Acute complications of otitis media in adults

Objectives: To establish the incidence, current treatment and outcome of adult patients with acute intratemporal and intracranial complications of otitis media (OM). Design: A retrospective chart review with a sent questionnaire. Setting: Tertiary referral centre, University hospital. Participants: Adult patients treated for acute intratemporal and intracranial complications of OM over the past 15 years (1990–2004) in the study hospital. Main outcome measures: Incidence, treatment and outcome of patients with intratemporal and intracranial complications of OM. Results: Fifty patients aged 16–75 years were treated. The annual age‐adjusted incidence of acute intratemporal and intracranial complications was 0.32/100 000. Forty‐one (82%) of the complications were intratemporal and nine (18%) were intracranial. The ear disease behind the acute complication was acute otitis media (AOM) in 80% (40/50), chronic otitis media (COM) in 12% (6/50) and COM with cholesteatoma in 8% (4/50). Mastoiditis was complicated by subperiosteal abscess, labyrinthitis and facial paresis in 7% (3/41), 15% (6/41) and 32% (13/41) respectively. Mastoidectomy was performed on 56% (28/50) of the patients. Four (44%) of the intracranial complications were intracranial abscesses, four (44%) were meningitis and one (11%) was sinus thrombosis. Permanent hearing loss occurred in 13 (26%) patients and one patient died due to otogenic meningitis. Conclusions: Severe complications of the OM in adults are rare in Finland. The commonest cause is AOM rather than COM. Operative treatment is predominantly needed for intracranial complications and intratemporal abscesses. Complications of OM are still associated with considerable morbidity, and early recognition is most likely to form the basis for effective treatment.     

Intracranial complications of chronic otitis media

The objective of this study was to review our experience on intracranial complications (ICC) secondary to chronic otitis media (COM), and to investigate its clinical characteristics and treatment approaches. From January 1996 to December 2012, 17 patients with ICC secondary to COM were identified and included in this study, and were analyzed retrospectively. 13 out of these 17 cases (76.4 %) have cholesteatoma. The most common intracranial complication is brain abscesses (52.9 %), followed by meningitis (29.4 %), perisinus abscess (11.7 %), and epidural abscess (6 %). All patients underwent emergency mastoidectomy within the first 24 h after clear diagnosis. 7 patients underwent brain abscess drainage or abscess excision at the time of ear surgery. The mortality rates are 0 %. No recurrence was found in the 24-month follow-up period. Cholesteatoma was strongly associated with ICC. An early diagnosis and active surgical intervention in collaboration with proper antibiotic treatment is the key to cure.     

Mastoidectomy for acute otomastoiditis: our experience

We conducted a retrospective study of 53 mastoidectomies in 51 patients with acute otomastoiditis. In 26 cases (49.1%), surgery had been performed within 48 hours of the development of symptoms. The most common complication of acute otomastoiditis was subperiosteal abscess, which occurred in 37 cases (69.8%). Intracranial complications were seen in 6 cases (11.3%). The most common pathogens isolated from subperiosteal abscesses, the mastoid cavity, and intracranial collections were Streptococcus spp and Staphylococcus aureus. In 14 cases (26.4%), conservative treatment failed to cure acute otomastoiditis; such cases should raise a suspicion of a subperiosteal abscess, an underlying cholesteatoma, or an infection caused by gram-negative bacteria. Upon hospital admission, patients should receive antibiotics that are effective against both gram-positive and gram-negative organisms. Patients with intracranial complications or facial nerve paralysis may require a combination of two or more antibiotics. Long-term follow-up is highly recommended.     

The complications of chronic otitis media: report of 93 cases

The aim of this study was to investigate the incidence, mortality and morbidity of complications due to chronic otitis media (COM). During the nine-year period 1990-1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97 per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial complications (EC). In three patients more than one complication was observed. Meningitis and brain abscess were common in the IC group. Subperiosteal abscess (mastoid and Bezold's abscess) was a common complication in the EC group. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both groups. Fifteen patients died from IC. Overall, the mortality rate was 16.1 per cent in all patients having complications, and in patients with IC it was 26.3 per cent. In all of the patients with complications, the morbidity rate was 11.8 per cent. Our study supports the finding that meningitis and brain abscess are the common complications of COM and the main reason for mortality.     

Otogenic cerebellar abscesses (in the light of 10-year observation materials at the ENT clinic at the Tashkent institute of continuing education of physicians)

In 1989-1998 ENT specialists of the Tashkent Institute of Postgraduate Medical Education treated 109 patients with otogenic intracranial complications. 13 (11.9%) of them had cerebellar abscess. Clinical symptoms of the abscesses were obscure or absent. Head ache was the leading symptom. Other hypertensive symptoms presented with nausea, (n = 2), vomiting (n = 5), bradycardia (n = 7). Changes on the fundus of the eye were not registered in 6 patients. Defective coordination of movements, scanning speech were observed in 11 and 3 patients, respectively. Large-swinging, mixed horizontal nystagmus was truncal, in 11 patients it was directed to the side of the abscess, in 2 patients--in both directions. Symptoms of the secondary meningitis arose in 12 patients. The patients underwent surgical cleaning of the middle ear and opening cerebellar abscess under drug therapy. One patient died of purulent ventriculitis (lethality 7.6%). It is inferred that cerebellar abscesses often run with mild symptoms. This creates diagnostic difficulties.     

Intracranial complications of sinusitis: a 15-year review of 39 cases

Despite improvements in antibiotic therapies and surgical techniques, sinusitis still carries a risk of serious and potentially fatal complications. We examined the charts of 82 patients who had been admitted to the University of Mississippi Medical Center between Jan. 1, 1985, and Dec. 31, 1999, for treatment of complications of sinusitis. Of these 82 patients, 43 had orbital complications and 39 had intracranial complications. In this article, we describe our findings in those patients who had intracranial complications (our findings in patients with orbital complications will be reported in a future article). The most common intracranial complication was meningitis; others were epidural abscess, subdural abscess, intracerebral abscess, Pott's puffy tumor, and superior sagittal sinus thrombosis. Most patients with meningitis were treated with drug therapy only; patients with abscesses were generally treated with intravenous antibiotics and drainage of the affected sinus and the abscess. Advancements in antibiotic therapy, endoscopic surgery, imaging studies, and computer-assisted surgery have helped improve outcomes. Management of these patients should be undertaken immediately and is best achieved via a multidisciplinary approach, involving the otolaryngologist, neurosurgeon, radiologist, anesthesiologist, infection disease specialist, pediatrician, internist, and others.     

Intracranial complications of sinusitis in children and adolescents and their outcomes

OBJECTIVE: To gain insight into patterns of presentation, imaging, microbiological aspects, therapy, disease course, and outcome of intracranial complications of sinusitis (ICS), which are challenging conditions with the potential to cause significant morbidity and mortality. We reviewed our experience with ICS in children and adolescents. DESIGN: Consecutive case series with a mean follow-up of 12 months. SETTING: Tertiary pediatric referral center. PATIENTS: Consecutive sample of 25 children and adolescents treated for 35 intracranial complications (mean age, 13.2 years [range, 4-18 years]). INTERVENTIONS: Medical and surgical management. MAIN OUTCOME MEASURES: Survival and temporary and permanent neurologic sequelae. RESULTS: Most patients were adolescents (n = 19; 76%) and male (n = 19; 76%). Epidural abscess was most common (13 complications), followed by subdural empyema (n = 9), meningitis (n = 6), encephalitis (n = 2), intracerebral abscess (n = 2), and dural sinus thrombophlebitis (n = 2). Abscesses were primarily located in the frontal or frontoparietal regions. Magnetic resonance imaging was extensively used and was superior to contrast computed tomography in diagnosis. All patients received intravenous antibiotics, 21 underwent endoscopic sinus surgery, and 13 underwent neurosurgical drainage. Only 1 death occurred from sepsis secondary to meningitis (mortality, 4%). Overall, neurologic outcome was excellent. Although 10 patients (40%) had neurologic deficits, most resolved within 2 months. Only 2 patients had permanent neurologic sequelae. Among ICS, epidural abscess appeared to be a distinct clinical entity. Epidural abscesses typically presented without specific neurologic symptoms or signs, were more often associated with orbital complications, and had outcomes considerably better than the other ICS. CONCLUSION: Intracranial complications of sinusitis are challenging, but prognosis can be favorable in children and adolescents by using aggressive medical and surgical management.     

Intracranial abscesses secondary to nasal, sinus, and orbital infections in adults and children

Nineteen cases of intracranial abscesses secondary to infection of the midface are reported. The most common underlying cause was bacterial sinusitis. Other etiologic factors included mucormycosis following steroid therapy, Wegener's granulomatosis, nasal dermoid cyst and sinus tract, tooth abscesses, aspergillosis following chemotherapy for leukemia, squamous cell carcinoma of the frontal sinus, infected methylmethacrylate plate for a prior skull fracture, and a case of gauze packing left in the sinus following surgery. Anaerobic organisms were the predominant cause of the abscesses. The most dangerous intracranial complication was subdural abscess, which occurred in seven patients in this series. Three of them died. Four cases of frontal and parietal lobe abscesses were treated with systemic antibiotics only. This approach has not been well emphasized in our literature. Steroid therapy should not be used for the treatment of sinus and orbital infections. It can result in dreadful complications. The overall mortality rate in this series was 21% (4 of 19), despite aggressive treatment and close cooperation between the neurosurgeon, otolaryngologist, and other specialists. Early diagnosis and adequate treatment are paramount.     

Absceso retrofaríngeo. Revisión clínica de veinticinco años

IntroductionRetropharyngeal abscess is a serious condition. Its rare occurrence, thus sharing symptoms with other processes, make it a diagnostic challenge for the clinician. Therefore, it is critical to make an early diagnosis to prevent delaying treatment and avoid complications.ObjectivesTo gain knowledge of the epidemiology, pathogenesis, clinical manifestations, the most commonly implicated microorganisms, the type of treatment used, morbidity and mortality of retropharyngeal abscesses at a tertiary institution over the last 25 years.MethodsA retrospective study was conducted by reviewing medical records of all patients diagnosed with retropharyngeal abscess in a single centre between 1 January 1990 and 31 February 2016. Thirty-three patients were included in our study. Data such as personal history, present illness, diagnoses and treatment procedures were collected from the medical records.ResultsThe incidence during the years of study was 0.2 cases/100 000 inhabitants/year. Personal medical histories most often associated were alcoholism, smoking, diabetes and obesity. The most common aetiology found was impaction of a foreign body (especially fishbone). The most common presenting symptoms were odynophagia and neck pain accompanied by fever. Preventive tracheotomy was performed in the initial management of the patient in 9 cases (27%). The most frequent complication was descending necrotizing mediastinitis. Surgical drainage of the abscess was required in 27 patients (82%), especially with external approaches (17 cases). Two patients had sequelae: paralysis of unilateral vocal cord and Horner's syndrome. No mortality was observed in the patients of the study.ConclusionRetropharyngeal abscesses must be considered medical-surgical emergencies as they are likely to produce serious complications. We must pay attention to the warning symptoms such as odynophagia and cervical pain, associated or otherwise with dyspnoea, stridor, trismus, and neck stiffness. Advances in diagnostic and therapeutic procedures together with advances in critical care have been a key factor in improving the prognosis and mortality of these patients.     

Central nervous system complications secondary to oto-rhinologic infections. An analysis of 39 pediatric cases.

Fifty-eight central nervous system complications were noted in 39 pediatric patients with a primary oto-rhinological infection. The ages ranged from 1 to 15 years. Eleven patients (25%) had more than one complication. 12.8% of the cases died. Leptomeningitis was the most common intracranial complication (54%) Lateral sinus thrombosis (LST) occurring in 10 patients (26%) was accompanied with other intracranial abnormalities in 80% of cases. Brain abscess as an initial or concomitant complication was associated with the highest mortality rates (40%). In two of these fatal cases multiple brain abscesses were detected. The low incidence of intracranial infections secondary to oto-rhinologic infections and the masking effect of antibiotics present difficulties in the early recognition of the CNS complication. Despite the value of the modern imaging techniques in the investigation of the CNS complication, the clinical oto-rhinologic examination is of paramount importance in detecting the original infection in the pneumatic spaces of the upper respiratory tract. Additionally, bone scans were found of value in demonstrating the osteitic process of these cases.     

Intracranial complications of pediatric frontal rhinosinusitis

BACKGROUND: The aim of this study was to review the presentation and management of children admitted for intracranial complications arising from frontal rhinosinusitis. We performed a retrospective case series review at two academic tertiary care children's hospitals. METHODS: This study consisted of children < 18 years old who presented with intracranial complications from frontal rhinosinusitis between January 1, 1990 and December 31, 2002. Relevant literature was reviewed with the assistance of Medline. Presentation, type of intracranial complication, radiographic evaluations, response to treatment, and prognosis were evaluated. RESULTS: Sixteen patients were identified with intracranial complications due to frontal rhinosinusitis. Patients were usually older (mean age, 14 years and 3 months), of male gender (M/F, 4.3:1.0), and African American (AA/W, 3.0:1.0). Headache, nasal congestion, and visual changes were the most common early symptoms and neurological findings indicated advanced disease. Subdural (56%), epidural (44%), and cerebral abscesses (19%) were the most common complications. Meningitis alone was identified in 13% and was associated with another intracranial complication in 6%. Multiple intracranial complications were noted in 31%. Polymicrobial cultures were obtained in 50% of patients. Although CT was excellent in identifying orbital pathology, MRI was superior for characterization of intracranial disease. CONCLUSION: Intracranial complications of frontal rhinosinusitis are rare in children. Early symptoms often are nonspecific, with neurological findings more commonly seen in advanced disease. Adolescent African American male patients were found to be at highest risk for intracranial complications from frontal rhinosinusitis. Headache and orbital complaints associated with rhinosinusitis in older children failing to respond to initial therapy should prompt an aggressive evaluation including MRI.     

CNS complications of ear, nose and throat infections: an analysis of 50 consecutive cases

Sixty-four diverse central nervous system (CNS) complications were noted in a series of 50 patients initially suffering from an otorhinological infection. Thirty-five patients (70%) were in pediatric age groups (1-15 years). Twelve patients (24%) had more than one complication. Mortality rates were 16% in patients with one CNS complication and 25% in patients with multiple complications. Overall mortality rate was 18%. Leptomeningitis was the most common intracranial complication (42%) occurring, mainly in pediatric patients. Lateral sinus thrombosis (LST) was accompanied with other intracranial abnormalities in 72% of the cases. Brain abscess as an initial or concomitant complication was associated with the highest mortality rates (44%). Three of these fatal cases had multiple brain abscess. The rarity of intracranial suppurations secondary to ear and nose infections and the masking effect of the antibiotics bring difficulties in the early detection of CNS complications. Although the modern imaging techniques contribute to the recognition and localization of the intracranial pathology, the clinical investigation is still of paramount importance in detection of the original infection in the pneumatic spaces of the upper respiratory tract.     

The Intracranial Complications of Rhinosinusitis: Can They Be Prevented?

OBJECTIVES/HYPOTHESIS: Reference textbooks on the intracranial complications of rhinosinusitis imply that many of the intracranial complications of rhinosinusitis can be prevented. We sought to examine whether or not this is true. STUDY DESIGN: A retrospective case series. METHODS: The study included 47 consecutive patients presenting with intracranial complications secondary to rhinosinusitis between 1992 to 1999 with a mean follow-up of 5 years and 1 month. RESULTS: The most common presenting symptoms of intracranial involvement were an altered mental state, headache, fever, seizure, vomiting, a unilateral weakness or hemiparesis, or a cranial nerve sign. These justify an urgent magnetic resonance imaging or computed tomography scan. The importance of imaging before a lumbar puncture cannot be overemphasized. Of particular note was the finding that 21 patients (45%) presented with a periorbital cellulitis or frontal swelling. Therefore, it does not follow that because a collection of pus presents anteriorly it precludes any intracranial involvement. More than half of our patients (55%) had visited their primary care physician with an upper respiratory tract infection and had been treated appropriately. Once any central symptoms or signs developed, there was little evidence of any significant delay in referral to our unit. Only six patients had a history of nasal disease, three having had recent sinus surgery and three having had nasal polyps. Nine patients had significant long-term morbidity, seven patients had epilepsy, one patient had dysphasia, and one patient had right arm weakness. The single death in our series was associated with a cavernous sinus thrombosis. CONCLUSIONS: The report emphasizes the need for surgeons to be alert to the diagnosis, particularly in patients with a periorbital abscess or frontal swelling. Sinus surgery has a role in obtaining pus for culture, as well as draining the sinus if it is in continuity with an intracranial collection. Intracranial infections secondary to rhinosinusitis occur sporadically and, although it appears that this cannot be prevented, early recognition and treatment are essential to reduce any subsequent morbidity or mortality.     

Complications of chronic otitis media with cholesteatoma during a 10-year period in Kosovo

We review and discuss the results of treatments for complications of cholesteatomatous chronic otitis media (CCOM) in a tertiary health care center. In a retrospective study, the medical records of patients with complications of CCOM who had undergone surgical treatment at the ENT Clinic of the University Clinical Center of Kosovo for the period 1994–2004 were reviewed. From a total of 1,803 patients suffering from CCOM, in 91 patients, 55 (60.4%) men and 36 (39.6) women, one or two complications are recorded. The mean age of the subjects was 30 years, and the age range was from 1 to 76 years. Extracranial (EC) complications were observed in 52 cases (57.1%), and intracranial (IC) complications were seen in 29 patients (31.9%). Twelve patients (11%) had multiple complications. For the EC cases, we found that subperiostal mastoidal abscess occurred in 26% of the all patients, facial nerve palsy was seen in 16.48% and labyrinthine fistula occurred in 10%. For the IC cases, meningitis (19.7%) and perisinusal abscess (15.3%) were the most common complications. The most often isolated pathogen from ear swabs was Proteus mirabilis in 33.3% of cases. The most frequent radiological diagnostic procedures were mastoid tip X-rays, which were performed in 77% of the patients, and computed tomography in 24%; magnetic resonance imaging was not performed on any of the patients during the study period. Patients with EC complications were treated in the ENT Clinic, whereas patients with IC complications, after otologic surgical procedures, were transferred to the Neurosurgery Clinic or to the Clinic for Infectious Diseases. In this series, three patients (3.3%) died as a result of complications, while the remaining 96.7% survived. Complications of COM with cholesteatoma can represent life-threatening conditions, and close cooperation between otosurgeons, neurosurgeons and infectious disease specialists is mandatory.     

Complications of chronic suppurative otitis media: a retrospective review

The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold’s abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach.     

Retropharyngeal and parapharyngeal infections in children: the Toronto experience

OBJECTIVE: To review the Hospital of Sick Children, Toronto's experience of the diagnosis and management of retropharyngeal and parapharyngeal infections with particular emphasis on the role of computed tomography (CT) imaging in diagnosing the presence of an abscess. METHODS: A retrospective analysis of all patients diagnosed with retropharyngeal and parapharyngeal infections from 1987 to 1999 was performed. Demographic data, presenting symptoms, season of presentation, management and complications were reviewed. The CT scans of 27 patients who underwent surgical treatment were retrospectively examined by two neuroradiologists who were blinded to the patient's history and outcome. The sensitivity, specificity and predictive values for the specific features and overall assessment were calculated. RESULTS: Fifty-four children were identified. There were 46 retropharyngeal infections, 6 parapharyngeal infections and 2 patients had both retropharyngeal and parapharyngeal infections. All patients were treated with parenteral antibiotics. Thirty-seven patients underwent surgical drainage and in 27 there was a positive finding of pus. The retrospectively assessed CT scans of the 21 patients who underwent surgery were found to have a sensitivity of 81% in detecting an abscess by CT scan but the specificity was 57%. There were four complications including mediastinitis, aspiration pneumonia, internal jugular vein thrombosis and common carotid artery aneurysm. All patients recovered but abscess recurred in five patients. CONCLUSION: Not all patients with retropharyngeal and parapharyngeal abscesses require surgery. Whilst CT scans are helpful in diagnosing and assessing the extent of these infections they are not always accurate in detecting an abscess. A decision to drain an abscess should therefore not be made based solely on the CT findings.     

The clinical picture and outcome of rhinosinusogenic pyoseptic complications in children

The objective of the present work was to study peculiarities of the clinical picture and the results of the treatment of rhinosinusogenic complications in children and to evaluate the diagnostic and prognostic significance of systemic inflammatory response syndrome (SIRS) and other mediators of inflammation. A total of 103 case histories were available for the analysis. The age of the patients varied from 1 month to 15 years. Pyogenic orbital pathology was documented in 55 (53.4%) children, eyelid abscess and subperiosteal abscess in 13 (23.6%), orbital phlegmona and retrobulbar abscess in 38 (69.1%), osteomyelitis of the facial skeleton in 4 (10.5%), and intracracnial complications in 48 (46.6%) children (including pachimeningitis/extradural abscess in 5, meningitis in 10, meningoencephalitis in 6, subdural empyema in 12, cavernous sinus abscess in 8, and cerebral abscess in 7 patients). SIRS was diagnosed in 24 (42.8%) children with orbital complications and in 100% of the patients suffering intracranial pathology. It was shown that a rise in the C-reactive peptide level to above 50 mg/l in conjunction with two or more signs of SIRS may serve as a sensitive diagnostic criterion for the severe infection while a decrease in C-reactive protein to below 50 mg/l within the first days of the disease is a reliable prognostic factor of its favourable outcome. The blood level C-reactive protein in the patients presenting with intracranial complications exceeded 0.1 mcg/l and continued to increase in proportion to the severity of the disease. A total of 43 (41.8%) children were available for the long-term follow-up (seven of them developed a relapse of frontitis that required reoperation, one patient presenting with nasal liquorrhea needed plastic closure of the liquor fistula, and one more died after the one-year follow-up period had elapsed because of polyorgan insufficiency).     

Subdural empyema as a complication of sinusitis in the pediatric population

OBJECTIVE: Sinusitis is a rare cause of intracranial infection in children. While intracranial complications of sinusitis are rare, the morbidity and mortality remain high. Subdural empyema is recognized as the most common sinogenic intracranial complication. We undertook a review of our cases of subdural empyema and other intracranial complications of sinusitis over the past 8 years at a busy inner city hospital. Our intent was to identify factors that may predispose children to these serious complications. METHODS: A retrospective chart review was conducted using ICD-9 codes to identify pediatric patients treated for complications of sinusitis at University Hospital (UH) from 1996 to 2004. Only patients age 18 or younger at the time of admission were included in this study. The following data were collected from hospital medical records: age, gender, past medical and social history, presenting symptoms, history of present illness, microbiology, surgical and medical intervention, and outcome. RESULTS: Twelve patients were identified that fit the criteria for this study. The mean age of these patients was 14.1 years, and 10 of our 12 patients were male (83.3%). The most common presenting complaints were fever, headache, altered mental status, orbital cellulitis, nasal symptoms, nausea and vomiting, and photophobia. In the week prior to admission for intracranial complications, nine patients were seen by a physician: five patients were seen in the ER and four by a primary care physician. Subdural empyema was the most commonly observed intracranial complication in this series. Microaerophilic and anaerobic organisms were most commonly identified in this series. Most sinus procedures consisted of endoscopic ethmoid and maxillary sinus drainage. There was a long-term morbidity rate of 16% and a mortality rate of 8%. CONCLUSIONS: Three conclusions may be drawn from this study. First, the morbidity and mortality of intracranial complications of sinusitis remain high in the pediatric inner-city population despite adequate access to medical care. Second, subdural empyema appears to arise in the setting of subacute rather than acute frontal sinusitis. Lastly, there may be an under-diagnosis and delay in treatment of patients with frontal sinusitis, resulting in subsequent intracranial complications.     

耳源性颅内并发症临床特点分析

目的 探讨近25年来耳源性颅内并发症的临床特点和诊治措施.方法 采用回顾性分析方法 ,对1982至1987年和1997年至2006年北京协和医院耳鼻咽喉科收治的耳源性颅内并发症患者的临床资料进行总结.14例患者中,男10例,女4例,发病年龄12～62岁,平均32.1岁;颅内病变与耳部病变均为同侧.耳部病变中,中耳胆脂瘤12例,非胆脂瘤性慢性化脓性中耳炎2例.颅内并发症中,大脑颞叶脓肿6例次、小脑脓肿4例次、乙状窦周围脓肿3例次、乙状窦血栓性静脉炎和脑膜炎2例次,硬脑膜外脓肿1例次.入院主诉中,头痛13例次、高热11例次和恶心呕吐10例次.所有患者均有耳道溢脓.脓液培养结果 显示,变形杆菌(5例次)、表皮葡萄球菌(3例次)和绿脓杆菌(2例次)最多见.所有患者均急诊行乳突单凿术或乳突根治术.采用抗生素+甘露醇联合方案者12例,单独使用抗生素治疗者2例.结果 14例患者均临床治愈后出院,治愈率100%.1982至1987年间的4例患者出院后失随访,可以随访到的5例患者中,目前情况良好者4例(随诊时间为22.5至24.4年,平均23.8年);死亡1例(出院后19.2年死于心脑血管疾病).1997至2006年间的5例患者中,其中1例因乙状窦周围脓肿入院行乳突根治术和抗感染治疗,假性治愈出院后第24天突发高热、恶心和意识障碍,经MRI证实为颞叶脓肿,再次入院治疗,治愈后出院;所有这5例患者随访至今情况良好,随访时间1.5～10.6年,平均6.5年.结论 耳源性颅内并发症更好发于男性、年轻患者,颅内并发症以大脑脓肿、小脑脓肿和脑膜炎最为多见,不同文献报道的菌培养结果 各异.随着时间的推移,致病菌、并发症的类型和选用的抗生素均有演变,及时的乳突手术脓腔开放引流和药物联合治疗有效地提高了本病的治愈率.CT、MRI对耳源性颅内并发症的诊断具有重要价值,MRI的应用可以弥补CT的不足.     

Complications of acute otitis media in children in southern Finland

BACKGROUND: The incidence of intratemporal and intracranial complications of acute otitis media (AOM) has decreased and the need for operative treatment is declined in developed countries during the antibiotic era. OBJECTIVES: To establish the clinical picture, diagnostic procedures, outcome and current treatment of pediatric patients with intratemporal and intracranial complications of AOM. METHODS: A retrospective chart review with a sent questionnaire. All pediatric patients treated for intratemporal and intracranial complications of AOM over the past 10 years (1990-2000) at the Department of Otolaryngology in the Helsinki University Central Hospital. RESULTS: During the study period 33 children (incidence 1.1/100,000 per year), aged from 3 months to 14.2 years were treated for intratemporal [97% (32/33)] and intracranial [3% (1/33)] complications of AOM. Facial paresis was found in 9% (3/33) of the patients. The only intracranial complication was an extradural abscess with meningitis. Eighteen patients (55%) were on antibiotic treatment because of AOM prior to the diagnosis of complication. Neither the duration or severity of the signs and symptoms of infection at the time of admittance nor a lack of antibiotic treatment before admittance were statistically significantly associated with the need for mastoidectomy or duration of hospitalization. Streptococcus pneumoniae 25% (8/33) and Pseudomonas aeruginosa 22% (7/33) were the most frequently found bacteria in the culture of middle ear and mastoid effusions. Mastoidectomy was performed on 55% (18/33) of the patients. After half a year of follow-up, all the patients had normal hearing and facial function. CONCLUSIONS: Severe complications of AOM are rare today in southern Finland and the need for mastoidectomy has declined significantly. With early recognition and effective treatment of complications, the prognosis is good.