Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only th...Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal abscesses.Patient’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by S.pneumoniae infection.The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.Interventions:The patient underwent intravenous antibiotic therapy and surgical treatment.Outcomes:The patient was discharged 14 days after hospitalization with an improved condition.Lessons:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even life-threatening.Complications are prevalent in children under 2 years,in whom the disease progresses more rapidly and severely.The vaccination with a 13-valent vaccine may not result in sufficient immunity against S.pneumoniae,a predominant pathogen in children affected by acute coalescent mastoiditis.展开更多
Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoidit...Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoiditis. This study aims to view the clinical presentation and management approaches in Khartoum Ear, Nose and Throat Hospital. Methodology: This is a prospective case series and a hospital-based study conducted at Khartoum Ear, Nose and Throat Hospital during the period from November 2017 to November 2019. A total of 61 patients were included in the study. Results: The median age at presentation is 5 years old, males are more affected than females with a ratio of 1.35:1, and the mean duration of symptoms prior to hospital admission was 9.6 days. The most common presenting symptoms were otalgia (83.3%), ear discharge (83.3%) and post-auricular swelling (83.3%), and the most common signs at admission were tenderness over the mastoid (95.1%), retroauricular swelling and protrusion of the auricle (82%), and redness over the mastoid (77%). The abnormal tympanic membrane was found in all patients with central perforation being the commonest finding (73.8%), and bulging tympanic membrane (21.3%). 34.4% of patients received oral antibiotics before admission and the mean duration of symptoms prior to admission increased significantly in those who received antibiotics 12.7 days in comparison to those who didn’t 8.3 days. Only 52.5% of patients had a past history of recurrent acute otitis media, and 8.2% had a past history of acute mastoiditis. All the patients with recurrent mastoiditis had a past history of recurrent acute otitis media. Computed Tomography (CT) scans were obtained for 50.8% and 83.9% of those scans showed coalescent mastoiditis. Further evidence of intracranial extension was found in 6.5% and Magnetic Resonance Imaging (MRI) was obtained for them. Of the study group, 67.2% presented with subperiosteal abscess, 4.9% with facial nerve palsy and 3.3% with brain abscess. Thirteen patients with no 展开更多
Mastoiditis is a common complication of acute otitis media. It is common in younger age compared to adulthood. Mastoiditis occurs when an otitis media infection spread directly to involve the bone of mastoid air cell ...Mastoiditis is a common complication of acute otitis media. It is common in younger age compared to adulthood. Mastoiditis occurs when an otitis media infection spread directly to involve the bone of mastoid air cell causing osteitis. Cholesteatoma can contribute to the development of mastoiditis. This typically leads to breakdown of some of the fine bony trabeculae of mastoid cells producing a coalescent mastoiditis with an emphyema in mastoid antrum. Cholesteatoma can contribute to the development of mastoiditis. The common treatment for mastoiditis is intravenous antibiotic. Our cases show that local antibiotic treatment is superior compared to systemic antibiotic in treating multi-drug resistant chronic. Pseudomonas mastoiditis compared to intravenous antibiotic. However, if it presents together with cholesteatoma the main treatment is still early mastoidectomy.展开更多
Background:Tuberculosis(TB)of the middle ear cleft(MEC)is a rare extra-pulmonary manifestation.Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making earl...Background:Tuberculosis(TB)of the middle ear cleft(MEC)is a rare extra-pulmonary manifestation.Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult.Objectives:To study the clinical presentations,complications and effective diagnostic modalities in tuberculosis of middle ear cleft.Methods:We retrospectively studied 10 patients diagnosed with chronic otitis media,unresponsive to 2 months conventional treatment.Pure tone audiogram,High resolution computed tomography(HRCT)of temporal bone,and AFB staining of ear discharge were done.All patients underwent mastoid surgery.AFB staining and histopathological examination of granulation tissue removed from the middle ear and mastoid were also done.Results:Clinical findings were mastoid swelling,facial palsy and post-aural fistula 3,4&2 patients respectively.All patients had persistent ear discharge and three had vertigo.Hearing loss was of moderate conductive type in five,sensorineural type in three and mixed type in two.HRCT of temporal bone revealed soft tissue density in MEC in 9 and evidence of bone destruction in 6 cases.Diagnosis of TB was confirmed either by(a)demonstration of AFB in ear discharge(4 patients)/tissue removed during surgery(4 patients)or(b)by demonstration of tuberculous granulomas with necrosis on histopathological examination of tissue from MEC(8 patients).Conclusion:Tuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas.Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods.展开更多
文摘Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal abscesses.Patient’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by S.pneumoniae infection.The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.Interventions:The patient underwent intravenous antibiotic therapy and surgical treatment.Outcomes:The patient was discharged 14 days after hospitalization with an improved condition.Lessons:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even life-threatening.Complications are prevalent in children under 2 years,in whom the disease progresses more rapidly and severely.The vaccination with a 13-valent vaccine may not result in sufficient immunity against S.pneumoniae,a predominant pathogen in children affected by acute coalescent mastoiditis.
文摘Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoiditis. This study aims to view the clinical presentation and management approaches in Khartoum Ear, Nose and Throat Hospital. Methodology: This is a prospective case series and a hospital-based study conducted at Khartoum Ear, Nose and Throat Hospital during the period from November 2017 to November 2019. A total of 61 patients were included in the study. Results: The median age at presentation is 5 years old, males are more affected than females with a ratio of 1.35:1, and the mean duration of symptoms prior to hospital admission was 9.6 days. The most common presenting symptoms were otalgia (83.3%), ear discharge (83.3%) and post-auricular swelling (83.3%), and the most common signs at admission were tenderness over the mastoid (95.1%), retroauricular swelling and protrusion of the auricle (82%), and redness over the mastoid (77%). The abnormal tympanic membrane was found in all patients with central perforation being the commonest finding (73.8%), and bulging tympanic membrane (21.3%). 34.4% of patients received oral antibiotics before admission and the mean duration of symptoms prior to admission increased significantly in those who received antibiotics 12.7 days in comparison to those who didn’t 8.3 days. Only 52.5% of patients had a past history of recurrent acute otitis media, and 8.2% had a past history of acute mastoiditis. All the patients with recurrent mastoiditis had a past history of recurrent acute otitis media. Computed Tomography (CT) scans were obtained for 50.8% and 83.9% of those scans showed coalescent mastoiditis. Further evidence of intracranial extension was found in 6.5% and Magnetic Resonance Imaging (MRI) was obtained for them. Of the study group, 67.2% presented with subperiosteal abscess, 4.9% with facial nerve palsy and 3.3% with brain abscess. Thirteen patients with no
文摘Mastoiditis is a common complication of acute otitis media. It is common in younger age compared to adulthood. Mastoiditis occurs when an otitis media infection spread directly to involve the bone of mastoid air cell causing osteitis. Cholesteatoma can contribute to the development of mastoiditis. This typically leads to breakdown of some of the fine bony trabeculae of mastoid cells producing a coalescent mastoiditis with an emphyema in mastoid antrum. Cholesteatoma can contribute to the development of mastoiditis. The common treatment for mastoiditis is intravenous antibiotic. Our cases show that local antibiotic treatment is superior compared to systemic antibiotic in treating multi-drug resistant chronic. Pseudomonas mastoiditis compared to intravenous antibiotic. However, if it presents together with cholesteatoma the main treatment is still early mastoidectomy.
文摘Background:Tuberculosis(TB)of the middle ear cleft(MEC)is a rare extra-pulmonary manifestation.Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult.Objectives:To study the clinical presentations,complications and effective diagnostic modalities in tuberculosis of middle ear cleft.Methods:We retrospectively studied 10 patients diagnosed with chronic otitis media,unresponsive to 2 months conventional treatment.Pure tone audiogram,High resolution computed tomography(HRCT)of temporal bone,and AFB staining of ear discharge were done.All patients underwent mastoid surgery.AFB staining and histopathological examination of granulation tissue removed from the middle ear and mastoid were also done.Results:Clinical findings were mastoid swelling,facial palsy and post-aural fistula 3,4&2 patients respectively.All patients had persistent ear discharge and three had vertigo.Hearing loss was of moderate conductive type in five,sensorineural type in three and mixed type in two.HRCT of temporal bone revealed soft tissue density in MEC in 9 and evidence of bone destruction in 6 cases.Diagnosis of TB was confirmed either by(a)demonstration of AFB in ear discharge(4 patients)/tissue removed during surgery(4 patients)or(b)by demonstration of tuberculous granulomas with necrosis on histopathological examination of tissue from MEC(8 patients).Conclusion:Tuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas.Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods.
