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Acta Bio-medica : Atenei Parmensis Feb 2020Acute mastoiditis is the most common complication of acute otitis media. Although rare, the disease is carefully studied by otolaryngologists because it usually affects... (Review)
Review
Acute mastoiditis is the most common complication of acute otitis media. Although rare, the disease is carefully studied by otolaryngologists because it usually affects very young children with severe clinical course and sometimes causes serious complications. Most important risk factors are the young age (often>2 years), high fever, alteration of the laboratory findings (very high values of WBC count, absolute neutrophil count and C-reactive protein), while less important are previous antibiotic therapy or previous middle ear infections. The main pathogen of the acute mastoiditis is Streptococcus pneumoniae, followed by Streptococcus piogenes, Haemophilus influentiae, and Staphylococcus aureus. The finding of Pseudomonas aeruginosa is not uncommon, but often its presence is often considered a contamination or simultaneous infection. The complications can be extracranial (subperiosteal abscess, Bezold's abscess); intratemporal (facial nerve palsy, labyrinthitis) and intracranial (subdural abscess). The complications have often a very serious clinical course and potentially life-threatening. Antibiotic therapy is the main treatment in not complicated forms. Considering the prevalence of Streptococcus pneumoniae, cephalosporins are the antibiotic of choice, but they have to be administrated intravenously in hospitalized patients. Combinations with other antibiotic are suggested when multibacterial flora is present. In complicated forms of acute mastoiditis, the antibiotic treatment can be particularly important, in combination with other specific drugs (i.e. anticoagulants and/or corticosteroids). Surgical treatments, such as incision of abscesses, mastoidectomy, and neurosurgical procedures, are sometimes performed in combination with medical therapy in very severe complications. Data from our experience are briefly reported.
Topics: Acute Disease; Anti-Bacterial Agents; Child; Humans; Mastoiditis
PubMed: 32073562
DOI: 10.23750/abm.v91i1-S.9259 -
Hearing Research Jun 2022In bone conduction (BC) stimulation, the sound travels from the site of stimulation to the ipsilateral and contralateral cochlea. A frequency dependent reduction in BC... (Review)
Review
In bone conduction (BC) stimulation, the sound travels from the site of stimulation to the ipsilateral and contralateral cochlea. A frequency dependent reduction in BC hearing sensitivity occurs when sound travels to the contralateral cochlea as compared to the ipsilateral cochlea. This effect is called transcranial attenuation (TA) that is affected by several factors. Experimental and clinical studies describe TA and the factors that have an effect on it. These factors include stimulus location, coupling of a bone conduction hearing aid to the underlying tissue, and the properties of the head (such as geometry of the head, thickness of the skin and/or skull, changes due to aging, iatrogenic changes such as bone removal in mastoidectomy, and occlusion of the external auditory canal). While TA has an effect of the patient's benefit of BCHAs, there seems to be a discrepancy between experimental measurements and clinical relevance. The effects are small and the interindividual variability, in comparison, is rather large. However, a better understanding of these factors may help to determine the site of attachment, the coupling mode, and possibly the fitting of a BCHA, depending on its indication.
Topics: Acoustic Stimulation; Bone Conduction; Cochlea; Hearing Aids; Humans; Mastoidectomy; Sound; Vibration
PubMed: 34334219
DOI: 10.1016/j.heares.2021.108318 -
Indian Journal of Otolaryngology and... Dec 2022Facial nerve paralysis is one of the most common symptom an otology surgeon comes across. Aim of this article is to review the literature, to study the important causes,...
Facial nerve paralysis is one of the most common symptom an otology surgeon comes across. Aim of this article is to review the literature, to study the important causes, pathogenesis and to know the common sites of involvement in different types of facial paralysis with importance of imaging in identifying the site of lesion and role of surgery and outcome of conservative management in case of infranuclear facial paralysis. This is a prospective study of 23 cases of infranuclear facial paralysis in case of post-head injury, post-mastoidectomy and otitis media. Facial paralysis due to post head injury is more common in adult males due to their active life and road traffic accident is the main cause. Longitudinal Fracture of temporal bone is a common fracture and it accounts for more number of facial paralysis. Decompression of the Facial nerve has beneficial effects. HRCT delineates the status of facial nerve in intratemporal part. Cholesteatoma and granulation tissue both play equal causative role for facial paralysis in otitis media.
PubMed: 36742893
DOI: 10.1007/s12070-020-01905-x -
The Journal of International Advanced... Jan 2021To describe the clinical course and outcome of a group of adults who presented with a subperiosteal abscess (SPA) MATERIALS and METHODS: A retrospective chart review of...
OBJECTIVES
To describe the clinical course and outcome of a group of adults who presented with a subperiosteal abscess (SPA) MATERIALS and METHODS: A retrospective chart review of patients with SPA.
RESULTS
Between 2001 and 2015, 7 such patients-5 men and 2 women-were identified. Their age ranged from 18 to 62 years. Six of them suffered from chronic otitis media (COM) and presented with signs and symptoms of otalgia, pain, and swelling around the mastoid. Five of the patients underwent a previous mastoidectomy for cholesteatoma (4- canal wall down and 1 had canal wall up). One of the non-operated patients had cholesteatoma and the other one had chronic suppurative otitis media without cholesteatoma. One patient developed peripheral facial nerve palsy that resolved after surgery, otherwise, no other intratemporal or intracranial complications were observed. Management included a canal wall down mastoidectomy, abscess drainage, and parenteral wide-spectrum antibiotics. One patient suffered cardiovascular and respiratory comorbidities, requiring the delay of surgery for 6 days. This patient underwent incision and drainage of the abscess before surgery. Pathogens were recognized in 4 of the patients and included Streptococcus pneumoniae, Candida albicans, Staphylococcus aureus, and Corynebacterium.
CONCLUSION
SPA in adults is rare but may be seen in cases of neglected COM, whether previously operated or not. Comorbidities in older population group may require postponing surgery, so immediate incision and drainage may be warranted, as well as post-surgical intensive care.
Topics: Abscess; Adolescent; Adult; Cholesteatoma, Middle Ear; Female; Humans; Male; Mastoid; Middle Aged; Otitis Media; Otitis Media, Suppurative; Retrospective Studies; Young Adult
PubMed: 33605218
DOI: 10.5152/iao.2020.8432 -
European Archives of... Aug 2023It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different...
PURPOSE
It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case.
CASE PRESENTATION
A 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy.
CONCLUSIONS
Canal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure.
Topics: Female; Humans; Adult; Mastoidectomy; Retrospective Studies; Mastoid; Ear, Middle; Ear Diseases; Ear Canal; Cholesteatoma, Middle Ear
PubMed: 37195344
DOI: 10.1007/s00405-023-08021-w -
Journal of Otology Mar 2020Pediatric cholesteatoma occurs in one of two forms: congenital cholesteatoma, developing from embryonic epidermal cell rests or acquired cholesteatoma, associated with a... (Review)
Review
Pediatric cholesteatoma occurs in one of two forms: congenital cholesteatoma, developing from embryonic epidermal cell rests or acquired cholesteatoma, associated with a focal defect in the tympanic membrane. This disease has been traditionally managed with the operating microscope, often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities. Recently, advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive, transcanal endoscopic approach. This review discusses the current literature relating to the etiopathogenesis, assessment and endoscopic management of pediatric cholesteatoma. Early outcomes of endoscopic treatment, emerging trends and technologies are also reviewed.
PubMed: 32110236
DOI: 10.1016/j.joto.2018.11.009 -
Journal of Otology Jul 2021To review the published literature related to the different obliteration and reconstruction techniques in the management of the canal wall down mastoidectomy. (Review)
Review
OBJECTIVE
To review the published literature related to the different obliteration and reconstruction techniques in the management of the canal wall down mastoidectomy.
METHODS
A PubMed (Medline) and LILACS databases as well as crossed references search was performed with the following Mesh terms: "cholesteatoma", "cholesteatoma-middle ear", "otitis media", "otitis media, suppurative", "mastoiditis", "mastoidectomy", "canal wall down mastoidectomy", "radical mastoidectomy", "mastoid obliteration" and crossed references. Inclusion criteria were adult patients subject to mastoid cavity obliteration and posterior canal wall reconstruction. The technique and materials used, anatomic and functional results, complications, recurrence rates, and changes in quality of life, were analyzed. A total of 94 articles were screened, 38 were included for full-text detailed review.
RESULTS
Twenty-one articles fulfilled the inclusion criteria. Techniques and materials used for canal wall reconstruction, tympanoplasty, and ossiculoplasty were varied and included autologous, biosynthetic, or both. Auditory results were reported in 16 studies and were inconsistent. Three studies reported improvement in the quality of life using the GBI scale. Follow-up time ranged from 1 to 83 months. Eleven articles used imaging studies to evaluate postoperative disease recurrence. The highest recurrence rate reported for cholesteatoma after obliteration was 19%. The most frequently reported complications were retraction pockets and transient otorrhea.
CONCLUSION
Plenty of techniques combining grafts and other materials have been used to overcome mastoidectomy cavity problems. So far, it is still not possible to standardize an ideal procedure. The available level of evidence for this topic is low and limited.
PubMed: 34220986
DOI: 10.1016/j.joto.2021.01.002 -
The Turkish Journal of Pediatrics 2023Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus... (Review)
Review
BACKGROUND
Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus regarding the management of AM has been identified. The current guidelines include a conservative approach (parenteral antibiotics alone, antibiotics plus minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess through retro-auricolar incision or needle aspiration) or surgical treatment (mastoidectomy). The main aim of this review was to evaluate and summarize the current knowledge about the management of pediatric AM by analyzing the current evidence in the literature.
METHODS
We examined the following bibliographic electronic databases: Pubmed and the Cochrane Library, from the inception date until February 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISM). The key words used for the search across electronic databases were: `mastoiditis` and `management`; `mastoiditis` and `surgery`; `mastoiditis` and `conservative`; `mastoiditis` and `antibiotics`; `mastoiditis` and `myringotomy`; `mastoiditis` and `grommet`; `mastoiditis` and `drainage`; and `mastoiditis` and `mastoidectomy`.
RESULTS
We selected 12 articles involving 1124 episodes of mastoiditis. Some of these studies considered medical therapy alone as a valid first step, whereas others considered a minor surgical intervention as an initial approach along with antibiotic therapy. Considering the studies that evaluated medical therapy as the initial sole treatment option, the success rate of antibiotics alone was 24.6%. Overall, the success rate of minor surgical procedures, excluding mastoidectomy, was 87.7%, whereas the mastoidectomy success rate was 97%.
CONCLUSIONS
Overall, there is no shared consensus on the diagnostic or therapeutic approach to mastoiditis. Conservative therapy has gained considerable ground in recent times, quite limiting the predominant role of mastoidectomy. Further studies will be necessary to definitely develop standardized protocols shared in the scientific community.
Topics: Humans; Child; Mastoiditis; Abscess; Anti-Bacterial Agents; Conservative Treatment
PubMed: 38204305
DOI: 10.24953/turkjped.2023.320