Complications in Pediatric Acute Mastoiditis: HCUP KID Analysis

Objective A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and mortality. The aim of this study was to evaluate the incidence and management of complications related to pediatric acute mastoiditis using a national database. Study Design Retrospective review of 2016 Kids’ Inpatient Database, part of the Healthcare Cost and Utilization Project. Setting Academic, community, general, and pediatric specialty hospitals in the United States. Methods International Classification of Diseases, Tenth Revision, Clinical Modification code H70.XXX was used to retrieve records for children admitted with a diagnosis of mastoiditis. Data included patient demographics, intracranial infections, procedures (middle ear drainage, mastoidectomy, and intracranial drainage), length of stay (LOS), and total charges. Results In total, 2061 children aged ≤21 years were identified with a diagnosis of acute mastoiditis. Complications included subperiosteal abscess (6.90%), intracranial thrombophlebitis/thrombosis (5.30%), intracranial abscess (3.90%), otitic hydrocephalus (1.20%), encephalitis (0.90%), subperiosteal abscess with intracranial complication (0.60%), petrositis (0.60%), and meningitis (0.30%). Children with intracranial abscesses were more likely ( P < .001) to undergo myringotomy ± ventilation tube insertion (63.7%), mastoidectomy (53.8%), mastoidectomy with ventilation tube or myringotomy (42.5%), intracranial drainage procedure (36.3%), or all 3 key procedures (15.0%). Children with any type of intracranial complication had a significantly longer LOS ( P < .001) and higher total charges ( P < .001). Both a diagnosis of bacterial meningitis and undergoing an intracranial drainage procedure ( P < .001) contributed significantly to LOS and total charges. Conclusion Patients with intracranial complications are more likely to undergo surgical procedures; however, there is still wide variability in practice patterns, illustrating that controversies in the management of otitis media complications persist.

Epidural Abscess and Sigmoid Sinus Thrombosis as Intracranial Complications of the Middle Ear Cholesteatoma

The otogenic intracranial complications are rare manifestations in modern era of antibiotics. An early antibiotic therapy often covers typical clinical signs and symptoms for each complication. A sigmoid sinus thrombosis is often associated with other intracranial complications, as in this case, an epidural abscess. We are presenting a case of 12-year-old girl with the sigmoid sinus thrombosis and epidural abscess as complications of chronic infection to the middle ear with cholesteatoma. In the active phase of chronic inflammation of the middle ear she was treated with the antibiotic therapy that covered early symptoms of intracranial complication development. A humid attic perforation of the tympanic membrane with protrusion of choleastoma and evident signs of bony wall destruction to the external auditory canal was noticed by performing routine otomicroscopy and otoendoscopic examination. Assuming intracranial complication, magnetic resonance imaging (MRI) of the endocranium was undertaken. The MRI showed inflammatory changes of both middle ears with intracranial complications: the right sigmoid sinus thrombosis and epidural abscess of the same side. During the surgery we have noticed an extensive middle ear cholesteatoma with significant destruction of the bony tissue and purulent collection between sigmoid sinus changed with granulation and respective dural segment of the posterior cranial cavity.Timely diagnosis, multidisciplinary approach with an adequate choice of the antibiotic therapy and surgical technique have a crucial prognostic significance.

Clinical features and short-term outcome of presumptive intracranial complications associated with otitis media/interna: a multi-center retrospective study of 19 cats (2009–2017)

Objectives The aim of this study was to compile an overview of the clinical features of intracranial complication of otitis media/interna (OMI) in cats managed across five veterinary referral hospitals. Of additional interest were culture results that could inform empirical antibiotic selection, as well as outcome with both medical and surgical management. Methods A retrospective medical record review was conducted at five veterinary referral practices to identify cats with a diagnosis of intracranial complication secondary to OMI between 2009 and 2017. Clinical features, diagnostic findings, treatment and outcome were recorded. Results At total of 19 cats were identified. Sixty-three percent had no previous history of ear infection. Otoscopic examination was normal in 47% of cases. The most common bacterial isolate was Pasteurella multocida, which was identified in 24% of cases. Outcome was successful for 83% of cats managed with ventral bulla osteotomy (VBO) and in 66% of cats managed without surgical intervention. Conclusions and relevance Clinical suspicion of intracranial complications of OMI should remain high in cats with central vestibular disease even if otoscopic examination is normal. Antibiotic selection should be based on a culture and sensitivity; however, initial antibiotic therapy should include broad-spectrum coverage with special consideration for P multocida. Cats with intracranial complications of OMI can have a good outcome with either surgical or medical management and prospective studies are needed to assess the role of VBO in enhancing recovery.

A Case of Chronic Otitis Media Complicated with Cerebellar Abscess

Introduction:Intracranial complications are a known sequale of chronic otitis media. Meningitis is the most common intracranial complication, followed by otogenic brain abscess. Temporal lobe abscesses are more frequently reported in the literature as compared to cerebellar abscesses.Case Report: We present a case of chronic otitis media with cerebellar abscess that need drainage of the abscess twice. The mastoidectomy was done few days later once the patient stable.Conclussion: The case report highlights the increasing incidence of cerebellar abscess as an intracranial complicationwith literatures review. Besides that, we also discuss about the appropriate timing of ear surgery and neurosurgical drainage, as well as its outcome.Bangladesh Journal of Medical Science Vol.17(1) 2018 p.149-151