Acute mastoiditis: 20 years of experience with a uniform management protocol

Mansour, Tamer; Yehudai, Noam; Tobia, Amjad; Shihada, Rabia; Brodsky, Alex; Khnifies, Riad; Barzilai, Roni; Srugo, Isaac; Luntz, Michał

doi:10.1016/j.ijporl.2019.07.014

Cited by 23 publications

(28 citation statements)

References 29 publications

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“…Furthermore, complications to AOM are somewhat more common in boys in many studies (44)(45)(46). Among these studies, only two investigated inflammatory markers (CRP, fever or white blood cell counts), and neither in relation to gender (45,46). However, other studies have reported that CD8 + cytotoxic T lymphocytes, Interestingly, our results also indicated a niche-dependent inflammatory profile in relation to specific biomarker species.…”

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confidence: 49%

“…However, these gender differences in the immune response in OME may be of interest since myringotomy with ventilation tube insertion is more common among boys (57 to 60%) than among girls (40 to 43%) in the United States, as well as in Sweden ( 42 , 43 ). Furthermore, complications to AOM are somewhat more common in boys in many studies ( 44 – 46 ). Among these studies, only two investigated inflammatory markers (CRP, fever, or white blood cell counts), and neither did so in relation to gender ( 45 , 46 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, complications to AOM are somewhat more common in boys in many studies ( 44 – 46 ). Among these studies, only two investigated inflammatory markers (CRP, fever, or white blood cell counts), and neither did so in relation to gender ( 45 , 46 ). However, other studies have reported that CD8 + cytotoxic T lymphocytes, CD4 + T helper cells, and mediators such as IL-1, TNF-α, IL-2, and IL-12 are involved in protection against potential pathogens ( 41 , 47 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

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Niche- and Gender-Dependent Immune Reactions in Relation to the Microbiota Profile in Pediatric Patients with Otitis Media with Effusion

et al. 2020

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Otitis media with effusion (OME) is a common inflammatory disease, primarily affecting children. OME is defined as a chronic low-grade inflammation of the middle ear (ME), without any signs of infection and with effusion persisting in the ME for more than three months. The precise pathogenesis is, however, not fully understood. Here, we comprehensively characterized and compared the host immune responses (inflammatory cells and mediators) and the overall microbial community composition (microbiota) present in matched middle ear effusion samples (MEE), external ear canal lavages, and nasopharynx (NPH) samples from children with OME. Female patients had significantly increased percentages of T lymphocytes and higher levels of a wide array of inflammatory mediators in their MEEs compared to male patients, which was unrelated to microbiota composition. The relative abundances of identified microorganisms were strongly associated with their niche of origin. Furthermore, specific inflammatory mediators were highly correlated with certain bacterial species. Interestingly, some organisms displayed a niche-driven inflammation pattern, where presence of Haemophilus spp and Corynebacterium propinquum in MEEs was accompanied by pro-inflammatory mediators, whereas their presence in NPH was accompanied by anti-inflammatory mediators. For Turicella and Alloiococcus we found exactly the opposite results, i.e., an anti-inflammatory profile when present in MEEs, whereas their presence in the NPH was accompanied by a pro-inflammatory profile. Altogether, our results indicate that immune responses in children with OME are highly niche- and microbiota-driven, but gender-based differences were also observed, providing novel insight into potential pathogenic mechanisms behind OME.

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confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Niche- and Gender-Dependent Immune Reactions in Relation to the Microbiota Profile in Pediatric Patients with Otitis Media with Effusion

et al. 2020

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“…Acute mastoiditis (AM) is a complication of acute otitis media and is common in the pediatric population (1)(2)(3) . Management is usually conservative and includes performing a wide myringotomy, middle ear fluid (MEF) cultures, and parenteral administring antibiotics.…”

Section: Introductionmentioning

confidence: 99%

The clinical course of children undergoing mastoidectomy due to complicated mastoiditis

Ziv

Sapir

Leibowitz

et al. 2021

Preprint

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Objectives: To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) undergoing simple mastoidectomy. Study Design: A retrospective chart review of children diagnosed with CAM who underwent a mastoidectomy during 2012-2019. Setting: Tertiary care university hospital. Participants: 33 patients were divided into two groups: 17 patients with subperiosteal abscess (SPA) alone- single complication group (SCG) and 16 patients with SPA and additional complications (sigmoid sinus vein thrombosis, perisinus fluid/abscess, epidural abscess)-multiple complications group (MCG). Main Outcome Measures: post-operative data were collected. Demographics, microbiology data, inflammatory parameters, hospitalization length, and POF pattern were recorded, compared, and analyzed. Results: Of 162 acute mastoiditis patients, 33(20.4%) underwent surgery due to CAM; 17(51%) and 16(49%) belonged to the SCG and MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P=0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P=0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings; A total of 18 positive cultures were reported. Fusobacterium necrophorum counted for 8/18(44.5%) of all positive cultures, 7/9(77.8%) in the MCG vs. 1/9(11.1 %) in the SCG, P=0.004. Streptococcus pneumoniae was reported only in SCG (5/9, 55.5%, vs. 0/9, P=0.008). Conclusion: Post-mastoidectomy fever due to CAM is not unusual and seems to be a benign condition for the first 5-6 days following surgery. MCG patients are more prone to develop POF. F. necrophorum is more likely to be associated with MCG, and S. pneumoniae is common in SCG patients. Keywords: Mastoiditis, post-operative fever, complications, microbiology

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“…Its microbial etiology is usually S. pneumoniae or GAS, 18,19 where GAS is the causative agent in 14% to 53% of hospitalized AOM/AM cases. 18,20,21 The incidence of invasive GAS infections, including severe AOM and AM, has been shown to fluctuate with a cycle of approximately 7 to 8 years. 5,[21][22][23] In Finland, the number of invasive GAS infections increased significantly in 2017 compared to previous years (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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

Laakso

Rissanen

Ruotsalainen

et al. 2021

Laryngoscope Investig Oto

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Objective: To describe the characteristics, diagnostics, treatment, and outcome of severe acute otitis media (AOM) and acute mastoiditis (AM) caused by group A betahemolytic streptococcus (GAS). Study design:A retrospective cohort study. Methods:The yearly incidence of inpatient care-needing GAS AOM/AM patients in our hospital catchment area between 2002 and 2018 was investigated. A detailed analysis was performed for cases treated during the last GAS epidemic in 2017-2018. Anamnesis, signs and symptoms, pure-tone audiometry results, treatment, complications, and outcome were collected from medical charts. Patients responded to an otology-specific health-related quality of life survey (EOS-16) 1.5 to 3 years after their treatment. Results:The number of GAS infections peaks at approximately 7-year intervals. During 2017 and 2018, altogether 37 patients (29 adults and 8 children) were hospitalized due to GAS AOM/AM. AM was diagnosed in 14 (38%) patients. The disease progression was typically very rapid. At presentation, all patients had severe ear pain, 68% tympanic membrane perforation and discharge, 43% fever, and 43% vertigo. In pure-tone audiometry, there was usually a marked mixed hearing loss at presentation. There was a significant recovery in both air and bone conduction thresholds; the pure tone average improvement from presentation was 32.3 ± 14.8 dB. Rapid strep tests (RST) proved to be more sensitive than bacterial culture in identifying GAS as a cause of AOM/AM. Conclusion: GAS AOM/AM has a rapid onset. Hearing loss usually includes a sensorineural component, which is usually reversible with adequate treatment. RST seems to be useful in detecting GAS from middle ear discharge.

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Acute mastoiditis: 20 years of experience with a uniform management protocol

Cited by 23 publications

References 29 publications

Niche- and Gender-Dependent Immune Reactions in Relation to the Microbiota Profile in Pediatric Patients with Otitis Media with Effusion

Niche- and Gender-Dependent Immune Reactions in Relation to the Microbiota Profile in Pediatric Patients with Otitis Media with Effusion

The clinical course of children undergoing mastoidectomy due to complicated mastoiditis

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

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