Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoidit...Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoiditis. This study aims to view the clinical presentation and management approaches in Khartoum Ear, Nose and Throat Hospital. Methodology: This is a prospective case series and a hospital-based study conducted at Khartoum Ear, Nose and Throat Hospital during the period from November 2017 to November 2019. A total of 61 patients were included in the study. Results: The median age at presentation is 5 years old, males are more affected than females with a ratio of 1.35:1, and the mean duration of symptoms prior to hospital admission was 9.6 days. The most common presenting symptoms were otalgia (83.3%), ear discharge (83.3%) and post-auricular swelling (83.3%), and the most common signs at admission were tenderness over the mastoid (95.1%), retroauricular swelling and protrusion of the auricle (82%), and redness over the mastoid (77%). The abnormal tympanic membrane was found in all patients with central perforation being the commonest finding (73.8%), and bulging tympanic membrane (21.3%). 34.4% of patients received oral antibiotics before admission and the mean duration of symptoms prior to admission increased significantly in those who received antibiotics 12.7 days in comparison to those who didn’t 8.3 days. Only 52.5% of patients had a past history of recurrent acute otitis media, and 8.2% had a past history of acute mastoiditis. All the patients with recurrent mastoiditis had a past history of recurrent acute otitis media. Computed Tomography (CT) scans were obtained for 50.8% and 83.9% of those scans showed coalescent mastoiditis. Further evidence of intracranial extension was found in 6.5% and Magnetic Resonance Imaging (MRI) was obtained for them. Of the study group, 67.2% presented with subperiosteal abscess, 4.9% with facial nerve palsy and 3.3% with brain abscess. Thirteen patients with no complications were managed initially with injectable and topical antibiotics and were successful in only 6 of them (46%), abscess incisions and drainages were needed in 46 patients and were successful in 34 of them (73.9%). Eighteen patients (29.5%) needed mastoidectomy and all of them were managed successfully (100%). One patient (1.6%) was referred for intracranial abscess drainage in a specialized hospital, also one patient (1.6%) initially presented with intracranial abscess died on the second day of admission and 96.8% were discharged in good condition. The mean duration of hospital stay was 7.5 days. Conclusion: Patients present to the hospital after a prolonged period with a higher rate of complications, and the delayed presentation increased significantly in patients who received oral antibiotics prior to admission. Conservative medical treatment in non-complicated acute mastoiditis was ineffective in more than half of the patients and abscess incision and drainage and/or mastoidectomy are often necessary for the management.展开更多
目的系统评价人文关怀护理应用于耳鼻喉内窥镜检查患者的效果。方法系统检索中国生物医学文献数据库、中国学术期刊网络出版总库、维普中文科技期刊全文数据库等。采用Cochrane系统评价员手册5.1.0质量评价标准对所纳入的研究进行评价,...目的系统评价人文关怀护理应用于耳鼻喉内窥镜检查患者的效果。方法系统检索中国生物医学文献数据库、中国学术期刊网络出版总库、维普中文科技期刊全文数据库等。采用Cochrane系统评价员手册5.1.0质量评价标准对所纳入的研究进行评价,通过Rev Man 5.3软件进行Meta分析。结果共纳入11个RCT,耳鼻喉内窥镜检查患者1737例,所纳入研究质量一般。11个研究显示：与常规护理比较,人文关怀护理可显著减轻患者的焦虑情绪[RR=0.47,95%CI：0.38~0.57,P〈0.01]、紧张情绪[RR=0.41,95%CI：0.35~0.49,P〈0.01]和偏执情绪[RR=0.41,95%CI：0.32~0.53,P〈0.01],差异有高度统计学意义。5个研究显示人文关怀护理的满意度优于常规护理[RR=1.27,95%CI：1.18~1.37,P〈0.01],差异有高度统计学意义。结论人文关怀护理能减轻耳鼻喉内窥镜检查过程中患者的焦虑、紧张、偏执等不良心理状况,提高患者的满意度。展开更多
文摘Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoiditis. This study aims to view the clinical presentation and management approaches in Khartoum Ear, Nose and Throat Hospital. Methodology: This is a prospective case series and a hospital-based study conducted at Khartoum Ear, Nose and Throat Hospital during the period from November 2017 to November 2019. A total of 61 patients were included in the study. Results: The median age at presentation is 5 years old, males are more affected than females with a ratio of 1.35:1, and the mean duration of symptoms prior to hospital admission was 9.6 days. The most common presenting symptoms were otalgia (83.3%), ear discharge (83.3%) and post-auricular swelling (83.3%), and the most common signs at admission were tenderness over the mastoid (95.1%), retroauricular swelling and protrusion of the auricle (82%), and redness over the mastoid (77%). The abnormal tympanic membrane was found in all patients with central perforation being the commonest finding (73.8%), and bulging tympanic membrane (21.3%). 34.4% of patients received oral antibiotics before admission and the mean duration of symptoms prior to admission increased significantly in those who received antibiotics 12.7 days in comparison to those who didn’t 8.3 days. Only 52.5% of patients had a past history of recurrent acute otitis media, and 8.2% had a past history of acute mastoiditis. All the patients with recurrent mastoiditis had a past history of recurrent acute otitis media. Computed Tomography (CT) scans were obtained for 50.8% and 83.9% of those scans showed coalescent mastoiditis. Further evidence of intracranial extension was found in 6.5% and Magnetic Resonance Imaging (MRI) was obtained for them. Of the study group, 67.2% presented with subperiosteal abscess, 4.9% with facial nerve palsy and 3.3% with brain abscess. Thirteen patients with no complications were managed initially with injectable and topical antibiotics and were successful in only 6 of them (46%), abscess incisions and drainages were needed in 46 patients and were successful in 34 of them (73.9%). Eighteen patients (29.5%) needed mastoidectomy and all of them were managed successfully (100%). One patient (1.6%) was referred for intracranial abscess drainage in a specialized hospital, also one patient (1.6%) initially presented with intracranial abscess died on the second day of admission and 96.8% were discharged in good condition. The mean duration of hospital stay was 7.5 days. Conclusion: Patients present to the hospital after a prolonged period with a higher rate of complications, and the delayed presentation increased significantly in patients who received oral antibiotics prior to admission. Conservative medical treatment in non-complicated acute mastoiditis was ineffective in more than half of the patients and abscess incision and drainage and/or mastoidectomy are often necessary for the management.
文摘目的系统评价人文关怀护理应用于耳鼻喉内窥镜检查患者的效果。方法系统检索中国生物医学文献数据库、中国学术期刊网络出版总库、维普中文科技期刊全文数据库等。采用Cochrane系统评价员手册5.1.0质量评价标准对所纳入的研究进行评价,通过Rev Man 5.3软件进行Meta分析。结果共纳入11个RCT,耳鼻喉内窥镜检查患者1737例,所纳入研究质量一般。11个研究显示：与常规护理比较,人文关怀护理可显著减轻患者的焦虑情绪[RR=0.47,95%CI：0.38~0.57,P〈0.01]、紧张情绪[RR=0.41,95%CI：0.35~0.49,P〈0.01]和偏执情绪[RR=0.41,95%CI：0.32~0.53,P〈0.01],差异有高度统计学意义。5个研究显示人文关怀护理的满意度优于常规护理[RR=1.27,95%CI：1.18~1.37,P〈0.01],差异有高度统计学意义。结论人文关怀护理能减轻耳鼻喉内窥镜检查过程中患者的焦虑、紧张、偏执等不良心理状况,提高患者的满意度。
