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Severe acute otitis media and mastoiditis caused by group A beta-hemolytic streptococcus

Juha T Laakso1, Valtteri Rissanen1, Eeva Ruotsalainen2

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center Helsinki University Hospital and University of Helsinki Helsinki Finland.

Laryngoscope Investigative Otolaryngology
|October 20, 2021
PubMed
Abstract

Insights

Group A Streptococcus (GAS) causes severe acute otitis media (AOM) and acute mastoiditis (AM) with rapid onset and reversible hearing loss. Rapid strep tests (RST) effectively identify GAS in middle ear infections.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Microbiology

Background:

  • Severe acute otitis media (AOM) and acute mastoiditis (AM) can be caused by Group A Streptococcus (GAS).
  • Understanding the characteristics and outcomes of GAS-induced AOM/AM is crucial for effective management.

Purpose of the Study:

  • To delineate the clinical features, diagnostic approaches, treatment strategies, and patient outcomes for severe AOM and AM specifically caused by GAS.
  • To analyze the incidence and trends of GAS AOM/AM requiring hospitalization over a 16-year period.

Main Methods:

  • Retrospective cohort study analyzing patient data from 2002-2018.
  • Detailed case review of patients treated during the 2017-2018 GAS epidemic, including audiometry and quality of life surveys (EOS-16).
  • Comparison of diagnostic sensitivity between Rapid Strep Tests (RST) and bacterial cultures for GAS identification.

Main Results:

  • GAS infections causing AOM/AM exhibit epidemic peaks approximately every 7 years.
  • During 2017-2018, 37 patients (29 adults, 8 children) were hospitalized; 14 (38%) had acute mastoiditis.
  • Common symptoms included severe ear pain, tympanic membrane perforation, discharge, fever, and vertigo. Marked mixed hearing loss was typical, with significant (32.3 ± 14.8 dB) reversible improvement post-treatment. RST showed higher sensitivity than bacterial culture for GAS detection.

Conclusions:

  • GAS-associated AOM/AM presents with rapid progression and often includes a reversible sensorineural hearing loss component.
  • Prompt and adequate treatment leads to significant recovery of hearing thresholds.
  • Rapid Strep Tests are a valuable tool for the rapid diagnosis of GAS in middle ear infections.
Keywords:
Streptococcus pyogenesacute mastoiditisacute otitis mediagroup A beta‐hemolytic streptococcushealth‐related quality of life

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