Otogenic Intracranial Abscesses, Our Experience Over the Last Four Decades.

OBJECTIVE: To evaluate the predisposing factors for otogenic intracranial abscesses, assess their changes over time, and analyze how they differ from those due to other causes. MATERIALS AND METHODS: The medical records of all patients treated for otogenic intracranial abscesses, between 1970 and 2012 at a tertiary referral center, were retrospectively analyzed. The analysis included patient demographics, clinical characteristics, causative pathogens, treatments, outcomes, and comparisons of otogenic and non-otogenic intracranial abscesses. RESULTS: Of all intracranial abscesses, 11% (n=18) were otogenic. In the 1970s, otogenic infections were a common predisposing factor for intracranial abscess; but within our study period, the incidence of otogenic intracranial abscesses decreased. Most (94%) otogenic cases were due to chronic suppurative otitis media and 78% were associated with cholesteatoma. Most patients (94%) had ear symptoms. The most common presenting symptoms were discharge from the infected ear (50%), headache (39%), neurological symptoms (28%), and fever (17%). The most common pathogens belonged to Streptococcus spp. (33%), Gram-negative enteric bacteria (22%), and Bacteroides spp. (11%). Neurosurgery was performed on all patients, 69% of which were prior to a later ear surgery. Surgery of the affected ear was performed on 14 patients (78%). A favorable recovery was typical (78%); however, one patient died. CONCLUSION: Otogenic intracranial abscesses were most commonly due to a chronic ear infection with cholesteatoma. Ear symptoms and Gram-negative enteric bacteria were more common among patients with otogenic than non-otogenic intracranial abscesses.

Intracranial abscesses over the last four decades; changes in aetiology, diagnostics, treatment and outcome.

Background The development of modern medicine has resulted in changes in the predisposing conditions, clinical picture, treatment and results of treatment of intracranial abscesses. This study sought to evaluate these changes in a hospital district. Methods A retrospective analysis of the clinical data of all patients treated due to intracranial abscesses at a tertiary referral centre, between 1970-2012. Results The total number of intracranial abscesses was 166. The incidence of intracranial abscesses was 0.33/100 000/year (2000-2012). The most common predisposing conditions were infection of the ear-, nose- and throat region (22%), odontogenic infection (15%) and cardiac anomaly (13%). Lately (2000-2012), infections of the ear-, nose- and throat region (15%) and cardiac anomalies (5%) have become less common, whereas odontogenic infections (32%) have become more common. The most common pathogens belong to Streptococcus spp (42%), Fusobacteriae (14%), Actinomycetales (8%) and Staphylococcus spp (8%). Most patients (66%) experienced a favourable recovery; the proportion of patients with favourable outcome enabling return to prior occupation rose over time, from 12% in 1970-1989 to 24% in 1990-2012. Conclusions The predisposing conditions for intracranial abscesses have changed markedly within the study period. Odontogenic infections have become a common predisposing condition, whereas infections of the ear-, nose- and throat region and cardiac malformations are nowadays less common as predisposing conditions compared to at the beginning of the study period. The proportion of patients with favourable outcome enabling return to prior occupation seems to have increased with time.

Complications of acute otitis media in children.

The clinical picture and the treatment of acute otitis media (AOM) and its complications have changed during the past decades. The availability of antibiotics has decreased the incidence of complications of AOM significantly. The treatment of complications of AOM is conservative in most cases. Mastoidectomy is needed when abscess-forming mastoiditis or intracranial complications develop. Although intratemporal and intracranial complications of AOM are rare today, they still cause morbidity, and need prompt treatment. Occasionally, permanent damage of the ear leads to hearing loss, vertigo, and sometimes, facial weakness. Antibiotic treatment has decreased the mortality associated with the complications of AOM, but it is still high in countries with developing health care systems. Early diagnosis and effective treatment of the complications are the bases for a good prognosis.

Complications of acute otitis media in children in southern Finland.

BACKGROUND: The incidence of intratemporal and intracranial complications of acute otitis media (AOM) has decreased and the need for operative treatment is declined in developed countries during the antibiotic era. OBJECTIVES: To establish the clinical picture, diagnostic procedures, outcome and current treatment of pediatric patients with intratemporal and intracranial complications of AOM. METHODS: A retrospective chart review with a sent questionnaire. All pediatric patients treated for intratemporal and intracranial complications of AOM over the past 10 years (1990-2000) at the Department of Otolaryngology in the Helsinki University Central Hospital. RESULTS: During the study period 33 children (incidence 1.1/100,000 per year), aged from 3 months to 14.2 years were treated for intratemporal [97% (32/33)] and intracranial [3% (1/33)] complications of AOM. Facial paresis was found in 9% (3/33) of the patients. The only intracranial complication was an extradural abscess with meningitis. Eighteen patients (55%) were on antibiotic treatment because of AOM prior to the diagnosis of complication. Neither the duration or severity of the signs and symptoms of infection at the time of admittance nor a lack of antibiotic treatment before admittance were statistically significantly associated with the need for mastoidectomy or duration of hospitalization. Streptococcus pneumoniae 25% (8/33) and Pseudomonas aeruginosa 22% (7/33) were the most frequently found bacteria in the culture of middle ear and mastoid effusions. Mastoidectomy was performed on 55% (18/33) of the patients. After half a year of follow-up, all the patients had normal hearing and facial function. CONCLUSIONS: Severe complications of AOM are rare today in southern Finland and the need for mastoidectomy has declined significantly. With early recognition and effective treatment of complications, the prognosis is good.

Alloiococcus otitidis in acute otitis media.

OBJECTIVE: The bacterium Alloiococcus otitidis has been found to be associated with otitis media with effusion (OME). When the culture method is used, its detection rate is low, whereas applying the polymerase chain reaction (PCR) yields significantly higher frequencies. This study was carried out to investigate the incidence of A. otitidis in children with acute otitis media (AOM). METHODS: Multiplex PCR was used to detect A. otitidis together with Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae in the middle ear effusions (MEEs) of 118 children with AOM. The clinical outcome of AOM and the bacterial findings of MEEs were compared. RESULTS: A. otitidis was detected in 25% (30 of 118) of the tested MEE samples. Children over 2 years of age had significantly more often A. otitidis-positive MEEs (37%; 22 of 59) than younger children (14%; 8 of 59) (chi-square test, P<0.01). There were no significant differences in the duration, clinical failures (after antibiotic treatment), or number of recurrences of AOM between the A. otitidis-positive and A. otitidis-negative children. CONCLUSIONS: A. otitidis is found from the MEEs of AOM. The present data suggest that it has no clinical significance in AOM, and it does not increase the risk of developing OME after AOM.

Acute mastoiditis caused by Moraxella catarrhalis.

Acute mastoiditis is the most frequent intratemporal complication of otitis media. The bacteriology of acute otitis media is changing continuously and it differs markedly from the bacteriology of acute mastoiditis. Moraxella catarrhalis (M. catarrhalis) is the third most common bacteria found in acute otitis media, and in recent years its importance as an etiological factor of acute otitis media has markedly increased in certain geographic areas. However, there are no reports of acute mastoiditis caused solely by M. catarrhalis. This report describes a case of a 2-year-old girl with acute mastoiditis and M. catarrhalis in the bacterial culture of middle ear effusion.

The clinical role of Alloiococcus otitidis in otitis media with effusion.

OBJECTIVE: To investigate the presence of Alloiococcus otitidis (A. otitidis) in MEEs from patients with otitis media with effusion (OME) using PCR and to correlate the findings with the clinical picture of children with OME for assessing the clinical role of A. otitidis in OME. METHODS: Bacterial culture and PCR were used to detect A. otitidis, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in MEE samples from 123 patients with OME. The culture and PCR results and the clinical picture of the patients were compared. RESULTS: Bacteria were cultured in 55 (45%) of the 123 MEEs, and major pathogens (S. pneumoniae, H. influenzae and M. catarrhalis) were found in 40 (33%); A. otitidis was not found in culture. PCR of the MEEs yielded positive results for one or more of the four tested pathogens in 108 (88%) of the samples and 25 (20%) were positive for A. otitidis. The effusions that persisted 3 months or longer had a higher prevalence of A. otitidis than those with shorter durations (P=0.03). A. otitidis was found to be more often positive in PCR in mucoid MEEs than in mucoserous MEEs (30 vs. 9%; P=0.015). CONCLUSIONS: While A. otitidis is extremely difficult to detect with bacterial culture, PCR provides a sensitive and specific means for detecting it. A. otitidis is associated with a more prolonged course and mucoid MEEs in OME. Thus, its existence seems to be related to a more chronic stage of OME, but its pathogenic potential should be the subject of further investigation.