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Intracranial complications of acute mastoiditis
C Go1, J M Bernstein, A L de Jong
1The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, One Baylor Plaza, SM 1727, Houston, TX, USA. cgo@bcm.tmc.edu
Objective:
Oral antibiotic use may have changed the incidence and microbiology of otitic intracranial complications. We reviewed cases of acute mastoiditis to document: (1) incidence of intracranial complications; (2) risk factors; and (3) identify pathologic organisms.
Methods:
A retrospective study of children at a tertiary care children's hospital with acute mastoiditis from July, 1986 through June, 1998.
Results:
118 children with acute mastoiditis were identified. Eight patients (6.8%), ages 20 months to 14 years, had intracranial complications related to acute mastoiditis. Three children had a sigmoid sinus thrombosis, two children had an epidural abscess, and two children had both complications of sigmoid sinus thrombosis and epidural abscess, and a sigmoid sinus thrombosis and meningitis was present in one child. Pre-admission oral antibiotics were administered for an average of 10 days in seven of the eight patients. Persistent otorrhea and/or otalgia were present in all patients. Intraoperative cultures were negative in four cases (50%). Organisms isolated included: Streptococcus pneumoniae (2); Proteus mirabilis (1); Pseudomonas aeruginosa (1); and coagulase negative Staphylococcus (1). Multi-drug resistant organisms were documented in only one case. All patients underwent a contrast enhanced CT of the temporal bones and brain. Surgical management included complete mastoidectomy in all patients and a pressure equalization tube in seven of the eight cases.
Conclusions:
Our review did not document an increase in the incidence of otitic intracranial complications. Persistent otalgia or otorrhea while on oral antibiotics with associated neurologic symptoms are ominous signs suggestive of a complication. Multi-drug resistant organisms are uncommon whereas negative intraoperative cultures are common.
Insights
Oral antibiotic use did not increase otitic intracranial complications in children with acute mastoiditis. Persistent ear pain or discharge with neurological symptoms warrants further investigation for complications.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Neurosurgery
Background:
- Oral antibiotic use is common for acute otitis media and acute mastoiditis.
- The impact of oral antibiotics on the incidence and microbiology of otitic intracranial complications remains unclear.
Purpose of the Study:
- To determine the incidence of intracranial complications in children with acute mastoiditis.
- To identify risk factors associated with these complications.
- To characterize the causative pathogens.
Main Methods:
- Retrospective study of pediatric patients diagnosed with acute mastoiditis between July 1986 and June 1998.
- Analysis of patient demographics, clinical presentation, treatment, and outcomes.
- Review of microbiological data and imaging studies (contrast-enhanced CT).
Main Results:
- Eight out of 118 children (6.8%) developed intracranial complications, including sigmoid sinus thrombosis, epidural abscess, and meningitis.
- Seven of the eight patients had received oral antibiotics for an average of 10 days prior to admission.
- Commonly isolated organisms included Streptococcus pneumoniae and Proteus mirabilis; multi-drug resistant organisms were rare.
Conclusions:
- The incidence of otitic intracranial complications did not appear to increase.
- Persistent otalgia or otorrhea with neurological symptoms during oral antibiotic treatment are critical indicators of potential complications.
- Negative intraoperative cultures are frequent, and multi-drug resistant organisms are uncommon in these cases.