Presentation, diagnosis and management of neck abscesses in children.

UNLABELLED: The aim of the study was to analyze the presenting signs and symptoms, diagnostic procedures, clinical course, pathogenic organisms and management of neck abscesses in children. MATERIALS AND METHODS: This retrospective medical records review comprised of 51 pediatric cases referred because of neck abscess from 2001 to 2014. Medical records of the patients were reviewed for demographic data, clinical presentation, treatment before referral, localization of the abscess, imaging evaluation, medical and surgical treatment, bacteriological data and complications. RESULTS: Average age of the patients was 4.9 years. 18 (35%) of the children were below one year of age. The submandibular was the most common area involved (41,2%). Contrast-enhanced computed tomography (CECT) was performed in 45% of patients mainly with deep neck abscesses. All CECT scans showed the fluid collections. In all but one of the patients treated surgically and diagnosed with ultrasound and/or CECT surgical intervention revealed presence of pus. The most common pathogen was Staphylococcus aureus- SA (78% of all isolates) of which 24% were methicillin resistant Staphylococcus aureus - MRSA. Clindamycin resistance was detected in 28% of all SA isolates and in 67% (4/6) of all MRSA isolates. All MRSA isolates were sensitive to vancomycin. CONCLUSIONS: CECT is reliable imaging technique for diagnosing deep neck abscesses in children. Infants with neck abscesses are at higher risk of having MRSA as offending pathogen which should be taken into consideration when considering empiric treatment. Vancomycin is recommended as empiric antibiotic therapy in newborns with neck abscess.

[Influence of tympanic membrane changes on immittance and extended frequency audiometric findings]. / Wplyw zmian strukturalnych blony bebenkowej na wyniki audiometrii impedancyjnej i tonalnej w rozszerzonym zakresie czestotliwosci.

INTRODUCTION: The aim of the study is to analyze the relationship between otoscopic tympanic membrane abnormalities, results of impedanace and extended-high-frequency audiometry in subjects with history of treatment of secretory otitis media (SOM) and ventilation tube insertion. MATERIAL AND METHODS: 97 subjects treated because of SOM were examined in years 1999-2000. Videootoscopic examinations, extended-high-frequency audiometry and tympanometry with ispilateral acoustic reflex were performed in each patient. The results were analysed in three groups: no otoscopic abnormalities (BZO), retraction pockets (KR) and atrophy and myringosclerosis (AM). The results were compared to otologicaly healthy control group in the same age. RESULTS: The most common tympanic membrane abnormality were focal atrophy (64.7%) of ears and myringosclerosis (37.2%). Mean pure-tone audiometric threshold were significantly higher in groups KR and AM than in control and BZO groups. Low degree of positive correlation was found between the presence of myringosclerosis and atrophy and audiometric thresholds above 1 kHz. No such correlation was observed with the presence of retraction pockets. In the BZO group middle ear admittance was observed significantly higher than in control group. The absent ipsilateral stapedial reflex was observed in 10.8% ears in BZO group, 16.9% in AM and 33.3% in KR. No correlation was found between the parameters of tympanometric evaluation and results of extended-high-frequency audiometry. CONCLUSIONS: In ears treated because of SOM with ventilation tube insertion the middle ear compliance is higher. In the presence of myringosclerosis and atrophy higher audiometric thresholds are observed. Tympanic membrane abnormalities have been more clearly indicated by the absent ipsilateral stapedial reflex than tympanometry.

[Long term sequelae of otitis media with effusion during childhood]. / Trwale nastepstwa wysiekowego zapalenia ucha w wieku dzieciecym.

INTRODUCTION: Otitis media with effusion is the most common cause of hearing loss in children and myringotomy with tympanostomy tube insertion is recommended procedure to deal with the problem. The objective of the present study was to determine the results of treatment, incidence and prevalence of middle ear sequelae and hearing results among children with chronic otitis media with effusion who received standard treatment with tympanostomy tubes. MATERIAL AND METHODS: The group of 97 patients treated by tympanostomy tubes insertion in the years 1999-2001 was reevaluated after mean period of follow up 7.3 years. At the control examination videootoscopy and audiologic examinations were performed. Audiological assessment consisted of tympanometry and pure-tone thresholds of air and bone conduction. RESULTS: Recurrent otitis media with effusion requiring tube insertion occurred during follow up period in 23.7% of patients. At the control examination 16.5% of children had an ongoing otitis media or ventilation tube in place or tympanic membrane perforation. Most common tympanic membrane abnormality were focal atrophy (67.2% of ears) and myringosclerosis (39.5%) followed by retraction pockets of pars flaccida (29.9%) and tensa (9.6%). Mean pure-tone audiometric threshold were significantly higher in ears with tympanic membrane abnormality by the difference did not excide 5dB HL in ears with focal atrophy and myringosclerosis and 6.5 dB HL in ears with retraction pockets. CONCLUSIONS: As the percentage of recurrences after tympanostomy tubes insertion are not uncommon prolonged period of follow up of those children is recommended. Although ventilation tubes have proven very effective in improving hearing in short term, they have not proven effective in preventing long-term sequelae of tympanic membrane and some degree of hearing loss. The decision about surgical treatment should be taken cautiously taking into account the chance of spontaneous resolution.