RESUMO
Primary tuberculous otomastoiditis is a rare condition. Mastoiditis is an infection of the mastoid part of the temporal bone that often happens as a complication of otitis media. The spread of infection from the middle ear and mastoid to adjacent structures might result in rare but serious complications. We present a case of an 8-year-old female with recurrent episodes of acute otitis media and foul-smelling yellowish discharge with hearing loss. Imaging revealed multiple abscesses. Intraoperatively, samples were taken from the abscesses and sent for complete analysis revealing a tuberculous infection. A diagnosis of primary Mycobacterium tuberculosis (MTB) otomastoiditis was made using MTB polymerase chain reaction from the Bezold's abscess. The patient was started on anti-MTB therapy. Follow-up imaging showed resolution of abscesses and otomastoiditis. An indolent course of otitis media along with poor response to conventional antibiotics regimen should raise the suspicion of rare and unusual infectious etiologies.
RESUMO
BACKGROUND: Rhinosinusitis (RS) is a term used in clinical practice to describe inflammation of the paranasal and nasal sinuses. This condition can be categorized based on the duration of symptoms into acute, subacute, and chronic RS. It is important to note that RS presents differently in pediatric patients compared to adults. In children, typical symptoms include cough, bad breath (halitosis), irritability, fatigue, and swelling around the eyes. This study aims to shed light on the prevalence and clinical characteristics of RS in the pediatric age group. METHODS: This retrospective cohort study was conducted at King Abdullah Specialized Children's Hospital (KASCH) in Riyadh, Saudi Arabia, which is a tertiary care center under the authority of the Ministry of National Guard Health Affairs (MNGHA) in Saudi Arabia, using the medical records of all patients diagnosed with RS between 2019 and 2022. RESULTS: In this study, 345 pediatric patients with RS were examined. A significant portion (n = 106, 30.7%) were older than 12 years, and males made up the majority (n = 210, 60.9%). Chronic RS without nasal polyps prevailed (n = 299, 86.7%), mainly affecting the maxillary sinus (n = 200, 58%). Notably, 29% (n = 100) were diagnosed after age 12. Key symptoms included nasal congestion (n = 233, 67.5%), nasal discharge (n = 202, 58.6%), and facial discomfort (n = 191, 55.4%). Most (n = 314, 91%) received medical treatment, resulting in improvement for 78.8% (n = 272). Of those not improving (n = 73, 21.2%), 47.9% (n = 35) received medical management, and the rest underwent surgery, primarily functional endoscopic sinus surgery (n = 38, 52.1%). CONCLUSION: RS is a common condition affecting children, with symptoms like nasal obstruction, discharge, and facial discomfort. Chronic RS, particularly in the maxillary sinus, is the most prevalent type. Medical treatment was the first choice and generally effective, but when needed, surgical intervention, mainly functional endoscopic sinus surgery, was pursued.
