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Endaural Endoscopic Atticoantrotomy Retrograde Mastoidectomy using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
[Clinical analysis of complications of suppurative otitis media in children]
1Department of Otolaryngology Head and Neck Surgery，Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine；Institute of Ophthalmology，School of Medicine，Shanghai Jiaotong University；Shanghai key Laboratory of Otolarsal Disease Transformation，Shanghai，200092，China.
Insights
Complications of childhood suppurative otitis media can be severe, particularly in young children. Early diagnosis and prompt surgical intervention are crucial for preventing irreversible hearing loss and other serious conditions.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Infectious Diseases
Background:
- Suppurative otitis media (SOM) in children can lead to severe complications.
- Early symptoms may be subtle, especially in younger children.
- Conservative treatment failure necessitates surgical evaluation.
Purpose of the Study:
- To analyze clinical features and surgical outcomes for SOM complications in children.
- To identify risk factors and effective management strategies.
Main Methods:
- Retrospective analysis of 35 children under 14 with SOM unresponsive to conservative treatment.
- Surgical interventions included mastoidotomy, grommet insertion, and mastoidectomy.
- Clinical data, CT scans, and audiology tests were reviewed.
Main Results:
- Common complications included subperiosteal abscess (65.7%) and facial paralysis (20.0%).
- CT revealed bone destruction in 6 cases.
- Hearing loss severity correlated with auricular meatus purulence (P<0.05).
- Postoperative hearing improved in 18/26 patients; 2 had a 10-15 dB HL increase in air-bone gap.
Conclusions:
- SOM complications in children, especially under five, can be severe and insidious.
- Recurrent ear discharge may signal hearing impairment.
- Early microbiological assessment and prompt surgical treatment guided by imaging and hearing tests are vital to prevent permanent hearing loss and other sequelae.
Abstract:
Objective:To summarize and analyze the clinical manifestations and surgical treatment for complications of suppurative otitis media in children. Method:The characteristic of 35 children under 14 years old with suppurative otitis media who had no response to conservative treatment were analyzed retrospectively. Of the patients, 23 cases（65.7%） with subperiosteal abscess, 7 cases （20.0%） with peripheral facial paralysis, 2 cases（5.7%） with brain abscess, 1 case（2.9%） with Bezold abscess, 1 case（2.9%） with labyrinthitis, 1 case （2.9%） with sigmoid sinus thrombophlebitis. Thirty cases（85.7%） were less than 5 years old. The operation methods included mastoidotomy（17 cases）, mastoidotomy combined with grommet insertion（12 cases）, canal wall up mastoidectomy（4 cases）, canal wall down mastoidectomy（2 cases）. Result:CT examination showed that 6 cases of middle ear infection complicated with extensive bone destruction in mastoid process, middle cranial fossa base and auditory ossicles. The severity of hearing loss was positively correlate to the presence of auricular meatus purulence（P<0.05）, but not to the onset time of hearing loss, disease duration and the bacteria species（P>0.05）. After a 6 months postoperative follow-up, all the wounds were well recovered. 26 patients received audiology tests at 3 months after operation, 18 cases with normal hearing or mild conductive hearing loss preoperatively had normal hearing after operation, 2 cases with moderate conductive hearing loss had a 10-15 dB HL increase in air-bone gap after operation,hearing reconstructions surgery was not performed in 1 case of severe mixed hearing loss and 1 case of moderate conductive hearing loss due to serious damage in the middle ear structure, therefore no significant improvement in hearing in these two cases,four cases with extremely severe hearing loss before the operation had no hearing improvement, while nine cases did not provide the hearing results. Conclusion:The symptoms of otitis media in children were not obvious while the complications could be severe, especially in younger children. Repeatedly auricular meatus purulence may indicate hearing impairment. Microbiological examination should be conducted at the early stage, and prompt treatment should be performed based on hearing and temporal bone CT scan to prevent irreversible complications and sensorineural hearing impairment.
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