Paediatric acute mastoiditis: the Alder Hey experience

2002 ◽  
Vol 116 (6) ◽  
pp. 440-442 ◽  
Author(s):  
S. De ◽  
Z. G. G. Makura ◽  
R. W. Clarke
Keyword(s):  
Retrospective Study ◽  
Conservative Treatment ◽  
Clinical Management ◽  
Surgical Intervention ◽  
Common Condition ◽  
Acute Mastoiditis ◽  
Cortical Mastoidectomy ◽  
Intravenous Antibiotics ◽  
One Year ◽  
Alder Hey

Acute mastoiditis was a common condition in the pre-antibiotic era, but has become rare now with the widespread use of antibiotics.A retrospective study was carried out of patients with acute mastoiditis who were seen at Alder Hey Children’s Hospital, Liverpool over a five-year period. Their case records were identified and details of gender, age at presentation, symptoms, signs and clinical management were noted and analysed.Twenty-one patients who presented with acute mastoiditis were identified. The patients’ age at presentation ranged from three months to 14 years. Five cases out of 21 (23.8 per cent) were under one year of age.Eighteen cases (85.7 per cent) presented with post-aural swelling while 12 (57.1 per cent) had aural discharge.All patients were treated with intravenous antibiotics and only five patients (23.8 per cent) required surgical intervention in the form of a cortical mastoidectomy with, or without, myringotomy.A significant number of cases can be treated conservatively with intravenous antibiotics. Surgery in the form of cortical mastoidectomy can be reserved for complicated cases and in those in whom conservative treatment has failed.

Does Hydrogen Peroxide Mouthwash Improve the Outcome of Secondary Post-Tonsillectomy Bleed? A 10-year Review

2005 ◽  
Vol 133 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Irumee Pai ◽  
Stephen Lo ◽  
Satsuki Brown ◽  
Abbad G. Toma
Keyword(s):  
Hydrogen Peroxide ◽  
Retrospective Study ◽  
Study Design ◽  
Broad Spectrum ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Control Group ◽  
Intravenous Antibiotics ◽  
The Common

Objective: To determine whether hydrogen peroxide (H2O2) mouthwash influences the outcome of secondary post-tonsillectomy hemorrhage in children. Study Design: Ten-year retrospective study of all children with secondary post-tonsillectomy hemorrhage. Setting: Tertiary otolaryngology center. Results: Of the 156 patients, 59 received H2O2 and 97 did not. All patients received broad-spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H2O2 group) and 1.6 days (control group). In the H2O2 group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H2O2 group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration ( P = 0.49), rate of surgical intervention ( P = 0.85), and rate of readmission with further hemorrhage ( P = 0.92). Conclusion: Hydrogen peroxide mouthwash does not improve the outcome of secondary post-tonsillectomy hemorrhage in pediatric patients. Significance: This study does not support the common practice of treating post-tonsillectomy hemorrhage with H2O2.

The plantar transverse incisional approach for heel spur syndrome. A retrospective study

1999 ◽  
Vol 89 (11) ◽  
pp. 560-570
Author(s):  
D Thornton ◽  
AL Ruelle
Keyword(s):  
Retrospective Study ◽  
Conservative Treatment ◽  
Plantar Fasciitis ◽  
Surgical Intervention ◽  
Patient Records ◽  
Heel Spur ◽  
Perioperative Course ◽  
Surgical Treatments

The efficacy of the transverse plantar incisional approach for the treatment of recalcitrant heel spur syndrome or plantar fasciitis was investigated by evaluating cases of this procedure performed by the authors from 1991 to 1998. Patient records were reviewed for conservative treatment rendered prior to surgical intervention as well as for the perioperative course of the patient. All patients were asked to complete questionnaires regarding their heel spur syndrome or plantar fasciitis and their opinion of both the conservative and the surgical treatments received.

Acute mastoiditis in children: presentation and long term consequences

2007 ◽  
Vol 122 (3) ◽  
pp. 233-237 ◽  
Author(s):  
F Glynn ◽  
L Osman ◽  
M Colreavy ◽  
H Rowley ◽  
T P O Dwyer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Previous History ◽  
Acute Otitis Media ◽  
Cell System ◽  
Acute Mastoiditis ◽  
Subperiosteal Abscess ◽  
Lack Of Information ◽  
Cortical Mastoidectomy ◽  
One Year

AbstractAcute mastoiditis, a destructive bacterial infection of the mastoid bone and air cell system, is relatively uncommon today but remains a potentially serious condition. There is a lack of information in the literature regarding the long term otological problems that children may face following an episode of this condition.Objectives:Our aim was to examine the presentation, complications and hospital course in this patient population, and to ascertain whether these patients had long term otological problems.Methods:We retrospectively reviewed the medical records of all patients presenting with acute mastoiditis between January 1990 and December 2005. Patients' parents were contacted by telephone and questioned about further otological problems.Results:Twenty-nine patients were included in the study, and 27 of these patients' parents were contactable to complete the telephone questionnaire. Sixty-nine per cent of children had no previous history of acute otitis media prior to presentation. Forty-five per cent of patients had received oral antibiotics prior to presentation. Sixty-two per cent of patients developed complications, i.e. a subperiosteal abscess or failure to respond to medical therapy, resulting in the need for surgical intervention (in the form of incision and drainage of periosteal abscess, cortical mastoidectomy, or grommet insertion). Mean follow up of patients was eight years and one month; five (17 per cent) patients had been followed up for less than one year. Two (7 per cent) patients developed a further episode of mastoiditis within six weeks of initial presentation, both of whom required cortical mastoidectomy. Three (10 per cent) patients had further problems with recurrent acute otitis media, requiring tympanostomy tube insertion. One patient required a modified radical mastoidectomy for cholesteatoma (15 years later). Twenty-two patients (91 per cent) had been followed up for longer than one year; these patients had subjectively normal hearing and were asymptomatic at the time of study.Conclusion:The majority of patients who had suffered an episode of acute mastoiditis had no adverse long term otological sequelae.

scholarly journals Brief resolved unexpected event: prevalence, etiology and epidemiologic characteristics in Lebanon. a retrospective study of hospitalizations in a tertiary-care center

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Stephanie Antoun ◽  
Sandra Sabbagh
Keyword(s):  
Retrospective Study ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Chief Complaint ◽  
Common Condition ◽  
Esophageal Reflux ◽  
Unexpected Event ◽  
One Year ◽  
Epidemiologic Characteristics

Objective: A Brief Resolved Unexplained Event (BRUE) is a common condition in infancy. However, no epidemiological study has been undergone in Lebanon. This study aims to establish the prevalence and the characteristics of the population hospitalized after a BRUE. Material and methods: A single-center retrospective study performed from 1998 to 2018 included 156 hospitalized infants, aged less than one year old, in a tertiary medical center. Data were collected from hospital archives. Results: Most infants (92.9%) hospitalized after a BRUE were aged less than 6 months old, with a slight masculine predominance (52.6%). No pathognomonic symptom was identified. In terms of recurrence of the initial episode, it occurred in 55.1% of the cases. A transfer to a reanimation unit took place in 35.9% of patients, with an average stay of 6.3 days. Two infants were deceased and six were readmitted for the same chief complaint. Final confirmed diagnosis was a Gastro-Esophageal Reflux (GER) in 60.9%. Consequently, a milk change occurred in 17.9% and a GER treatment in 65.4%. Conclusion: Infants younger than one year and hospitalized for a BRUE present a majority of confirmed GER diagnosis, and seem to have an excellent prognosis.

Ganglions of the foot and ankle. A retrospective analysis of 63 procedures

1999 ◽  
Vol 89 (4) ◽  
pp. 163-168 ◽  
Author(s):  
J Pontious ◽  
J Good ◽  
SH Maxian
Keyword(s):  
Retrospective Study ◽  
Statistical Analysis ◽  
Conservative Treatment ◽  
Retrospective Analysis ◽  
Significant Relationship ◽  
Surgical Intervention ◽  
Foot And Ankle ◽  
Temple University ◽  
Surgical Recurrence ◽  
Ganglion Cysts

A retrospective study was conducted to evaluate treatment of foot and ankle ganglion cysts seen at the Foot and Ankle Institute at the Pennsylvania College of Podiatric Medicine (now Temple University School of Podiatric Medicine). From 1990 to 1997, 63 patients (63 ganglion cysts) were treated by conservative or surgical means. Statistical analysis of data collected showed a significant relationship between type of treatment received and recurrence of the cyst. Surgical intervention resulted in significantly less recurrence (11%) than conservative treatment (63%). Regardless of whether treatment was conservative or surgical, there was no significant relationship between location of the cyst and recurrence. The type of conservative treatment was not significantly related to recurrence of the cyst. The surgical recurrence rate reported here is comparable to that reported in other studies of foot and ankle ganglion cysts. The number of foot and ankle ganglion cysts evaluated in this study is the largest in the literature.

Bilateral acute mastoiditis and subperiosteal abscesses in a child managed by simultaneous bilateral mastoid surgery

2012 ◽  
Vol 126 (8) ◽  
pp. 825-829 ◽  
Author(s):  
I F Hathorn ◽  
S S M Hussain
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Free Field ◽  
Hearing Threshold ◽  
Successful Management ◽  
Acute Mastoiditis ◽  
Cortical Mastoidectomy ◽  
Intravenous Antibiotics ◽  
Simultaneous Surgery ◽  
Mastoid Surgery

AbstractObjective:We report a case of bilateral acute mastoiditis and subperiosteal abscesses successfully managed with simultaneous surgery.Method:A case report and literature review are presented.Results:A two-year-old boy presented with fever, otalgia, otorrhoea and bilateral protruding ears. He was treated for 72 hours with intravenous antibiotics but failed to improve. Computed tomography confirmed bilateral mastoid abscesses with destruction of the mastoid cortex. Bilateral drainage of the subperiosteal abscesses and bilateral cortical mastoidectomies were carried out. Post-operatively, he recovered well, and free field audiometry showed a normal hearing threshold of 20 dB across all test frequencies.Conclusion:This is only the second reported case of bilateral mastoiditis and subperiosteal abscesses. This case illustrates the use of bilateral cortical mastoidectomy in the successful management of this condition following failed antibiotic therapy, and highlights important management considerations.

Acute mastoiditis in children: is surgical treatment necessary?

1999 ◽  
Vol 113 (12) ◽  
pp. 1081-1085 ◽  
Author(s):  
R. Cohen-Kerem ◽  
N. Uri ◽  
H. Rennert ◽  
N. Peled ◽  
E. Greenberg ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Middle Ear ◽  
Surgical Intervention ◽  
Bacterial Pathogen ◽  
Acute Mastoiditis ◽  
Abscess Drainage ◽  
Ear Infection ◽  
Middle Ear Infection ◽  
Intravenous Antibiotics

AbstractAcute mastoiditis in children remains an otological problem. Although the widespread use of antibiotics has reduced the need for surgical intervention, surgery is frequently used in the treatment of acute mastoiditis and its complications. The charts of 44 patients hospitalized with signs of acute mastoiditis were reviewed. In 43.2 per cent of all patients, acute mastoiditis was the presenting sign of acute middle-ear infection. Post-auricular erythema and protrusion of the auricle were the most frequent signs at presentation. All four signs (post-auricular erythema, oedema, tenderness, and protrusion of the auricle) were present in 40.9 per cent of patients. No bacterial pathogen was isolated in 45.5 per cent of ear cultures. Complicated acute mastoiditis was diagnosed in 13.7 per cent of the patients. Eighty-seven per cent of patients responded well to intravenous antibiotics and myringotomy, and in 11.4 per cent mastoidectomy or abscess drainage were performed. We conclude that nearly all patients with uncomplicated mastoiditis recover following intravenous antibiotics and myringotomy. Mastoidectomy should be perfonned in selected cases, such as cases of complicated acute mastoiditis.

Paediatric acute mastoiditis, then and now: is it more of a problem now?

2015 ◽  
Vol 129 (10) ◽  
pp. 955-959 ◽  
Author(s):  
B Attlmayr ◽  
S Zaman ◽  
J Scott ◽  
S G Derbyshire ◽  
R W Clarke ◽  
...  
Keyword(s):  
Historical Data ◽  
Surgical Intervention ◽  
Paediatric Population ◽  
Resonance Imaging ◽  
Acute Mastoiditis ◽  
Retrospective Case ◽  
Historical Cohort ◽  
Intracranial Complications ◽  
Alder Hey ◽  
Case Note Review

AbstractBackground:Acute mastoiditis is a significant cause of morbidity in the paediatric population. This paper reviews our experience with this condition over the last 10 years and compares it with historical data from Alder Hey Children's Hospital, Liverpool, UK.Method:A retrospective case note review of patients who presented between 2003 and 2012 was performed.Results:Forty-six patients with acute mastoiditis were identified. Imaging with computed tomography and magnetic resonance imaging was carried out in 14 cases (30.4 per cent). Intracranial complications were identified in six patients (13.0 per cent), one of whom required neurosurgical intervention. In 27 cases (58.7 per cent), a surgical procedure was performed. Data from 1995 to 2000 revealed similar rates of imaging (30.0 per cent), but significantly lower rates of surgical intervention (23 per cent). A lower rate of intracranial complications (4.8 per cent) in the historical cohort did not prove to be statistically significant (p = 0.419).Conclusion:The numbers of paediatric patients presenting with acute mastoiditis appears essentially unchanged. Improvement in imaging technology and aids to interpretation may explain the apparent increase of intracranial complications.

Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study

2019 ◽  
Vol 31 (2) ◽  
pp. 271-278 ◽  
Author(s):  
Narihito Nagoshi ◽  
Osahiko Tsuji ◽  
Daisuke Nakashima ◽  
Ayano Takeuchi ◽  
Kaori Kameyama ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Surgical Intervention ◽  
Lesion Size ◽  
Sudden Onset ◽  
Neurological Function ◽  
Neurological Injury ◽  
Prognostic Indicators ◽  
Asymptomatic Patients ◽  
Surgical Data ◽  
Unstable Gait

OBJECTIVEIntramedullary cavernous hemangioma (CH) is a rare vascular lesion that is mainly characterized by the sudden onset of hemorrhage in young, asymptomatic patients, who then experience serious neurological deterioration. Despite the severity of this condition, the therapeutic approach and timing of intervention for CH remain matters of debate. The aim of this study was to evaluate the clinical characteristics of CH patients before and after surgery and to identify prognostic indicators that affect neurological function in these patients.METHODSThis single-center retrospective study included 66 patients who were treated for intramedullary CH. Among them, 57 underwent surgery and 9 patients received conservative treatment. The authors collected demographic, symptomology, imaging, neurological, and surgical data. Univariate and multivariate logistic regression analyses were performed to identify the prognostic indicators for neurological function.RESULTSWhen comparing patients with stable and unstable gait prior to surgery, patients with unstable gait had a higher frequency of hemorrhagic episodes (52.4% vs 19.4%, p = 0.010), as assessed by the modified McCormick Scale. The lesion was significantly smaller in patients who underwent conservative treatment compared with surgery (2.5 ± 1.5 mm vs 5.9 ± 4.1 mm, respectively; p = 0.024). Overall, the patients experienced significant neurological recovery after surgery, but a worse preoperative neurological status was identified as an indicator affecting surgical outcomes by multivariate analysis (OR 10.77, 95% CI 2.88–40.36, p < 0.001). In addition, a larger lesion size was significantly associated with poor functional recovery in patients who had an unstable gait prior to surgery (8.6 ± 4.5 mm vs 3.5 ± 1.6 mm, p = 0.011).CONCLUSIONSOnce a hemorrhage occurs, surgical intervention should be considered to avoid recurrence of the bleeding and further neurological injury. In contrast, if the patients with larger lesion presented with worse preoperative functional status, surgical intervention could have a risk for aggravating the functional deficiencies by damaging the thinning cord parenchyma. Conservative treatment may be selected if the lesion is small, but regular neurological examination by MRI is needed for assessment of a change in lesion size and for detection of functional deterioration.

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