RESUMO
OBJECTIVES: To characterize the clinical presentation of pediatric patients who, upon AM diagnosis, also had imaging-diagnosed ICCs (ID-ICCs); to define the group of AM patients at risk of developing ID-ICCs; and to update knowledge about organisms causing AM. STUDY DESIGN: Analysis of all AM patients admitted between 1997 and 2018 and treated according to an obligatory protocol including both brain imaging and sampling for bacterial culture upon clinical diagnosis of AM. RESULTS: Of 166 admitted patients (0.5-19 years old) 22 (13%) already had ID-ICCs. In patients who, on admission, had already received antibiotics for acute otitis media (AOM) and also had CRP (C-reactive protein) levels above 93.5â¯mg/L, the risk of ID-CC was increased by 22.5-fold (Pâ¯<â¯0.0001). Bacterial culture results were available for all patients and were positive in 115 (69%). Organisms most commonly found in patients without prior antibiotic treatment were group A Streptococcus pyogenes (53%), Streptococcus pneumoniae (23%), and Haemophylus influenzae (11%), while with prior antibiotic treatment they were Fusobacterium necrophorum (21%), Streptococcus pyogenes (18%) and Pseudomonas aeruginosa (18%). CONCLUSIONS: Since the risk of ID-ICC in patients with the abovementioned CRP and prior antibiotic treatment was significantly higher than in the others, these high-risk patients should undergo diagnostic imaging on admission. Antibiotic treatment prior to AM development may promote growth of non-AOM pathogen.
Assuntos
Antibacterianos/uso terapêutico , Mastoidite/diagnóstico , Mastoidite/terapia , Doença Aguda , Adolescente , Criança , Pré-Escolar , Protocolos Clínicos , Feminino , Fusobacterium necrophorum , Hospitalização , Humanos , Lactente , Masculino , Mastoidite/microbiologia , Otite Média/tratamento farmacológico , Otite Média/microbiologia , Pseudomonas aeruginosa , Estudos Retrospectivos , Streptococcus pneumoniae , Streptococcus pyogenes , Resultado do Tratamento , Adulto JovemRESUMO
Schwannomas of the nasal cavity are extremely rare. We evaluated a 42-year-old woman who presented with a 4-year history of slowly progressive nasal obstruction. The cause of the obstruction was identified as a schwannoma in the left inferior turbinate. The tumor was completely excised, and no sign of recurrence was evident at the 1-year follow-up. To the best of our knowledge, this is only the third case of a schwannoma originating in the inferior nasal turbinate that has been reported in the English-language literature. We review the clinical and pathologic features of this case.
