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Children hospitalized due to acute otitis media: how does this condition differ from acute mastoiditis?
Anu Laulajainen-Hongisto1, Riste Saat2, Laura Lempinen3
1Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4E, PO Box 220, Helsinki FI-00029 HUS, Finland; Department of Allergy, University of Helsinki and Helsinki University Hospital, PO Box 160, Helsinki FI-00029 HUS, Finland.
Insights
Hospitalized acute otitis media in children shares pathogens with acute mastoiditis, differing from outpatient cases. These children required less surgery and shorter hospital stays than those with acute mastoiditis.
Area of Science:
- Otorhinolaryngology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Hospitalization for AOM suggests complicated disease, necessitating comparison with other severe forms like acute mastoiditis.
- Understanding the clinical and microbiological differences is crucial for effective management.
Purpose of the Study:
- To characterize the clinical presentation and microbiological findings of children hospitalized with AOM.
- To compare these findings with those of children diagnosed with acute mastoiditis during the same period.
- To identify distinct features that differentiate severe AOM from acute mastoiditis.
Main Methods:
- Retrospective review of medical records for children (0-16 years) hospitalized with AOM (2003-2012).
- Comparison with published data on pediatric acute mastoiditis cases from the same institution and timeframe.
- Analysis of common pathogens, clinical symptoms, and treatment outcomes.
Main Results:
- Common pathogens in hospitalized AOM included Streptococcus pneumoniae, Pseudomonas aeruginosa, Streptococcus pyogenes, and Staphylococcus aureus; Haemophilus influenzae was absent.
- S. pyogenes and P. aeruginosa were associated with otorrhea, with P. aeruginosa also linked to tympanostomy tube otorrhea.
- Children with hospitalized AOM had more comorbidities, bilateral infections, and facial nerve paresis but lower CRP and shorter hospital stays than those with acute mastoiditis. S. aureus was more prevalent, and resistant S. pneumoniae less common in hospitalized AOM.
- Surgical interventions like tympanostomy and mastoidectomy were less frequent in hospitalized AOM cases.
Conclusions:
- Hospitalized AOM and acute mastoiditis represent a spectrum of complicated AOM, distinct from typical outpatient infections.
- The bacteriology of hospitalized AOM more closely resembled that of acute mastoiditis than outpatient AOM.
- Children hospitalized for AOM required less surgical intervention and had shorter hospitalizations compared to those with acute mastoiditis.
Objectives:
To evaluate the clinical picture and microbiological findings of children hospitalized due to acute otitis media and to analyze how it differs from acute mastoiditis.
Methods:
A retrospective review of the medical records of all children (0-16 years) hospitalized due to acute otitis media in the Department of Otorhinolaryngology at the Helsinki University Hospital, between 2003 and 2012. Comparison with previously published data of children with acute mastoiditis (n=56) from the same institute and period of time.
Results:
The most common pathogens in the children hospitalized due to acute otitis media (n=44) were Streptococcus pneumoniae (18%), Pseudomonas aeruginosa (16%), Streptococcus pyogenes (14%), and Staphylococcus aureus (14%). One of the most common pathogens of out-patient acute otitis media, Haemophilus influenzae, was absent. Otorrhea was common in infections caused by S. pyogenes and otorrhea via tympanostomy tube in infections caused by P. aeruginosa. In children under 2 years-of-age, the most common pathogens were S. pneumoniae (43%), Moraxella catarrhalis (14%), and S. aureus (7%). S. pyogenes and P. aeruginosa were only found in children over 2 years-of-age. Previous health problems, bilateral infections, and facial nerve paresis were more common in children hospitalized due to acute otitis media, compared with acute mastoiditis, but they also demonstrated lower CRP values and shorter duration of hospital stay. The number of performed tympanostomies and mastoidectomies was also comparatively smaller in the children hospitalized due to acute otitis media. S. aureus was more common and S. pneumoniae, especially its resistant strains, was less common in the children hospitalized due to acute otitis media than acute mastoiditis.
Conclusions:
Acute otitis media requiring hospitalization and acute mastoiditis compose a continuum of complicated acute otitis media that differs from common out-patient acute otitis media. The bacteriology of children hospitalized due to acute otitis media resembled more the bacteriology of acute mastoiditis than that of out-patient acute otitis media. The children hospitalized due to acute otitis media needed less surgical treatment and a shorter hospitalization than those hospitalized due to acute mastoiditis.
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