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Intracranial complications of CSOM in pediatric patients: A persisting problem in developing countries
Avani Jain1, Nikhil Arora1, Ravi Meher1
1Department of ENT, MAMC, New Delhi, India.
Insights
Intracranial complications of chronic suppurative otitis media (CSOM) in children are serious but declining. Prompt treatment with antibiotics and surgery is crucial, as brain abscess is the most common complication, with a low fatality rate.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Infectious Diseases
Background:
- Intracranial complications (ICC) of chronic suppurative otitis media (CSOM) persist despite antibiotic availability.
- Pediatric patients, particularly in developing nations, face higher risks due to factors like poor hygiene, low immunity, and limited healthcare access.
Purpose of the Study:
- To investigate the incidence, clinical characteristics, management strategies, and outcomes of pediatric patients with intracranial complications stemming from chronic suppurative otitis media.
Main Methods:
- A 15-year retrospective analysis was performed at a tertiary care center.
- Data collected included patient demographics, clinical presentations, diagnostic investigations (laboratory and radiological), treatment protocols, hospitalization duration, and patient outcomes.
Main Results:
- Out of 142 pediatric patients diagnosed with ICC of CSOM, a decrease in incidence was observed.
- Brain abscess was the most frequent complication (58.5%).
- Treatment involved 4-6 weeks of intravenous antibiotics, canal wall down mastoidectomy, and, when necessary, neurosurgical intervention. The case fatality rate was 2.8%.
Conclusions:
- Otogenic intracranial complications pose a significant, potentially fatal risk if not managed promptly and effectively.
- Treatment typically requires broad-spectrum intravenous antibiotics for 4-6 weeks, often combined with mastoid exploration and potentially neurosurgical intervention.
- A high index of suspicion is essential for early diagnosis in patients exhibiting danger signs.
Background:
Intracranial complications (ICC) of chronic suppurative otitis media (CSOM) occur even in the antibiotic area. These complications are commonly seen in pediatric patients due to poor hygiene and low immunity. They are more prevalent in developing countries due to illiteracy, low socioeconomic status and lack of access to health care facilities.
Objective:
To study the incidence, clinical profile, treatment and outcome of pediatric patients presenting with intracranial complications of chronic suppurative otitis media.
Methods:
A retrospective analysis of intracranial complications of CSOM in pediatric patients was conducted over a period of 15 years at a tertiary level institute. Data regarding age, sex, clinical presentation, laboratory and radiological investigations, management, duration of hospitalization, and outcomes were recorded.
Results:
There were 142 patients, in the pediatric age group, diagnosed as having intracranial complications due to chronic otitis media during the study period. There was a decline in the incidence of ICC of CSOM. The most frequent intracranial complication seen was brain abscess (58.5%). All patients were administered intravenous antibiotics for 4-6 weeks and underwent canal wall down mastoidectomy. Neurosurgical intervention was considered in the required patients. The case fatality rate in our study was 2.8% (4 patients).
Conclusion:
Otogenic intracranial complications can be fatal if not managed appropriately and timely. Broad spectrum intravenous antibiotics are usually required for 4-6 weeks with or without neurosurgical intervention and mastoid exploration. A high index of suspicion is required in all patients presenting with danger symptoms.
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