the otolaryngology clinic at our medical center that agree to fulfill the questionnaire. Results: 186 questionnaires were completed. 74% of the patients thought that prior information would have helped them in their visit, 54% actually obtained information. Internet access was not age or education-dependent. 71 patients consulted their family physician, 94% were satisfied. The percentage of satisfaction from friends, medical leaflets, Internet, books and newspapers were 91%, 83%, 80%, 78% and 66%, respectively. 71% wanted to know more about their disease, 17% to reduce anxiety, 7% to accept their disease and 5% to treat themselves. Among patients who did not obtain information; 50% expected to get enough information at the visit, 17% did not think it was important, 27% did not have time and 6% did not have information access. Conclusions: Obtaining information prior to medical consultation is important to patients. The main and best source is family physicians. The patient - doctor encounter is expected by patients to provide information on their diseases.