Rotavirus gastroenteritis hospitalizations in provinces with different vaccination coverage rates in Spain, 2013-2018.

BACKGROUND: Rotavirus (RV) vaccines are available in Spain since 2006 but are not included in the National Immunization Program. RV vaccination has reached an intermediate vaccination coverage rate (VCR) but with substantial differences between provinces. The aim of this study was to assess the ratio of RV gastroenteritis (RVGE) admissions to all-cause hospitalizations in children under 5 years of age in areas with different VCR. METHODS: Observational, multicenter, cross-sectional, medical record-based study. All children admitted to the study hospitals with a RVGE confirmed diagnosis during a 5-year period were selected. The annual ratio of RVGE to the total number of all-cause hospitalizations in children < 5 years of age were calculated. The proportion of RVGE hospitalizations were compared in areas with low (< 30%), intermediate (31-59%) and high (> 60%) VCR. RESULTS: From June 2013 to May 2018, data from 1731 RVGE hospitalizations (16.47% of which were nosocomial) were collected from the 12 study hospitals. RVGE hospital admissions accounted for 2.82% (95 CI 2.72-3.00) and 43.84% (95% CI 40.53-47.21) of all-cause and Acute Gastroenteritis (AGE) hospitalizations in children under 5 years of age, respectively. The likelihood of hospitalization due to RVGE was 56% (IC95%, 51-61%) and 27% (IC95%, 18-35%) lower in areas with high and intermediate VCR, respectively, compared to the low VCR areas. CONCLUSIONS: RVGE hospitalization ratios are highly dependent on the RV VCR. Increasing VCR in areas with intermediate and low coverage rates would significantly reduce the severe burden of RVGE that requires hospital management in Spain. Clinical trial registration Not applicable.

Fiebre recurrente transmitida por garrapatas en área rural del sur de España / Tick-borne relapsing fever in a rural area of southern Spain

INTRODUCCIÓN: La fiebre recurrente transmitida por garrapatas (FRTG) es una enfermedad zoonótica producida por espiroquetas del género Borrelia. Es una enfermedad infradiagnosticada en nuestro medio debido al bajo índice de sospecha y a la dificultad en su diagnóstico. El objetivo del estudio es presentar nuestra experiencia en el manejo diagnóstico y terapéutico de la FRTG y revisar la literatura. MÉTODOS: Análisis retrospectivo de pacientes con FRTG ingresados en nuestro centro durante el periodo 2002-2012. Se analizan variables epidemiológicas, clínicas, microbiológicas, tratamiento y resultado. RESULTADO: Se identificaron 9 pacientes con FRTG. La mediana de edad fue de 11 años. Todos los casos ocurrieron durante meses cálidos. La clínica de presentación fue de episodios recurrentes de fiebre con escalofríos, cefalea, vómitos, mialgias y dolor abdominal. Se identificó afectación meníngea en 2 casos. En 2 pacientes existía infección por Borrelia en otros miembros de la familia en el momento del diagnóstico. La media de PCR fue de 187 mg/l y el 56% de casos presentaron trombocitopenia. Se visualizó Borrelia spp. en frotis de sangre periférica en el 67%. Todos los pacientes recibieron tratamiento antibiótico. Se empleó doxiciclina en mayores de 8 años y eritromicina y penicilina en menores de esta edad. Se produjo reacción de Jarisch- Herxheiner en un paciente. La evolución fue satisfactoria en todos los casos, sin secuelas. CONCLUSIONES: Subrayamos la importancia de mantener un elevado índice de sospecha de FRTG en regiones endémicas. El diagnóstico precoz, junto con el correcto tratamiento, permite evitar la aparición de recurrencias febriles y potenciales complicaciones

INTRODUCTION: Tick-borne relapsing fever (TBRF) is a zoonotic disease caused by spirochetes of the genus Borrelia. This disease is underdiagnosed in our area due to a low index of suspicion among clinicians, as well as its difficult diagnosis. This study aims to present our experience in the diagnosis and therapeutic management of TBRF and a literature review. METHODS: A retrospective medical chart review was carried out on children diagnosed of TBRF from 2002 to 2012 in our hospital, and included clinical, epidemiological, microbiological, treatment, and outcome data. RESULTS: Nine children with TBRF were identified. Median age was 11 years. All cases occurred during warm months. The most frequent presenting clinical findings were fever, chills, headache, vomiting, myalgia and abdominal pain. Meningeal involvement was identified in 2 cases. In the case of 2 patients, Borrelia infection was identified in several relatives at the time of diagnosis. Mean C-protein reactive was 187 mg/L, and low platelet counts were observed in 56% of the cases. Borrelia spp. was visualized in peripheral blood smears in 67% of cases. All of the patients received antibiotic treatment. Doxycycline was used in children older than 8 years and erythromycin and penicillin in the younger ones. Jarisch-Herxheiner reaction occurred in one patient. All cases resolved without sequelae. CONCLUSIONS: We emphasize the importance of maintaining a high level of suspicion in endemic regions of TBRF. Early diagnosis and a correct therapy can prevent the appearance of subsequent fever recurrences and potential complications

[Tick-borne relapsing fever in a rural area of southern Spain]. / Fiebre recurrente transmitida por garrapatas en área rural del sur de España.

INTRODUCTION: Tick-borne relapsing fever (TBRF) is a zoonotic disease caused by spirochetes of the genus Borrelia. This disease is underdiagnosed in our area due to a low index of suspicion among clinicians, as well as its difficult diagnosis. This study aims to present our experience in the diagnosis and therapeutic management of TBRF and a literature review. METHODS: A retrospective medical chart review was carried out on children diagnosed of TBRF from 2002 to 2012 in our hospital, and included clinical, epidemiological, microbiological, treatment, and outcome data. RESULTS: Nine children with TBRF were identified. Median age was 11 years. All cases occurred during warm months. The most frequent presenting clinical findings were fever, chills, headache, vomiting, myalgia and abdominal pain. Meningeal involvement was identified in 2 cases. In the case of 2 patients, Borrelia infection was identified in several relatives at the time of diagnosis. Mean C-protein reactive was 187 mg/L, and low platelet counts were observed in 56% of the cases. Borreliaspp. was visualized in peripheral blood smears in 67% of cases. All of the patients received antibiotic treatment. Doxycycline was used in children older than 8 years and erythromycin and penicillin in the younger ones. Jarisch-Herxheiner reaction occurred in one patient. All cases resolved without sequelae. CONCLUSIONS: We emphasize the importance of maintaining a high level of suspicion in endemic regions of TBRF. Early diagnosis and a correct therapy can prevent the appearance of subsequent fever recurrences and potential complications.

Escara necrótica y linfadenopatías cervicales tras una picadura de garrapata: TIBOLA / Necrotic eschar and neck lymphadenopathy after tick bite: TIBOLA

La linfadenopatía por picadura de garrapata (TIBOLA, por sus siglas en inglés: tick-borne lymphadenopathy) es una enfermedad emergente causada por Rickettsia slovaca. Es una zoonosis transmitida por la picadura de la garrapata Dermacentor marginatus. Los pacientes afectados presentan una escara necrótica rodeada de un halo eritematoso en el cuero cabelludo, así como adenopatías regionales dolorosas. Presentamos el caso de una niña de 4 años de edad con escara necrótica y linfadenopatías cervicales dolorosas tras una picadura de garrapata (AU)

Tick-borne lymphadenopathy (TIBOLA) is an emerging dise­ase caused by Rickettsia slovaca. It is a zoonoses transmitted to humans by Dermacentor marginatus tick-bite. Patients presents with a necrotic eschar surrounded by a perilesional erythematous halo on the scalp and painful regional lymphadenopathies. We present a case of a 4-years old girl with necrotic eschar on the scalp and painful cervical lymphadenopathy after tick bite (AU)

Hospitalizaciones por varicela en un hospital de tercer nivel / Hospital admissions due to varicella in a tertiary hospital

INTRODUCCIÓN: La varicela puede generar hospitalizaciones y complicaciones graves. Varios países han incluido la vacuna antivaricelosa en sus calendarios vacunales. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo de los pacientes ingresados por varicela y sus complicaciones en un centro de referencia entre 2005 y 2011. RESULTADOS: Consultaron por varicela en urgencias 1.192 niños, 99 (8,5%) precisaron ingreso. Incidencia anual de ingresos por varicela y varicela complicada: 19,4 y 15,3 casos por 100.000 menores de 14 años. Las complicaciones fueron más frecuentes en menores de 5 años (79,5%) y sin enfermedad de base (78,2%). La infección de piel y partes blandas fue la complicación más frecuente (62%). La estancia hospitalaria media ± desviación estándar fue de 4,5 ± 4 días. CONCLUSIONES: La varicela produce una elevada morbilidad; esta es más frecuente en términos absolutos en niños sanos menores de 5 años. Por este motivo, la vacunación sistemática recomendada por el Comité Asesor de Vacunas debería ser mandatoria

INTRODUCTION: Varicella (chickenpox) can cause serious complications and admission to hospital. Several countries included the varicella vaccine in their immunization schedules. MATERIAL AND METHODS: A descriptive and retrospective study of hospitalizations due to varicella and its complications was conducted in a referral center from 2005 to 2011.RESULTS: A total of 1192 children with varicella were seen in the emergency room, of which99 (8.5%) required admission. The annual incidence of admissions due to varicella and varicella complications was, 19.4 and 15.3 cases per 100,000 children under 14 years, respectively. Complications were more common in children under 5 years (79.5%), and with no underlying disease (78.2%). Infection of skin and soft tissue was the most common complication (62%). The mean hospital stay was 4.5 days (SD 4). CONCLUSIONS: Varicella causes high morbidity, and is more frequent in absolute terms in healthy children under 5 years of age. Therefore, routine vaccination recommended by the Immunization Advisory Committee should be mandatory

[Hospital admissions due to varicella in a tertiary hospital]. / Hospitalizaciones por varicela en un hospital de tercer nivel.

INTRODUCTION: Varicella (chickenpox) can cause serious complications and admission to hospital. Several countries included the varicella vaccine in their immunization schedules. MATERIAL AND METHODS: A descriptive and retrospective study of hospitalizations due to varicella and its complications was conducted in a referral center from 2005 to 2011. RESULTS: A total of 1192 children with varicella were seen in the emergency room, of which 99 (8.5%) required admission. The annual incidence of admissions due to varicella and varicella complications was, 19.4 and 15.3 cases per 100,000 children under 14 years, respectively. Complications were more common in children under 5 years (79.5%), and with no underlying disease (78.2%). Infection of skin and soft tissue was the most common complication (62%). The mean hospital stay was 4.5 days (SD 4). CONCLUSIONS: Varicella causes high morbidity, and is more frequent in absolute terms in healthy children under 5 years of age. Therefore, routine vaccination recommended by the Immunization Advisory Committee should be mandatory.

Variante otogénica del síndrome de Lemierre / Otogenic variant of Lemierre syndrome

No disponible

Abscesos retrofaríngeo y parafaríngeo: experiencia en hospital terciario de Sevilla durante la última década / Retropharyngeal and parapharyngeal abscess: experience in a tertiary-care center in Seville during the last decade

Introducción: Los abscesos retro y parafaríngeos son procesos infrecuentes aunque asociados con morbilidad significativa y potencial mortalidad. El objetivo del estudio es revisar nuestra experiencia en el manejo diagnóstico y terapéutico de los abscesos retro y parafaríngeos y comparar el resultado entre los pacientes tratados con antibioterapia exclusiva con aquellos que requirieron drenaje quirúrgico. Pacientes y métodos: Estudio retrospectivo de pacientes diagnosticados de abscesos retro y parafaríngeos en nuestro hospital terciario durante el periodo 2000-2009. Resultados: Treinta y un casos fueron identificados. Diecisiete presentaron absceso retrofaríngeo, 11 abscesos parafaríngeos y 3 ambos. Encontramos un incremento de la frecuencia media anual (1,4 casos/años en el periodo 2000-2004 versus 4,8 casos/año en el periodo 2005-2009, p=0,006). La mediana de edad fue 3 años (rango 1-10). Dieciocho (58%) pacientes recibieron antibioterapia por vía oral previa al ingreso (betalactámicos 84%). La clínica de presentación fue: fiebre (93%), linfadenopatías cervicales (93%), dolor cervical (90%), tortícolis (74%), odinofagia (64%), trismus (32%), sialorrea (22%) y estridor (6%). En 13 niños se realizó drenaje quirúrgico, siendo positivo el cultivo microbiológico en 8 casos; Streptococcus pyogenes fue el germen más frecuente (n=4). Todos los pacientes recibieron antibioterapia por vía intravenosa. No hubo diferencias en la estancia hospitalaria, complicaciones o recurrencias al comparar los tratados con antibioterapia exclusiva y los tratados con cirugía. Conclusiones: La frecuencia media anual de casos se incrementó durante la segunda mitad del periodo de estudio. La mayoría de niños fueron tratados satisfactoriamente con manejo conservador. La indicación quirúrgica debe basarse en la presentación clínica y la respuesta al tratamiento antibiótico (AU)

Introduction: Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention. Material and methods: A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre. Results: Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P=0.006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n=4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention. Conclusions: Retro- and parapharyngeal abscesses were increasingly observed during the 2nd part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy (AU)

[Retropharyngeal and parapharyngeal abscess: experience in a tertiary-care center in Seville during the last decade]. / Abscesos retrofaríngeo y parafaríngeo: experiencia en hospital terciario de Sevilla durante la última década.

INTRODUCTION: Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention. MATERIAL AND METHODS: A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre. RESULTS: Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P=.006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n=4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention. CONCLUSIONS: Retro- and parapharyngeal abscesses were increasingly observed during the 2(nd) part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy.

Mastoiditis aguda: experiencia en los últimos 10 años en hospital terciario del sur de España / Acute mastoiditis: experience in a tertiary-care center in the South of Spain during 1999–2008 period

Introducción: Recientemente se ha descrito en diversas áreas geográficas un incremento tanto en la incidencia de mastoiditis agudas como en su gravedad, sin que sus causas hayan sido del todo aclaradas. El objetivo de nuestro estudio es revisar nuestra experiencia reciente y compararla con aquello que otros autores han descrito. Paciente y métodos: Estudio retrospectivo de 145 pacientes diagnosticados de mastoiditis aguda en hospital terciario durante el periodo 1999–2008. Se analizan variables epidemiológicas, clínicas, microbiológicas, tratamiento y resultado. Resultados: La frecuencia anual de mastoiditis aguda presentó importantes variaciones a lo largo del estudio. La media anual fue de 14,5 casos/año. La mediana de edad fue de 3 años. Un 57,9% fueron varones. Un 53,8% recibió antibioterapia oral previa, principalmente B-lactámicos. La clínica más frecuente fue fiebre (77,9%), desplazamiento pabellón auricular (73,8%), otalgia (71,7%) edema/hinchazón retroauricular (70,3%). Se realizó cultivo exudado ótico en 53 pacientes, siendo Streptococcus pneumoniae el germen más frecuente. Se realizó TC en el 56,6% casos. El 100% de pacientes recibió antibioterapia intravenosa con una mediana de duración de 5 días. La cirugía otorrinolaringológica se realizó en 47 (32,4%) pacientes. Diecinueve (13,1%) pacientes presentaron complicaciones extracraneales. Doce (8,2%) pacientes presentaron complicaciones intracraneales, observándose un incremento significativo en su proporción al comparar los primeros con los segundos 5 años del estudio. Conclusiones: Encontramos importantes variaciones interanuales en la frecuencia de mastoiditis aguda. Subrayamos el aumento de la proporción de complicaciones intracraneales en los segundos 5 años del estudio (AU)

Introduction: An increase in both the incidence and severity of acute mastoiditis (AM) has been recently recorded in many different geographical areas. Causes remain unclear. This study aims to evaluate our clinical and epidemiological data in paediatric patients with AM and to compare them with recent reports. Material and methods: Retrospective chart review of 145 patients diagnosed of AM from 1999 to 2008 in our tertiary-care centre, including clinical, epidemiological, microbiological, treatment and outcome data. Results: The annual incidence showed a changeable trend throughout the study period. The average number of cases was 14.5 cases per year, with a median age of 3 years, and 57.9% males. A total of 53.8% received pre-admission oral antibiotics, mainly beta-lactamics. Most frequent presenting clinical findings were fever (77.9%), ear displacement (73.8%), otalgia (71.7%), and postauricular swelling (70.3%). Microbiological cultures were performed in 53 cases; S. pneumoniae was the most isolated microorganism. CT scans were performed in 56.6% cases. All patients received parenteral antibiotic treatment with a median duration of treatment of 5 days. Surgery was performed on 32.6%. Complications were seen in 20% of patients: 13.1% had extracranial complications, and 8.2% had intracranial complications. A significant increase in intracranial complications was detected in the second half of the study period. Conclusions: A changeable trend in the annual incidence of AM throughout the time of study was observed. A higher proportion of intracranial complications was detected in the last five years of the study period (AU)

[Acute mastoiditis: experience in a tertiary-care center in the South of Spain during 1999-2008 period]. / Mastoiditis aguda: experiencia en los últimos 10 años en hospital terciario del sur de España.

INTRODUCTION: An increase in both the incidence and severity of acute mastoiditis (AM) has been recently recorded in many different geographical areas. Causes remain unclear. This study aims to evaluate our clinical and epidemiological data in paediatric patients with AM and to compare them with recent reports. MATERIAL AND METHODS: Retrospective chart review of 145 patients diagnosed of AM from 1999 to 2008 in our tertiary-care centre, including clinical, epidemiological, microbiological, treatment and outcome data. RESULTS: The annual incidence showed a changeable trend throughout the study period. The average number of cases was 14.5 cases per year, with a median age of 3 years, and 57.9% males. A total of 53.8% received pre-admission oral antibiotics, mainly beta-lactamics. Most frequent presenting clinical findings were fever (77.9%), ear displacement (73.8%), otalgia (71.7%), and postauricular swelling (70.3%). Microbiological cultures were performed in 53 cases; S. pneumoniae was the most isolated microorganism. CT scans were performed in 56.6% cases. All patients received parenteral antibiotic treatment with a median duration of treatment of 5 days. Surgery was performed on 32.6%. Complications were seen in 20% of patients: 13.1% had extracranial complications, and 8.2% had intracranial complications. A significant increase in intracranial complications was detected in the second half of the study period. CONCLUSIONS: A changeable trend in the annual incidence of AM throughout the time of study was observed. A higher proportion of intracranial complications was detected in the last five years of the study period.

[Unusually high frequency of complications in acute otitis media]. / Frecuencia inusualmente elevada de complicaciones secundarias a otitis media aguda.

INTRODUCTION: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. MATERIAL AND METHOD: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. RESULTS: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. CONCLUSIONS: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events.

Frecuencia inusualmente elevada de complicaciones secundarias a otitis media aguda / Unusually high frequency of complications in acute otitis media

Introducción: las complicaciones intracraneales (CI) secundarias a otitis media son procesos infrecuentes aunque potencialmente graves. Recientemente hemos encontrado una frecuencia inusualmente elevada, cuyas características clínicas y epidemiológicas describimos. Material y método: estudio descriptivo retrospectivo de pacientes con complicaciones intracraneales secundarias a otitis media ingresados en nuestro hospital terciario durante el periodo abril de 2004-noviembre de 2007. Resultados: 8 pacientes han presentado CI: trombosis de seno sigmoideo (4), trombosis de seno lateral (1), meningitis (2), absceso epidural (1) e hidrocefalia otítica (1); 4 de los pacientes presentaban otomastoiditis. El 87,5% de los pacientes había recibido antibioterapia oral previa a la complicación. Los síntomas más frecuentes fueron fiebre, otalgia, cefalea, parálisis del VI par y parálisis facial. Se aisló el germen causal en 3 pacientes: Streptococcus pyogenes (2) y Proteus mirabillis (1). Los demás pacientes tuvieron cultivos negativos. Se realizó mastoidectomía radical en 2 pacientes y tratamiento médico con antibioterapia intravenosa de amplio espectro en todos los pacientes. Se produjo la curación sin secuelas en 6 casos y ninguna muerte. Conclusiones: hemos detectado un incremento en la frecuencia de CI secundarias a otitis media aguda. Para confirmarlo se requieren estudios prospectivos multicéntricos a fin de valorar si se ha producido un cambio epidemiológico en la incidencia de este tipo de complicaciones (AU)

Introduction: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. Material and method: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. Results: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. Conclusions: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events (AU)