ABSTRACT
OBJECTIVE: To review all cases intratemporal and intracranial complications of acute otitis media (AOM) in infants and children from 1998 to 2013. METHODS: Retrospective chart review of 109 consecutive patients admitted for complications of AOM during a 15-year period at a tertiary-care children's hospital. The main outcomes are: (1) complications of AOM, (2) bacteriology, (3) management strategies. RESULTS: In our population, complications included mastoiditis (86.1%), subperiosteal abscess (38%), facial nerve palsy (16.7%), sigmoid sinus thrombosis (8.3%) and epidural abscess (7.4%). Other complications included post-auricular cellulitis, otic hydrocephalus and elevated intracranial pressure, internal jugular thrombosis, cranial nerve VI palsy and Gradenigo's syndrome, labyrinthine fistula, sensorineural hearing loss, and cerebellar infarct. Sixty-one patients (56%) received antibiotics prior to presentation. Cultures revealed Streptococcus pneumoniae in 36 patients (33.3%), other bacteria in 30 patients (27.8%), and "no growth" in 33 patients (30.5%). Nine patients (8.3%) did not undergo culture. Of the patients with S. pneumoniae, 20 cultures (55%) were found to be multidrug-resistant. Eleven patients (10.2%) were treated non-surgically, 31 (31%) were treated with myringotomy and intravenous antibiotics. Forty patients (97.5%) presenting with subperiosteal abscess required mastoid surgery. Thirteen of 18 (72.2%) patients with facial paralysis had full recovery. Eight of 10 (80%) patients with epidural abscess empyema required mastoid surgery and incision and drainage of the abscess. CONCLUSION: Complications of AOM are uncommon, yet continue to have potentially serious consequences. The bacteriology in this population reveals an increasing trend of multi-drug resistant S. pneumoniae as the causative organism.
Subject(s)
Epidural Abscess/etiology , Mastoiditis/etiology , Otitis Media/complications , Pneumococcal Infections/complications , Acute Disease , Anti-Bacterial Agents/therapeutic use , Bell Palsy/etiology , Bone Diseases/etiology , Bone Diseases/surgery , Child, Preschool , Drug Resistance, Multiple, Bacterial , Facial Paralysis/etiology , Female , Hearing Loss, Sensorineural/etiology , Humans , Male , Mastoid/surgery , Middle Ear Ventilation , Otitis Media/drug therapy , Otitis Media/surgery , Pneumococcal Infections/drug therapy , Retrospective Studies , Sinus Thrombosis, Intracranial/etiology , Temporal BoneABSTRACT
Actinomyces is a rare pathogen that can be the cause of infections in the digestive and urinary tracts, skin, genitalia, and lungs, which generally have an indolent clinical course. However, in some cases these can be locally destructive and become generalized infections. Actinomyces has been previously implicated in infections of the middle ear, nasopharynx, and sinuses, occasionally causing complications such as chronic mastoiditis. Here we describe the case of a 10-year-old-male presenting with nausea, vomiting, and headache who developed intracranial complications of actinomycotic mastoiditis.
Subject(s)
Actinomycosis/microbiology , Fistula/microbiology , Labyrinth Diseases/microbiology , Mastoiditis/microbiology , Sinus Thrombosis, Intracranial/microbiology , Temporal Bone/microbiology , Actinomycosis/complications , Actinomycosis/diagnosis , Actinomycosis/drug therapy , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Biopsy , Child , Fistula/diagnosis , Fistula/drug therapy , Hearing Loss, Sensorineural/microbiology , Humans , Labyrinth Diseases/diagnosis , Labyrinth Diseases/drug therapy , Male , Mastoiditis/complications , Mastoiditis/diagnosis , Mastoiditis/drug therapy , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/drug therapy , Temporal Bone/diagnostic imaging , Temporal Bone/pathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJECTIVES: (1) Evaluate the presentation, diagnostic workup, and outcomes of contemporary surgical intervention for airway obstruction from innominate artery tracheal compression in children. (2) Assess the significance of synchronous airway lesions in the treatment of innominate artery tracheal compression. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care children's hospital. METHODS: This study is a retrospective medical record review of 26 consecutive children who underwent aortopexy for innominate artery tracheal compression at a tertiary care children's hospital. Presenting symptoms, diagnostic workup, presence of synchronous airway lesions, length of hospitalization, and treatment outcomes were examined. RESULTS: Twenty-six patients (17 male, 65%) were included in the study. All were diagnosed with bronchoscopy and confirmed with radiographic imaging. Median age at diagnosis and surgery was 9.7 and 10.0 months, respectively. Presenting symptoms included noisy breathing (93%), cough (78%), dyspnea (44%), apnea (44%), cyanosis (19%), and recurrent respiratory infections (15%). Average degree of tracheal compression was 71% (SD, 12%). Fifteen of 26 (58%) patients had synchronous airway lesions, including mild laryngomalacia and subglottic stenosis. Median length of stay was 2 days. Median follow-up was 10 months. Subjective improvement occurred in all 21 patients for whom follow-up information was available. CONCLUSION: Anterior tracheal vascular compression can cause a variety of airway symptoms. Mild synchronous airway lesions are common and do not prevent successful aortopexy. Aortopexy is a viable treatment option for symptomatic anterior tracheal vascular compression from the innominate artery.
Subject(s)
Airway Obstruction/etiology , Airway Obstruction/surgery , Aorta, Thoracic/surgery , Brachiocephalic Trunk , Tracheal Diseases/etiology , Tracheal Diseases/surgery , Age Factors , Airway Obstruction/diagnosis , Bronchoscopy , Child , Female , Humans , Infant , Male , Retrospective Studies , Suture Techniques , Tracheal Diseases/diagnosis , Treatment OutcomeABSTRACT
OBJECTIVES: To assess the impact of stoma maturation on pediatric tracheostomy-related complications and to report the incidence of pediatric tracheostomy-related complications. DESIGN: Retrospective medical chart review and data analysis. SETTING: Tertiary care children's hospital. PATIENTS: A total of 172 consecutive patients who underwent tracheotomy during a 4-year period. INTERVENTION: Tracheotomy with or without stoma maturation at the time of surgery was performed by 8 pediatric otolaryngologists. Stoma maturation was based solely on individual surgeon preference, not on patient factors. MAIN OUTCOME MEASURES: Early and late tracheostomy-related complications; correlation between stoma maturation and complication rate. RESULTS: The patients' mean (SD) age was 4.9 (6.6) years, with a mean follow-up of 35.4 (24.5) months. Of 156 patients for whom stoma maturation data were available, 48 (30.8%) underwent stoma maturation and 108 (69.2%) did not. Nineteen of 172 patients (11.0%) had an early complication (within the first 7 days), including accidental decannulation, bleeding, false tract, pneumonia, and tracheitis. Late complications included suprastomal tracheal granulation tissue (48.8%), tracheitis (48.8%), peristomal granulation tissue (26.7%), accidental decannulation (11.6%), and mucus plugging (9.9%). Among the 62 patients (36.0%) who were decannulated, 23 of 62 (37.1%) developed a persistent tracheocutaneous fistula. Younger patients had a higher rate of suprastomal granulation tissue, tracheitis, tracheocutaneous fistula, and repeated surgical procedures (P < .05). Patients with stoma maturation were incidentally older than patients without stoma maturation (P < .05). When corrected for age, stoma maturation did not have an impact on the incidence of any of the tracheostomy-related complications. CONCLUSION: There was no relationship between stoma maturation and tracheostomy-related complications, including rate of tracheocutaneous fistula and development of granulation tissue.
