Acute mastoiditis and intracranial complications in children

Objectives: Characterisation of clinical manifestations in children who had acute mastoiditis (AM) -related intracranial complications (ICCs) and to determine the incidence of ICCs in the study group. To define children with a higher risk of ICCs and gain new information on aetiological microbial agents of AM. Methods: A retrospective analysis of 137 paediatric patients with AM treated at a tertiary centre using standard dia­gnostic and therapeutic protocol between 2002 and 2019. Results: Altogether 137 patients with AM were hospitalised at our centre between 2002 and 2019. During this time, the occurrence of ICC in children with AM was low (n = 3, incidence 2.19%). Due to the low number of patients with ICC with AM in our patient group, we were unable to define a specific group of patients with a higher risk of ICC development in AM. Despite this fact, the average value and median of CRP were considerably higher in patients with AM-associated ICCs. The most frequent aetiological agent was Streptococcus pneumoniae. Conclusions: The low incidence of ICC in patients with AM in our patient group might be caused by routinely performed paracentesis in developed acute otitis, rational antibio­tic therapy and the good availability of an ENT specialist in the Czech Republic. The most common aetiological agent of AM was Streptococcus pneumoniae. Keywords: Streptococcus pneumoniae – acute mastoiditis – intracranial complications – aetiological agent – antibio­tic therapy – antromastoidectomy

A Review of Noninfectious Diseases Masquerading as Acute Mastoiditis

Objective Acute mastoiditis is commonly attributed to infection. Rarely do clinicians encounter cases that do not respond to traditional antibiotics or surgical management. The goal of this study was to systematically review the literature to characterize diseases masquerading as acute infectious mastoiditis. Data Sources PubMed, Embase, and Scopus. Review Methods A systematic review was performed to identify all publications that reported on diseases with presentations mimicking acute mastoiditis, defined as postauricular redness, swelling, and tenderness. We included clinical prospective studies, retrospective studies, and case series/reports. Exclusion criteria included non-English articles, letters/commentaries, abstracts, and review articles. Results Out of 3339 results, 35 studies met final inclusion criteria. In children, 11 diseases were reported to mimic mastoiditis, including solid tumors, hematologic diseases, and autoimmune/inflammatory diseases. The most common disease in children was Langerhans cell histiocytosis, followed by rhabdomyosarcoma and acute myelogenous leukemia. In adults, 8 additional diseases were reported. The most common disease in adults was squamous cell carcinoma, followed by nasopharyngeal carcinoma and Langerhans cell histiocytosis. Presenting symptoms are reviewed, as well as characteristic radiographic, laboratory, and intraoperative features that may assist with diagnosis. A diagnostic algorithm for atypical cases of acute mastoiditis is proposed. Conclusion A small but significant group of diseases in children and adults can mimic acute mastoiditis. In such cases, history and examination alone may be insufficient to reach a diagnosis, and further investigation may be necessary. Otolaryngologists should always be mindful of the possibility that noninfectious pathologies may present with a constellation of symptoms similar to mastoiditis.

Acute otitis medium complicated by mastoiditis in a child after a possible new coronoviral infection: a clinical case

В статье описан клинический случай острого среднего отита у ребенка 8 лет, осложненного мастоидитом, в крови ребенка выявлены антитела к коронавирусу SARS-CoV-2, IgG. Имеющиеся на сегодня данные свидетельствуют о том, что дети составляют до 10% в структуре инфицированных SARS-CoV-2 и до 2% в структуре пациентов с диагностированными клиническими случаями COVID-19. В Российской Федерации дети составляют 6-7% зарегистрированных случаев COVID-19. В начале пандемии было выявлено, что у детей имеет место более легкое течение заболевания и значительно реже встречаются осложнения и неблагоприятные исходы. Однако в последующие месяцы клиницисты стали отмечать многократный рост частоты госпитализации детей по поводу COVID-19. Описанный случай показывает молниеносное развитие острого мастоидита с деструкцией наружной пластинки височной кости у ребенка как осложнение острого среднего отита после перенесенной новой коронавирусной инфекции. Представлены сведения об актуальности эпидемиологии, клинической картины, диагностики и лечения острого среднего отита, осложненного мастоидитом, у детей. Следует подчеркнуть, что для достижения наиболее эффективной тактики ведения пациентов необходимо тесное сотрудничество врачей узких специальностей с педиатрами, массовое тестирование детского населения, дальнейшие исследования для получения достоверных данных о влиянии новой коронавирусной инфекции на организм ребенка. В настоящее время в доступной литературе недостаточно данных по влиянию COVID-19 на ЛОР-органы у детей. В связи с этим необходимы дальнейшие исследования по ЛОР-заболеваниям у данной категории пациентов на фоне или после перенесенной инфекции COVID-19. The article describes a clinical case of acute otitis media in an 8-year-old child complicated by mastoiditis, antibodies to SARS-CoV-2 and IgG coronovirus were detected in the child's blood. The data available today indicate that children make up up to 10% in the structure of infected SARS-CoV-2 and up to 2% in the structure of patients with diagnosed clinical cases of COVID-19. In the Russian Federation, children account for 6-7% of the registered cases of COVID-19. At the beginning of the pandemic, it was revealed that children have a lighter course of the disease and complications and unfavorable outcomes are much less common. However, in the following months, clinicians began to note a multiple increase in the frequency of hospitalization of children for COVID-19. The described case shows the rapid development of acute mastoiditis with the destruction of the outer plate of the temporal bone in a child, as a complication of acute otitis media, after a new coronavirus infection. The article presents information on the relevance of epidemiology, clinical picture, diagnosis and treatment of acute otitis media complicated by mastoiditis in children. It should be emphasized that in order to achieve the most effective tactics of introducing patients, close cooperation of doctors of narrow specialties with pediatricians is necessary, mass testing of the child population, further research to obtain reliable data on the impact of a new coronavirus infection on the child's body. Currently, there is insufficient data in the available literature on the effect of COVID-19 on ENT organs in children. In this regard, further studies on ENT diseases in this category of patients are needed on the background of or after a COVID-19 infection.

Prevalence of acute otitis media in children younger than four years

Background Acute otitis media (AOM) is one of the most common diseases in childhood, affecting approximately 50% of all children. The most common age range to develop AOM is 3–24 months, due to a current or recent upper respiratory tract infection, which induces the eustachian tube to develop fluid or secretion from the middle ear inflammation. The acute onset of symptoms in older children is characterized by otalgia and rubbing of the ear, however, AOM in younger children include nonspecific symptoms such as fever, irritability, or poor feeding, being unreliable guides to the diagnosis. Thus, the underdiagnosis of AOM can lead to serious complications include acute mastoiditis or meningitis. Hence, the study aims to investigate the prevalence of AOM in children younger than four years. Methods A cross-sectional study was conducted in a kindergarten, being enrolled children between 1 and 4 years. The protocol included otoscopy and tympanometry. Results A total of 23 children with a mean age of 2-year-old (SD = 0.88) were evaluated, with 17 children (34.8%) diagnosed with AOM, of whom 2 (15.4%) had unilateral alterations and 11 (84.6%) bilateral alterations. Conclusions AOM is one of the main childhood pathologies, affecting approximately 34.8% of younger children. Success in decreasing prevalence of AOM will depend on prevention of nasopharyngeal pathogen colonization, as well as decrease of viral upper respiratory tract infection, which can be reduced with nasal saline irrigation, a clinical and economic therapeutic approach.

Silent Mastoiditis Associated with Pneumococcal Meningitis

Streptococcus pneumoniae (S pneumoniae) can cause a wide spectrum of diseases which includes upper respiratory tract infection as well as more severe invasive disease such as meningitis. Meningitis may be caused by invasion of the organism through the blood brain barrier, either via haematological spread or from an adjacent focus of infection such as the ears. We describe two infants with pneumococcal meningitis and silent mastoiditis. They both presented with a classical history to suggest meningitis with no apparent focus of infection. A brain imaging was done in the first infant to look for the underlying cause of his focal seizure and in the second infant, to assess for complications of meningitis, as he had a slow recovery. While they did not have any clinical signs to point towards the diagnosis, they were both diagnosed to have acute mastoiditis from brain imaging. We would like to highlight the importance of brain imaging in excluding silent mastoiditis in infants with meningitis, particularly in those whose clinical course appears atypical.

Bakteri Penyebab Otitis Media Supuratif Kronis di Rumah Sakit Umum Universitas Kristen Indonesia

Abstrak Otitis media supuratif kronis (OMSK) merupakan inflamasi dari telinga tengah dan rongga mastoid kronis, ditandai dengan perforasi membran timpani serta cairan yang keluar dari telinga secara persisten. Gangguan pendengaran dan kecacatan umumnya disebabkan oleh OMSK. Komplikasi otitis media supuratif kronis lainnya dapat menyebabkan infeksi intrakranial yang fatal dan mastoiditis akut, terutama di Negara-negara berkembang. Penatalaksanaan yang efektif tergantung pada pengetahuan mengenai mikroorganisme penyebab dan sensitivitas mikroba. Penelitian ini bertujuan untuk mengetahui pola bakteri penyebab otitis media supuratif kronis di Rumah Sakit Umum Universitas Kristen Indonesia Tahun 2019. Metode penelitian yang digunakan adalah deskriptif dengan pendekatan secara clinical series yang dilakukan dari bulan Agustus 2019 sampai November 2019 di Poliklinik THT-KL RSU UKI dan Laboratorium Mikrobiologi FK UKI. Hasil dari 17 sampel menunjukkan bahwa Staphylococcus aureus merupakan bakteri terbanyak yang ditemukan pada penderita OMSK yaitu 6 (35,3%), diikuti Pseudomonas aerugenosa 5 (29,4%), Staphylococcus epidermidis 2 (11,8%), Klebsiella spp. 2 (11,8%), Proteus spp. 1 (5,9%), Escherichia coli 1 (5,9%). Kata kunci :otitis media supuratif kronis, pola bakteri. Abstract Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity, followed with recurrent ear discharges or otorrhoea through a tympanic perforation. Hearing impairment and disability are generally caused by CSOM. Other complications of chronic suppurative otitis media can lead to fatal intracranial infections and acute mastoiditis, especially in developing countries. Effectivity of the disease management depends on the knowledge of causative microorganisms and their antimicrobial sensitivity. The purpose of this study is to identify the bacterial pattern that cause chronic suppurative otitis media in Christian University of Indonesia General Hospital in 2019. This study is using the descriptive method with a clinical series approach, this study was carried out from August 2019 to November 2019 at the polyclinic of ENT-HNS RSU UKI and Microbiology Laboratory FK UKI. The results of 17 samples showed Staphylococcus aureus was the most bacteria found in CSOM patient 6 samples (35,3%), followed Pseudomonas aerugenosa 5 (29,4%), Staphylococcus epidermidis 2 (11,8%), Klebsiella spp. 2 (11,8%), Proteus spp. 1 (5,9%), Escherichia coli 1 (5,9%). Keywords: chronic suppurative otitis media, bacterial pattern