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Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2161-4. doi: 10.1016/j.ijporl.2014.09.032. Epub 2014 Oct 6.

Intratemporal and intracranial complications of acute otitis media in a pediatric population.

Author information

1
Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States.
2
Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States. Electronic address: David.Chi@chp.edu.

Abstract

OBJECTIVE:

To review all cases intratemporal and intracranial complications of acute otitis media (AOM) in infants and children from 1998 to 2013.

METHODS:

Retrospective chart review of 109 consecutive patients admitted for complications of AOM during a 15-year period at a tertiary-care children's hospital. The main outcomes are: (1) complications of AOM, (2) bacteriology, (3) management strategies.

RESULTS:

In our population, complications included mastoiditis (86.1%), subperiosteal abscess (38%), facial nerve palsy (16.7%), sigmoid sinus thrombosis (8.3%) and epidural abscess (7.4%). Other complications included post-auricular cellulitis, otic hydrocephalus and elevated intracranial pressure, internal jugular thrombosis, cranial nerve VI palsy and Gradenigo's syndrome, labyrinthine fistula, sensorineural hearing loss, and cerebellar infarct. Sixty-one patients (56%) received antibiotics prior to presentation. Cultures revealed Streptococcus pneumoniae in 36 patients (33.3%), other bacteria in 30 patients (27.8%), and "no growth" in 33 patients (30.5%). Nine patients (8.3%) did not undergo culture. Of the patients with S. pneumoniae, 20 cultures (55%) were found to be multidrug-resistant. Eleven patients (10.2%) were treated non-surgically, 31 (31%) were treated with myringotomy and intravenous antibiotics. Forty patients (97.5%) presenting with subperiosteal abscess required mastoid surgery. Thirteen of 18 (72.2%) patients with facial paralysis had full recovery. Eight of 10 (80%) patients with epidural abscess empyema required mastoid surgery and incision and drainage of the abscess.

CONCLUSION:

Complications of AOM are uncommon, yet continue to have potentially serious consequences. The bacteriology in this population reveals an increasing trend of multi-drug resistant S. pneumoniae as the causative organism.

KEYWORDS:

Acute otitis media; Complications; Intracranial; Intratemporal; Pediatric

PMID:
25447953
DOI:
10.1016/j.ijporl.2014.09.032
[Indexed for MEDLINE]

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