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The silent epidural abscess as a complication of acute otitis media in children
J G Bizakis1, G A Velegrakis, C E Papadakis
1Department of Otolaryngology, University of Crete School of Medicine, Heraklion, Greece.
Abstract:
Acute otitis media with complications is a persistent problem in the modern antibiotic era with a relatively high mortality rate. Acute mastoiditis is a serious complication of acute otitis media with potentially grave consequences and the epidural abscess constitutes the commonest of all intracranial complications, arising from middle ear infections. We report two cases of children with acute mastoiditis without evidence of intracranial complication or subperiosteal abscess, in whom the early evaluation with computed tomography (CT) disclosed an unsuspected epidural abscess. Therefore, we stress the use of CT as a rule of thumb for every child with acute mastoiditis.
Insights
Acute mastoiditis in children can hide serious intracranial complications like epidural abscesses. Early computed tomography (CT) scans are crucial for diagnosing these unsuspected complications in acute mastoiditis cases.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Neuroradiology
Background:
- Acute otitis media (AOM) with complications remains a significant challenge, carrying a notable mortality rate.
- Acute mastoiditis, a severe complication of AOM, can lead to grave outcomes.
- Epidural abscesses are the most frequent intracranial complications stemming from middle ear infections.
Observation:
- Two pediatric cases of acute mastoiditis were analyzed.
- These cases initially showed no signs of intracranial complications or subperiosteal abscess.
- Early computed tomography (CT) evaluation unexpectedly revealed epidural abscesses in both children.
Findings:
- Computed tomography (CT) is essential for detecting occult epidural abscesses in pediatric acute mastoiditis.
- The study highlights the diagnostic utility of CT in cases without overt signs of intracranial involvement.
- Early identification of epidural abscesses through CT is critical for timely intervention.
Implications:
- CT imaging should be routinely considered in the evaluation of all pediatric acute mastoiditis cases.
- Prompt diagnosis via CT can prevent severe neurological sequelae associated with epidural abscesses.
- This underscores the importance of advanced imaging in managing complex ear infections in children.