Severe Acute Otitis Media and Acute Mastoiditis in Adults

Abstract

OBJECTIVE:To evaluate and compare clinical and microbiological findings in adults hospitalized for acute otitis media (AOM) or mastoid infections (acute or latent). MATERIALS and METHODS:We retrospectively reviewed the medical records of all adults (≥17 years old) hospitalized (between 2003 and 2012) at a tertiary referral center for acute mastoid infections or AOM not responding to outpatient medical treatment. RESULTS:Of the 160 patients in the study sample, 19% had an infection caused by S. pyogenes, 14% by S. pneumoniae, and 11% by P. aeruginosa. AOM was the most common infection (38%), whereas 33% had acute mastoiditis (AM), 18% had latent mastoiditis (LM), and 13% AM of a chronically infected ear (AMc). In contrast to the other infections, P. aeruginosa (30%) and S. aureus (25%) were most common in AMc. Otorrhea (83%), tympanic membrane perforation (57%), and hearing problems (83%) were common in S. pyogenes infections. Patients with S. pneumoniae had longer lengths of hospitalization than those with other bacterial infections (7 vs. 4 days). Otorrhea (94%) and retroauricular symptoms were more common in P. aeruginosa infections. Hearing symptoms were common (67%) but fever (32%) and retroauricular symptoms were uncommon in AOM. Fever (44%) and mastoid tenderness (65%) were common in AM. Patients with LM underwent the most mastoidectomies (54%). Prior medical conditions, retroauricular symptoms, otorrhea (90%), and post-infection problems were common in AMc. CONCLUSION:The bacteriological etiology of hospitalized AOM more closely resembled those of LM and AM than that of AMc. Adults hospitalized for AOM or AM required fewer mastoidectomies than those hospitalized for LM or AMc.

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

“…Whether or not the tympanomastoidectomy was performed had no effect on the time of hospitalization. 20,21 Patients without mastoiditis had a shorter hospitalization period. In previous publications, there are no major differences in AOM/AM hospitalization times between different pathogens, but the hospitalization for S. pneumoniae was the longest.…”

“…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 …”

Metastatic Disease of the Temporal Bone: A Contemporary Review

“…Neural infiltration is observed via both direct epineural and perineurial invasion 32 . In TBM, the combination of these two intrusive processes often result in progressive nerve palsies 32,128 . One could expect that more extensive osseous and neural infiltration would portend more severe symptomatology in TBM.…”

“…This can likely be attributed to the mastoid housing the longest‐spanning portions of the facial nerve 127 . Other pathologies of the mastoid, primarily infectious in nature, have yielded similar palsies secondary to inflammation 128 . Mastoid lesions were also significantly associated with otalgia and otorrhea.…”

Acute Mastoiditis With Intracranial Complications in a Young Adult With History of Cranioplasty: The Rule in the Post-Antibiotic Era

“…Microbiology of mastoiditis varies according to the age group analyzed, with Streptococcus pneumoniae found in as much as one-third of the cases of pediatric cases, followed in frequency by S treptococcus pyogenes . In adults, the relationship inverts and S. pyogenes is most commonly seen [ 10 ]. Other pathogens such as Pseudomonas aeruginosa , Corynebacterium diphteriae , and Escherichia coli can be found as causative agents of mastoiditis in adults.…”