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Vol. 63. Issue 1.
Pages 21-25 (January - February 2012)
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Vol. 63. Issue 1.
Pages 21-25 (January - February 2012)
Original article
DOI: 10.1016/j.otoeng.2011.06.005
Intratemporal Complications From Acute Otitis Media in Children: 17 Cases in two Years
Diecisiete casos de complicaciones intratemporales de otitis media aguda en niños en dos años
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Silvana Pellegrini??
Corresponding author
silvanapellegrini75@hotmail.com

Corresponding author.
, María Emilia Gonzalez Macchi, Patricia Alejandra Sommerfleck, Patricia Cristina Bernáldez
Servicio de Otorrinolaringología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Argentina
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Abstract
Background

To describe the clinical features of intratemporal complications of acute otitis media (AOM) in children, a retrospective study was carried out for 2 years.

Methods

We considered acute mastoiditis, presence of postauricular swelling, erythema and tenderness, and anteroinferior displacement of the auricle; labyrinthitis, presence of vestibular symptoms (spontaneous nystagmus and ataxia with or without vomiting; and facial nerve palsy, absence or decreased motility in hemiface.

All children underwent otomicroscopy for evidence of coexistent or recent AOM. Cultures were obtained by tympanocentesis and myringotomy, drainage of subperiosteal abscess, or from granulation tissue during tympanomastoidectomy.

Results

From January 2008 to December 2009, 17 patients fulfilled the entry criteria. Median age: 54.2 months. Of the 17 cases, 30% were infants younger than 12 months and most were boys (70.6%).

8/17 were receiving antimicrobial treatment. Diagnoses included 9/17 (52.9%) acute mastoiditis, 7/17 (41.2%) labyrinthitis, and 1/17 (5.9%) facial nerve palsy. Intracranial complications were present in 17.6%. All required intravenous antimicrobial treatment. Myringotomy was performed in 16/17, drainage of subperiosteal abscess in 3/17, and tympanomastoidectomy in 2/17. Bacteriology was positive in 9/17 cases, isolating Streptococcus pyogenes (S. pyogenes) in 44% of patients. Secuelaes: One unilateral sensorineural hearing loss.

Conclusions

Acute mastoiditis is the most common complication. Labyrinthitis was diagnosed in 41.2% of cases. S. pyogenes was prevalent in these serious invasive infections in our area. Associated intracranial complications were present in 17.6% cases. Resolution of AOM complications required surgical procedures in all cases (myringotomy, drainage of subperiosteal abscess, or tympanomastoidectomy).

Keywords:
Complications
Acute otitis media
Mastoiditis
Labyrinthitis
Resumen
Introducción

Para describir las características clínicas de los niños con complicaciones intratemporales de otitis media aguda (OMA), se realizó un trabajo retrospectivo y descriptivo durante dos años.

Métodos

Se consideró mastoiditis al eritema y oedema retroauricular, protrusión del pabellón auricular y caída de la pared posterior del conducto auditivo externo; laberintitis, al vértigo con o sin náuseas, vómitos y nistagmus, y parálisis facial periférica, a la ausencia o disminución de la movilidad en hemicara.

Previa otomicroscopía para diagnóstico de enfermedad otológica aguda coexistente, se tomó material para estudio bacteriológico de oído medio, de absceso subperióstico o de cavidad mastoidea.

Resultados

Entre enero de 2008 y diciembre de 2009 fueron asistidos 17 pacientes con complicaciones intratemporales de OMA.

Edad media: 54,23 meses; 30% menores de 12 meses; 12/17 masculinos y 5/17 femeninos; 8/17 recibían antibioticoterapia; 7/17 presentaban fiebre; 9/17 (52,9%) con mastoiditis aguda; 7/17 (41,2%) con laberintitis y 1/17 (5,9%) con parálisis facial periférica. El 17,6% presentó complicaciones endocraneales. Todos requirieron antibioticoterapia parenteral. Se realizó miringotomía en 16/17 (94,1%); drenaje de absceso subperióstico en 3/17 (17,6%) y antromastoidectomía en 2/17 (11,8%). La bacteriología fue positiva en 9/17, aislándose Streptococcus pyogenes (S. pyogenes) en el 44% de los casos. Secuelas: una hipoacusia neurosensorial.

Conclusión

La mastoiditis aguda es la complicación intratemporal más frecuente. S. pyogenes es prevalente en estas infecciones invasivas en nuestro medio. La resolución de la OMA complicada requiere procedimientos quirúrgicos en todos los casos (miringotomía, drenaje de absceso subperióstico o antromastoidectomía) y tratamiento antimicrobiano parenteral.

Palabras clave:
Complicaciones
Otitis media aguda
Parálisis facial
Laberintitis

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