Acute coalescent mastoiditis in a 16-month-old child due to Streptococcus pneumoniae infection

Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal abscesses.Patient’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by S.pneumoniae infection.The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.Interventions:The patient underwent intravenous antibiotic therapy and surgical treatment.Outcomes:The patient was discharged 14 days after hospitalization with an improved condition.Lessons:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even life-threatening.Complications are prevalent in children under 2 years,in whom the disease progresses more rapidly and severely.The vaccination with a 13-valent vaccine may not result in sufficient immunity against S.pneumoniae,a predominant pathogen in children affected by acute coalescent mastoiditis.

Acute Mastoiditis Clinical Course and Management in Patients Presented to Khartoumar Ear, Nose and Throat Hospital during the Period from November 2017 to November 2019

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.

Persistent Pseudomonas Infection Mastoiditis—Local Antibiotic Treatment Is Superior than Systemic

Mastoiditis is a common complication of acute otitis media. It is common in younger age compared to adulthood. Mastoiditis occurs when an otitis media infection spread directly to involve the bone of mastoid air cell causing osteitis. Cholesteatoma can contribute to the development of mastoiditis. This typically leads to breakdown of some of the fine bony trabeculae of mastoid cells producing a coalescent mastoiditis with an emphyema in mastoid antrum. Cholesteatoma can contribute to the development of mastoiditis. The common treatment for mastoiditis is intravenous antibiotic. Our cases show that local antibiotic treatment is superior compared to systemic antibiotic in treating multi-drug resistant chronic. Pseudomonas mastoiditis compared to intravenous antibiotic. However, if it presents together with cholesteatoma the main treatment is still early mastoidectomy.

Complicated Fusobacterium necrophorum mastoiditis–More than meets the eye

Otitis media is common in children and Fusobacterium species are an emerging causative pathogen.These species have virulence factors which increase the risk of complicated otitis media.We discuss a case of F.necrophorum infection resulting in significant intracranial disease to highlight the epidemiology of these infections,risk factors for complicated disease and signs and symptoms to guide diagnosis and investigation.

Effects of Drilling in Mastoid Cavity over Hearing in the Contralateral Ear

In advanced otological surgeries, powered instruments form an indispensable part. The risk of deterioration to hearing in the operated ear is a commonly discussed issue, however, there remains a possibility of affecting the hearing in the contralateral ear due to transcranial vibration. So in this study we aimed to assess the possibility of the non-operated ear being affected by the noise generated during ear surgeries and whether it is temporary or permanent in nature. Methodology: This study included 63 patients diagnosed with unilateral disease who underwent mastoid surgery. Preoperatively all the patients were subjected to Pure tone audiometry (PTA), Transient evoked otoacoustic emission (TEOAE) and Distortion product otoacoustic emission (DPOAE). Patients were operated using both cutting and diamond burrs of ranging from sizes 1 - 6 mm. Total drilling time was recorded. Results: Post-operative hearing evaluation was done at 1 week, 4 weeks and 12 weeks. The sound emitted by various burrs was recorded by Sound Level Meter. Out of the total 58 patients that followed up, 46 showed change in at least one of the hearing parameters. Patients showing changes had a higher drilling time as compared to those with no changes. Of these, the changes associated with the total drilling time and with cutting burr time were found to be significant. The hearing changes seen on PTA, TEOAE and DPOAE were transient in nature with only one patient having a persistent decreased high frequency threshold at the end of 12 weeks. It was also found that cutting burrs produce more sound as compared to diamond burrs and a larger size burr of a type produces more sound than a smaller one of its type. Conclusion: The drilling of mastoid bone during ear surgeries can transiently impair the hearing in the contralateral ear which is of great significance in patients with only one hearing ear.

Chronic otitis media and middle ear variants:Is there relation?

BACKGROUND Chronic otitis media(COM)is an inflammatory disease that lasts for a long time.It is common in developing countries.Hearing loss can result from COM.The relationship between variations in middle ear anatomy and COM was investigated in our study.AIM To compare the prevalence of middle ear anatomic variations between the cases with COM and healthy individuals.METHODS This retrospective study included 500 patients with COM and 500 healthy controls.The presence of those variants was determined:Koerner’s septum,facial canal dehiscence,high jugular bulb,jugular bulb dehiscence,jugular bulb diverticulum,sigmoid sinus anterior location and deep tympanic recesses.RESULTS A total of 1000 temporal bones were examined.The incidences of these variants were respectively(15.4%-18.6%),(38.6%-41.2%),(18.2%-4.6%),(2.6%-1.2%),(1.2%-0%),(8.6%-0%),(0%-0%).It was observed that only high jugular bulb(P<0.001)and anteriorly located sigmoid sinus frequencies(P=0.002)in the case group were statistically significantly higher than the control groups.CONCLUSION COM is a multifactorial disease and variants of middle ear have always been important in terms of potential risk for complication during surgery but rarely associated with COM as an etiology or as a consequence of the disease.We didn't find a positive correlation between COM and Koerner’s septum and facial canal defect.We ended up with a significant conclusion with the variants of dural venous sinuses-high jugular bulb,dehiscence of jugular bulb,diverticulum of jugular bulb and anteriorly located sigmoid sinus-that have been studied less and frequently associated with inner ear illnesses.

Numerical Simulation of Droplets Interacting with a Microcolumnar Solid Structure

The VOF method is used to simulate the dynamics of a droplet interacting with a structure consisting of an array of microcolumns mounted on a flat surface.Such a specific configuration is intended to mimic the typical properties of lotus leaves,which typically display regularly arranged micron-scale papillary structures.After setting the initial velocity of the simulated droplet on the basis of practical considerations,an analysis is conducted about the effect of the characteristic size of the microstructure on the apparent contact angle.The pressure variation in the microstructure caves is also examined.The simulation results show that the change of the contact angle of the droplet in the quasi-static state is consistent with theoretical calculations and the contact angle in the dynamic state is smaller than that in the quasi-static state.Moreover,under dynamic conditions,the pressure fluctuation in the microstructure cave depends essentially on the characteristic size of the microstructure.

开放式鼓室成形术远期疗效

回顾分析我科2004～2007年间随访6个月～2年83例开放式鼓室成形术病例,探讨开放式鼓室成形术治疗胆脂瘤型中耳炎的远期疗效。

开放式改良乳突根治术后恢复期常见问题的原因及对策

慢性化脓性胆脂瘤型中耳炎为临床常见疾病，目前手术主要有开放式及闭合式两种，开放式因胆脂瘤复发率低，听力保留与闭合式差别不大，因而被广泛采用。开放式手术术后恢复期常见问题的防治，各家报道不一，现将本科室诊治经验报道如下。

鼓室成形术后迟发性面瘫临床观察

2003年3月～2006年12月我科发生中耳术后迟发性不全性面瘫7例,报道如下。 1资料与方法 1.1临床资料。 本组7例患者均为女性,年龄35～57岁。均为慢性化脓性中耳乳突炎,左耳3例,右耳4例。中耳乳突CT显示鼓窦、上鼓室扩大及高密度影，3例见听骨链缺损，2例听骨链固定，其中胆脂瘤型3例。

Tuberculous otitis media eseries of 10 cases

Background:Tuberculosis(TB)of the middle ear cleft(MEC)is a rare extra-pulmonary manifestation.Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult.Objectives:To study the clinical presentations,complications and effective diagnostic modalities in tuberculosis of middle ear cleft.Methods:We retrospectively studied 10 patients diagnosed with chronic otitis media,unresponsive to 2 months conventional treatment.Pure tone audiogram,High resolution computed tomography(HRCT)of temporal bone,and AFB staining of ear discharge were done.All patients underwent mastoid surgery.AFB staining and histopathological examination of granulation tissue removed from the middle ear and mastoid were also done.Results:Clinical findings were mastoid swelling,facial palsy and post-aural fistula 3,4&2 patients respectively.All patients had persistent ear discharge and three had vertigo.Hearing loss was of moderate conductive type in five,sensorineural type in three and mixed type in two.HRCT of temporal bone revealed soft tissue density in MEC in 9 and evidence of bone destruction in 6 cases.Diagnosis of TB was confirmed either by(a)demonstration of AFB in ear discharge(4 patients)/tissue removed during surgery(4 patients)or(b)by demonstration of tuberculous granulomas with necrosis on histopathological examination of tissue from MEC(8 patients).Conclusion:Tuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas.Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods.

Mastoid obliteration and reconstruction techniques:A review of the literature

Objective To review the published literature related to the different obliteration and reconstruction techniques in the management of the canal wall down mastoidectomy.Methods A PubMed(Medline)and LILACS databases as well as crossed references search was performed with the following Mesh terms:“cholesteatoma”,“cholesteatoma-middle ear”,“otitis media”,“otitis media,suppurative”,“mastoiditis”,“mastoidectomy”,“canal wall down mastoidectomy”,“radical mastoidectomy”,“mastoid obliteration”and crossed references.Inclusion criteria were adult patients subject to mastoid cavity obliteration and posterior canal wall reconstruction.The technique and materials used,anatomic and functional results,complications,recurrence rates,and changes in quality of life,were analyzed.A total of 94 articles were screened,38 were included for full-text detailed review.Results Twenty-one articles fulfilled the inclusion criteria.Techniques and materials used for canal wall reconstruction,tympanoplasty,and ossiculoplasty were varied and included autologous,biosynthetic,or both.Auditory results were reported in 16 studies and were inconsistent.Three studies reported improvement in the quality of life using the GBI scale.Follow-up time ranged from 1 to 83 months.Eleven articles used imaging studies to evaluate postoperative disease recurrence.The highest recurrence rate reported for cholesteatoma after obliteration was 19%.The most frequently reported complications were retraction pockets and transient otorrhea.Conclusion Plenty of techniques combining grafts and other materials have been used to overcome mastoidectomy cavity problems.So far,it is still not possible to standardize an ideal procedure.The available level of evidence for this topic is low and limited.

耳后带蒂肌骨膜瓣及自体骨粉在开放式乳突根治术腔填塞术中的应用研究

开放式乳突根治术是治疗中耳胆脂瘤及骨疡型中耳炎的主要手术方式,但手术后留下的宽大乳突术腔及外耳道后壁缺损给患者带来诸多不便,部分患者难以获得干耳,并影响听力重建的效果。外耳道后上壁重建术是消除开放式乳突术腔的常用手术方式,我们先前曾利用自体耳屏软骨重建外耳道后上壁及上鼓室外侧壁,术后获得接近正常的外耳道生理功能,但随着随访时间的延长,

Endoscopic ear surgery: A case series and first United Kingdom experience

AIM: To present the United Kingdom's first case series of 70 otological cases of endoscopic and non-endoscopic ear surgeries.METHODS: Prospective case series incorporating a range of endoscopic procedures performed using a 4 mm, 18 cm rigid endoscope, performed by a single surgeon at a single centre. Primary outcome measures included mean average pre and post-operative air-bone gap hearing thresholds and duration of surgery.RESULTS: Thirty-eight patients underwent endoscopic assisted ear surgery and 32 underwent non-endoscopic assisted ear surgery. In both surgical groups, there was a significant difference between pre and post-operative mean air-bone gaps(P = 0.02). Mean operating time was comparable between both groups. Eight patients developed post-operative complications.CONCLUSION: Endoscopic ear surgery can be performed safely in a range of otological procedures. This has the potential to become a well-established surgical option for middle ear surgery in the near future. Advantages and limitations are discussed.

儿童颞骨乳突B淋巴母细胞淋巴瘤1例

1临床资料患儿,男,9岁,主因间断右侧口角歪斜1月余,加重伴耳痛3天于2019-05-28入院。患儿入院前1月余无明显诱因间断出现右侧口角歪斜,伴右眼偏斜,偶伴右耳疼痛,每次持续约20~100 min,可自行恢复正常,病情间断反复发作,无发热、头痛、头晕及眩晕,无张口受限,无耳溢液及听力下降,曾就诊于神经内科,诊断不详,予营养神经等治疗后病情无缓解。入院前3天患儿无明显诱因口角歪斜呈持续性,伴右侧耳痛,门诊考虑“右侧周围性面神经麻痹待查;右侧中耳乳突炎”收治入院。患儿既往体健,家族中无遗传性疾病史。专科查体:右侧额纹消失,右眼闭合不全,无溢泪,右侧鼻唇沟变浅,口角对称,张口时口角左偏,伸舌无偏斜;双侧耳廓无畸形,右侧外耳道变窄、后壁肿胀,鼓膜不能窥及;右侧乳突区压痛;鼓腮漏气;左耳(-)。面神经检测未见异常。颞骨CT示右侧中耳鼓室及乳突小房渗出性病变,未见骨质破坏(图1A)。

Endoscopic Management of Pediatric Cholesteatoma

Pediatric cholesteatoma occurs in one of two forms:congenital cholesteatoma,developing from embryonic epidermal cell rests or acquired cholesteatoma,associated with a focal defect in the tympanic membrane.This disease has been traditionally managed with the operating microscope,often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities.Recently,advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive,transcanal endoscopic approach.This review discusses the current literature relating to the etiopathogenesis,assessment and endoscopic management of pediatric cholesteatoma.Early outcomes of endoscopic treatment,emerging trends and technologies are also reviewed.

Does preoperative bacterial culture have bearing on healing of mastoid cavity:A prospective study

Objective： To study the bacteriological profile in a healing mastoid cavity. Methods： This study was a single centre prospective study. Culture swabs from granulations in the mastoid cavity were sent in 40 consecutive patients with squamosal chronic otitis media undergoing mastoidectomy. Cultures were processed for both aerobic and anaerobic bacteria. Results： Preoperatively： specimens from 26 out of 40 （60.5%） had growth on culture, with 22 （55%） showing only one organism while 4 showing multiple organisms. The commonest organism isolated was pseudomonas aeruginosa （n=15）. At 1 month after mastoidctomy, 11 patients had sterile culture while 29 had growth, of which 26 had aerobic growth and 3 had anaerobic growth. Pseudomonas was seen in 22 patients and staphylococcus aureus in 2 patients. The mean Merchant score was 2. At 3 months： 29 patients （72.5%） had sterile culture from mastoid cavity while 11 patients （27.5%） had growth on culture. All positive cultures were aerobic, including pseudomonas （n=9） and proteus （n= 2）. The mean Merchant score was 1.03. Of the 40 patients, 16 （40%） had a different organism cultured postoperatively compared to preoperative swabs. Conclusion： Pseudomonas and proteus seem to be the most common organisms responsible for persistent otorrhea after mastoidectomy. Persistent sterile otorrhea was seen in 4 patients （10%） in this group at the end of 3 months. Sterile cultures of preoperative swab are more likely to remain sterile in the postoperative period.

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

Introduction:This study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication,i.e.postoperative surgical site infection(SSI)in cases with and without mastoid obliteration.Materials and methods:Retrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019.Patient characteristics,peri-and postoperative management and complications were reviewed.The cases were divided into two groups based on whether mastoid obliteration was performed or not.Results:A total of 336 cholesteatoma operations were performed,of which 248 cases received mastoid obliteration.In total 21 complications were observed,of which SSI was the most common(15/21).No difference in occurrence of any postoperative complication was seen between the obliteration and noobliteration group(p=0.798),especially not in the number of SSI(p=0.520).Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups.In the no-obliteration group a younger age(p=0.015),as well as primary surgery(p=0.022)increased the risk for SSI.In the obliteration group the use of bioactive glass(BAG)S53P4 was identified as independent predictor of SSI(p=0.008,OR 5.940).Discussion:SSI is the most common postoperative complication in cholesteatoma surgery.The causes of SSI are multifactorial,therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.

A large basal cell adenoma extending to the ipsilateral skull base and mastoid in the right parotid gland: A case report

BACKGROUND Basal cell adenoma (BCA) is a rare benign tumour that has unique histological characteristics and primarily arises in the parotid glands. According to published reports, nearby tissue destruction by BCA seems impossible. CASE SUMMARY We presented a case of a 54-year-old woman with a mass in the deep lobe of the right parotid gland involving the ipsilateral skull base and mastoid. The patient exhibited gradual right facial swelling but no other obvious symptoms. Combined resection of the total right parotid gland and partial skull base excision were performed. The biopsy conducted before the surgery and sections cut from intraoperatively obtained tissues were not definitive for identifying the character of the neoplasm. A final diagnosis of tubular BCA without malignant elements was established based on postoperative pathology results and immunohistochemical analysis. The tumour did not recur during the 12-mo follow-up period. CONCLUSION A diagnosis of BCA can only be established based on a histopathological examination after an excisional biopsy, and tubular BCA should carefully be considered as a destructive type.