Characteristics of CI children with complicated middle ear infections.

OBJECTIVE: To describe cases of complicated middle ear infections in children with cochlear implants (CI), i.e., episodes of acute otitis media (AOM) and acute mastoiditis (AM), resulting in hospitalization. METHODS: A total of 206 children under 16 years (300 implantations) were implanted between 1 January 2008 and 31 December 2014 at the West Danish CI Center, Department of Otorhinolaryngology Head and Neck Surgery, Aarhus, Denmark. By means of two prospective local databases, episodes of AOM or AM and demographics were retrieved including biochemistry, microbiology, length of follow- up, and variable treatment modalities (intravenous (IV) antibiotics, revision mastoidectomy, and insertion of ventilation tubes). RESULTS: Overall rate of AOM and/or AM was 9.2% (AOM: 9%, AM: 1.9%). Mean age at CI was 46 months. Mean follow-up was 45 months. Mean time from CI operation to AOM or AM was 3 and 4 months, respectively. Children younger than 2 years were at highest risk of AOM and/or AM. All had antibiotics prescribed before admittance, and two- thirds of infected ears had already ventilation tubes inserted. Bacteria could not be detected in more than half of cases. The most frequently isolated strains were pneumococci and nontypable Haemophilus influenzae. The majority of patients were successfully treated with IV cefuroxime (64% of cases) and insertion of ventilation tubes. None of the children developed facial nerve paralysis, intracranial infections, or septicemia. DISCUSSION: Almost 10% of CI children required at least one hospitalization due to AOM and/or AM compared with 0.1 per thousand of non-CI children. This discrepancy can be explained by a low threshold for active treatment of otitis media in CI children and hence referral to a CI center. The results suggest that benzylpenicillin might be an appropriate initial treatment of AOM and AM. However, cephalosporin was the most preferred antibiotic. Most CI children were already treated with ventilation tubes at admission and almost all children without ventilation tubes, had a tube inserted during admission. Insertion of ventilation tubes is still much debated and more research in this field is needed. CONCLUSION: AOM and/or AM were seen in Danish children with CI as often as in other western countries. Treatment of complicated middle ear infections was sufficient with IV cephalosporin and ventilation tube insertion. Special attention should be paid to children younger than 4 years and the associated microbiology including serotyping should be monitored.

Pain and bleeding are the main determinants of unscheduled contacts after outpatient tonsillectomy.

INTRODUCTION: The objective of this prospective cohort study was to measure the medical technical quality of outpatient tonsillectomy in Danish ear, nose & throat practices by indicators, standards and prognostic factors. MATERIAL AND METHODS: According to standardised and validated specific questionnaires, quality of surgery was measured in terms of postoperative bleeding, pain, gastrointestinal problems and infection. RESULTS: A total of 614 patients were included. 11% were younger than four years, and 93% were observed for less than four hours. A total of 23% had unscheduled postoperative contacts. Almost 12% of the patients contacted a physician due to pain; a percentage that exceeds the chosen standard of 10%. 4% were hospitalised due to bleeding exceeding the chosen standard of 1%. Secondary haemostatic procedures were performed in 2% of the patients. The indication chronic tonsillitis, being an adult, and a postoperative observation shorter than four hours increased the risk of unscheduled contacts. CONCLUSION: Outpatient tonsillectomy seems safe in Denmark. A minimum postoperative observation period of four hours will reduce the need for postoperative contacts. Because of the potentially life-threatening risk related to tonsillectomy, careful patient selection is mandatory and continuous monitoring of the quality of the procedure is essential. FUNDING: Not relevant. TRIAL REGISTRATION: Not relevant.

[Quality of outpatient tonsillectomy performed in ear, nose & throat practice]. / Kvaliteten af ambulant tonsillektomi udført i øre-naese-hals-praksis. Udvikling og valg af indikatorer, standarder og prognostiske faktorer.

In Danish healthcare there are increasing demands in the field of hospital care on performance and outcome measurement and quality improvement in relation to a number of diseases. Hitherto, corresponding measurements of quality have not been carried out among private specialized practitioners. The present project describes the development and selection of evidence-based national indicators, standards, and case mix factors in terms of prognostic factors with the purpose of measuring quality of out-patient tonsillectomy in Danish ear, nose & throat practices.