Single stage, transmastoid approach for otogenic intracranial abscess

2009 ◽  
Vol 123 (11) ◽  
pp. 1216-1220 ◽  
Author(s):  
K P Morwani ◽  
N Jayashankar
Keyword(s):  
Senior Author ◽  
Single Stage ◽  
Research Centre ◽  
Cerebrospinal Fluid Leakage ◽  
Case Review ◽  
Intracranial Abscess ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Transmastoid Approach

AbstractObjective:To evaluate the treatment of intracranial abscess of otogenic origin, and to study the outcome measures of single stage treatment of the otogenic focus and drainage of intracranial abscess via a transmastoid approach.Study design:Retrospective case review.Setting:Dr Balabhai Nanavati Hospital and Medical Research Centre, Mumbai, India, an academic tertiary referral centre, and Shri H Bhagwati Municipal General Hospital, Mumbai, India, an academic secondary referral centre.Patients:Seventy-three patients with intracranial abscess secondary to otogenic pathology, confirmed by computed tomographic scanning.Intervention:Single stage treatment of the ear pathology and drainage of intracranial abscess via a transmastoid approach, performed by the senior author (KPM).Results:Of the 73 patients, 12 were lost to follow up and were excluded from the study. Outcomes for the remaining 61 patients were known, and these patients were followed up for at least two years. Adults were more commonly affected by otogenic intracranial abscess than children, with a male preponderance. Otogenic intracranial abscess was associated with both cholesteatomatous (41 per cent) and non-cholesteatomatous ears (59 per cent). All cases were treated with transmastoid drainage of the intracranial abscess and canal wall up or down tympanomastoidectomy, depending on the ear pathology. Two cases developed post-operative cerebrospinal fluid leakage (3 per cent), and another two cases developed meningitis (3 per cent). Five patients had recurrent abscess; two of these patients (3 per cent) died but were included in the study. Three patients had residual abscess, improved with additional management.Conclusion:In this series, the low morbidity and mortality rate, combined with a shorter hospital stay, suggest that single stage, transmastoid drainage of intracranial abscess and concurrent treatment of the otogenic pathology is an effective treatment for otogenic intracranial abscess.

Otomastoiditis caused by non-tuberculous mycobacteria: report of 16 cases, 3 with infection intracranially

2015 ◽  
Vol 129 (7) ◽  
pp. 644-655 ◽  
Author(s):  
L Lundman ◽  
H Edvardsson ◽  
K Ängeby
Keyword(s):  
Antibiotic Treatment ◽  
Relevant Literature ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Mycobacterium Fortuitum ◽  
Case Review ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Medical Interventions

AbstractObjective:To analyse the clinical presentation, treatment and outcome in patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria.Methods:A retrospective case review of 16 patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria from 2000 to 2012 was conducted in a hospital and tertiary referral centre in Sweden. The main outcome measures were microbiology findings, and surgical and medical interventions and outcomes. In addition, the relevant literature was reviewed.Results:In three patients with otomastoiditis, the disease had spread intracranially. The bacteriological findings revealed Mycobacterium abscessus (n = 12), Mycobacterium fortuitum (n = 2) and Mycobacterium avium complex (n = 2). Surgical treatment was undertaken in all but three patients, including exploration of the temporal lobe in one patient. Systemic antibiotic treatment was given to all but one patient. Eight patients healed completely. Eight patients developed hearing loss. Two patients had relapse of the mycobacterial infection several months after the antibiotic treatment had been discontinued.Conclusion:Non-tuberculous otomastoiditis is a severe ear disease with challenging considerations, and should be treated aggressively in order to avoid morbidity.

Maturation sutures for the paediatric tracheostomy – an extra safety measure

2005 ◽  
Vol 119 (12) ◽  
pp. 985-987 ◽  
Author(s):  
M F Craig ◽  
Y Bajaj ◽  
B E J Hartley
Keyword(s):  
Late Complications ◽  
Case Note ◽  
Safety Measure ◽  
Complication Rates ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Fatal Complication ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Case Note Review

Objective: Displacement of the tracheostomy tube in paediatric patients is a potentially fatal complication. We describe an extra safety measure which facilitates tube replacement.Setting: Tertiary referral specialist paediatric centre.Materials and methods: The method involves the placement of sutures between the anterior tracheal wall and skin to hasten the formation of a mature stoma (maturation sutures). We also undertook a retrospective case note review on patients from an academic tertiary referral centre. Thirty-five notes were reviewed. The most common indication for tracheostomy was airway obstruction (65 per cent). Fourteen patients had early and 10 had late complications with three tube displacements occurring. No added complications due to the use of sutures were found.Conclusions: Our complication rates compare well with those in the literature, and we recommend considering the use of such a technique.

Acute mastoiditis in children: contemporary opportunities and challenges

2020 ◽  
Vol 134 (5) ◽  
pp. 434-439
Author(s):  
M Mather ◽  
S Powell ◽  
P D Yates ◽  
J Powell
Keyword(s):  
Sinus Thrombosis ◽  
Acute Otitis Media ◽  
Case Review ◽  
Acute Mastoiditis ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Median Hospital Stay ◽  
Surgical Interventions ◽  
North East ◽  
Median Hospital

AbstractBackgroundMastoiditis is the most common intra-temporal complication of acute otitis media. Despite potentially lethal sequelae, optimal management remains poorly defined.MethodA retrospective case review was conducted of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017.ResultsFifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0–27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred.ConclusionA detailed contemporary description of paediatric mastoiditis presentation and management is presented. The findings broadly mirror those published by other UK centres, but suggest a higher rate of identified disease complications and surgical interventions.

Manubrio-stapedioplasty: new surgical technique for malleus and incus fixation due to tympanosclerosis

2015 ◽  
Vol 129 (6) ◽  
pp. 587-590 ◽  
Author(s):  
L Sennaroglu ◽  
V Gungor ◽  
G Atay ◽  
S Ozer
Keyword(s):  
Glass Ionomer Cement ◽  
Glass Ionomer ◽  
Case Review ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Hearing Results ◽  
Conductive Hearing ◽  
Ionomer Cement ◽  
New Surgical Technique

AbstractObjective:This paper reports the authors' technique of manubrio-stapedioplasty using glass ionomer cement for malleus and incus fixation due to tympanosclerosis.Methods:A retrospective case review was conducted of five patients with conductive hearing loss (mean pre-operative air–bone gap of 42.75 dB) treated in a tertiary referral centre. The hearing results of a manubrio-stapedial bone cement ossiculoplasty technique, utilised on the five patients, were analysed. All cases were Wielinga and Kerr tympanosclerosis classification type 2 (attic fixation of the malleus-incus complex with a mobile stapes). The incus and head of the malleus were removed in all patients, and the manubrium was directly connected to the head of the mobile stapes using glass ionomer cement. Patients were evaluated in terms of pre- and post-operative audiometric results; hearing gain and post-operative air–bone gap were the main outcome measures.Results:Mean post-operative air–bone gap was 5.25 dB. Four patients had an air–bone gap of less than 10 dB; the remaining patient had an air–bone of 12.50 dB.Conclusion:Manubrio-stapedioplasty is an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.

Pre-operative overnight pulse oximetry to predict high dependency unit intervention in children undergoing adenotonsillectomy for obstructive sleep apnoea

2014 ◽  
Vol 128 (4) ◽  
pp. 360-364 ◽  
Author(s):  
K A Lightbody ◽  
A J Kinshuck ◽  
A J Donne
Keyword(s):  
Pulse Oximetry ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
High Dependency Unit ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
High Dependency ◽  
Obstructive Sleep ◽  
Case Note Review

AbstractBackground:Post-operative high dependency unit beds are often requested for patients undergoing adenotonsillectomy for obstructive sleep apnoea. This study evaluated the utilisation of high dependency unit beds for such cases at our institution, a paediatric tertiary referral centre.Method:A retrospective case note review of patients admitted to the high dependency unit following adenotonsillar surgery for obstructive sleep apnoea, over a two-year period, was performed.Results:Sixty-six cases were identified. Thirty-nine patients underwent pre-operative overnight pulse oximetry; of these, 30 patients had desaturations noted. Seventeen patients had significant post-operative desaturations. These were predicted in all 11 patients who had undergone pre-operative pulse oximetry. The remaining six had not undergone pre-operative pulse oximetry. Nineteen patients required high dependency unit care; eight had experienced post-operative desaturations.Conclusion:High dependency unit care may be required following adenotonsillectomy for obstructive sleep apnoea. In this study, pre-operative overnight pulse oximetry had 100 per cent sensitivity in predicting post-operative desaturations, and may therefore aid the appropriate utilisation of high dependency unit beds for patients undergoing adenotonsillectomy for obstructive sleep apnoea.

scholarly journals Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

2015 ◽  
Vol 172 (3) ◽  
pp. 243-250 ◽  
Author(s):  
L A Behan ◽  
M Sherlock ◽  
P Moyles ◽  
O Renshaw ◽  
C J T Thompson ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Plasma Sodium ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Significant Incidence ◽  
Cranial Diabetes Insipidus ◽  
Vasopressin Analogues

Context and objectivePatients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst.DesignThe study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis.ResultsA total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa+ 131–134 mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa+ ≤130 mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, P=0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02).ConclusionOPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.

Delayed-onset haematoma formation after cochlear implantation

2017 ◽  
Vol 131 (8) ◽  
pp. 684-687 ◽  
Author(s):  
W-K Low ◽  
S Xu
Keyword(s):  
Cochlear Implantation ◽  
Needle Aspiration ◽  
Predisposing Factors ◽  
Cerebrospinal Fluid Leakage ◽  
Case Review ◽  
Retrospective Case ◽  
Incision And Drainage ◽  
Delayed Onset ◽  
Cochlear Implant Surgery ◽  
Haematoma Formation

AbstractObjective:This paper presents our experience on delayed-onset haematoma formation after cochlear implantation, a topic which has not been well discussed in the literature.Method:Retrospective case review study.Results:Five children who had undergone cochlear implant surgery at 1.5 to 4 years of age (median, 2.5 years) were studied. The haematoma episodes occurred 2–12 years (median, 6 years) after cochlear implantation. Two patients had recurrent episodes. Two of the seven haematoma episodes were managed by needle aspiration alone, four by incision and drainage alone, and one by both needle aspiration and incision and drainage. Other than one patient with coagulopathy, there were no obvious predisposing factors, including trauma.Conclusion:The majority of delayed-onset haematomas occurred without obvious predisposing factors. Needle aspiration can differentiate a haematoma from an abscess or cerebrospinal fluid leakage, and it provides an effective immediate therapeutic solution. However, aseptic techniques are emphasised to minimise the chances of an uncomplicated haematoma converting into a septic one.

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