Search Results (13)

Background: Ongoing healthcare and medical education reforms in Kazakhstan have been accompanied by persistent workforce shortages and reduced inpatient capacity in pediatric care. Therefore, this study aimed to assess and forecast selected healthcare system indicators using acute mastoiditis (AM) as a sentinel condition while also describing its clinical and epidemiological characteristics. Materials and Methods: This study combined an analysis of national healthcare and demographic statistics in Kazakhstan from 1998 to 2024 with a retrospective review of pediatric AM patients treated at a tertiary referral center. Long-term trends in healthcare resources were assessed, and future needs were projected via average annual percentage change (AAPC) and time series forecasting methods. Clinical, laboratory, and radiological data were extracted from medical records. Statistical analyses were performed via SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Results: From 1998 to 2024, the number of pediatricians and ENT hospital beds declined, whereas the density of ENT physicians remained relatively stable, and the proportion of ENT surgical procedures increased. Projections to 2030 suggest continued constraints in pediatric and ENT workforce capacity and further reductions in inpatient beds despite sustained growth in surgical demand. Among 95 pediatric AM cases, complications, most commonly subperiosteal abscess and zygomatic abscess, were identified in 40% of patients. Conclusions: AM may be considered a contextual indicator of pressures within specialized pediatric ENT services rather than a direct measure of healthcare system performance. These findings highlight the need for further studies to validate these observations and better inform healthcare planning. Full article

Background: Acute mastoiditis is the most frequent suppurative complication of acute otitis media in children. AM can lead to both extracranial complications and intracranial complications. Recent studies suggest an increase in cases after the COVID-19 pandemic. Objective: To compare the epidemiological and clinical characteristics of pediatric patients diagnosed with acute mastoiditis admitted to Santobono-Pausilipon Children’s Hospital before and after COVID-19. Methods: We conducted a retrospective study including all patients aged 0–16 years with AM admitted to our hospital between January 2017 and December 2024. Patients were stratified into three groups: pre-COVID-19: 1 January 2017–28 February 2020; COVID-19: 1 March 2020–31 December 2021; and post-COVID-19: 1 January 2022–31 December 2024. Demographic data, clinical presentations, complications, laboratory findings, and treatment modalities were analyzed and compared between groups. Results: A total of 276 children (153 males and 123 females; median age: 49 months, age range: 1–177 months) were included. Hospital admissions for AM increased in the post-COVID-19 period, reaching more than a threefold increase in 2024 compared with the pre-COVID-19 years. Similar to the overall number of AM cases, the absolute number of complications, especially IC, such as thrombosis and empyema, increased. The rate of surgical procedures increased during the post-COVID-19 period, with an overall increase of 88.5%. Both the duration of antibiotic therapy and hospital stay were significantly longer in the post-COVID-19 period. Conclusions: The COVID-19 pandemic has been associated with epidemiological and clinical changes in pediatric AM patients. These findings highlight the need for effective preventive strategies, including enhanced vaccination coverage and the promotion of early diagnosis. Additionally, implementing standardized clinical protocols could support more efficient and consistent management, reducing hospital stays and recurrence rates. Full article

Background: Acute otomastoiditis (AOM) may occasionally progress to severe intracranial complications in children. While immunological and microbiological factors have been studied, the role of temporal bone anatomical variants remains less well-defined. The aim of this study is to investigate the prevalence of anatomical variants in pediatric patients with acute complicated otomastoiditis (ACOM) compared to those with uncomplicated ones (AUOM) and healthy controls (HC) and assess their potential association with intracranial complication patterns. Methods: This retrospective, single-center study reviewed clinical and neuroradiological data of patients aged 0–16 years admitted for AOM between 2018 and 2025. ACOM patients were compared to AUOM and HC groups (the latter undergoing neuroimaging for minor head trauma). Two experienced neuroradiologists evaluated imaging to identify anatomical variants involving the following: (1) sigmoid sinus and emissary veins; (2) tegmen tympani; and (3) mastoid pneumatization. Statistical analyses assessed prevalence differences across groups. Results: Among 282 AOM patients, 58 had intracranial complications. Anatomical variants were significantly more frequent in ACOM patients versus both AUOM and HC (p < 0.01). In this subgroup, vascular anatomical variants were notably associated with vascular or combined (vascular and infectious) complications; tegmen tympani and mastoid pneumatization variants showed no significant subgroup associations. Conclusion: Anatomical variants, particularly vascular anomalies of the sigmoid sinus and emissary veins, appear to increase pediatric AOM patients’ susceptibility to intracranial complications. Recognition of these configurations through early neuroimaging could aid risk stratification and improve diagnostic and therapeutic strategies. Full article

Background: Despite the widespread use of antibiotics, acute mastoiditis (AM) and related complications resulting from acute purulent otitis media continue to occur, predominantly in children. Although numerous studies have focused on the pathogenesis, aetiological agents, and treatment of AM, comprehensive investigations of the long-term outcomes of AM and the physiological consequences of surgical intervention in the temporal bone are lacking. Methods: Thirty patients who had undergone mastoidectomy for acute mastoiditis at a median age of 2.12 years were invited for evaluation at least five years postoperatively. The assessment included the Chronic Otitis Media Questionnaire 12, clinical examination with otomicroscopy, extended high-frequency pure-tone audiometry, distortion product otoacoustic emissions, middle ear impedance testing, and a newly developed protocol for noninvasive mastoid function measurement. Results were compared with a control group of 30 ears and with a group of 30 ears treated solely with tympanostomy for acute otitis media at risk of mastoiditis. Results: Although mean Chronic Otitis Media Questionnaire 12 scores were below 1 point, patients who had undergone mastoidectomy reported slightly greater difficulties with hearing in both quiet and noisy environments, along with an increased perception of tinnitus and unpleasant sensations around the ear. Otomicroscopy revealed minor structural changes in the test groups, which were absent from the control group. Pure-tone audiometry demonstrated approximately 10 dB higher thresholds at high and extended high frequencies, with similar findings observed in the distortion product otoacoustic emissions. Middle ear impedance testing indicated elevated stapedius reflex thresholds in the mastoidectomy group, while other parameters showed no statistically significant differences. Mastoid function testing demonstrated preserved pressure-buffering capacity but reduced thermal insulation of the vestibular organ under extreme thermal stimulation—an occurrence rarely encountered in daily life. Conclusions: In the long term, most patients recovering from acute mastoiditis exhibit only minor functional and structural sequelae, and the impact of mastoidectomy appears negligible compared with less invasive surgical interventions. Full article

Background/Objectives. Otomastoiditis, an inflammatory condition affecting the middle ear and mastoid cells, poses significant risks for hearing impairment. This study aimed to analyze the clinical presentations, anatomical variations, and audiometric outcomes associated with acute and chronic otomastoiditis over a five-year period at the ENT Clinic of the Clinical County Emergency Hospital of Craiova. Methods. A retrospective clinical–statistical analysis was conducted on 145 patients aged 2 to 78 years, who were treated for otomastoiditis. The study involved a comprehensive review of clinical and audiometric data, with a focus on the type of hearing loss (conductive or mixed), audiometric thresholds, and the relationship between the anatomical form of the disease and the severity of hearing loss. Results. The majority of cases (93.83%) were chronic otomastoiditis, with 66.89% of patients presenting with mixed hearing loss and 33.10% with conductive hearing loss. Audiometric assessments revealed significant air conduction deficits, particularly at low and mid-range frequencies, with losses averaging 50–55 dB in cases of conductive hearing loss. Chronic cases demonstrated notable bone conduction impairments, indicating progressive cochlear damage. Statistical analysis identified a moderate correlation between the anatomical form of the disease and the severity of hearing loss, particularly in patients with cholesteatomatous-suppurative forms. Conclusions. This study underlines the critical need for the early and precise diagnosis of otomastoiditis, supported by audiometric evaluations. Our findings emphasize the substantial risk of progressive cochlear damage in chronic cases, underscoring the necessity for timely intervention to mitigate long-term hearing loss. These results offer valuable insights for clinicians, potentially guiding improved therapeutic approaches and contributing to enhanced patient outcomes in managing chronic otomastoiditis. Full article

Background: Otogenic meningitis represents the most common and life-threatening complication of infective middle ear diseases. However, no guidelines are available to describe the optimal management strategy and the role of surgical intervention. Methods: A six-year multicenter retrospective study on consecutive patients treated for otogenic meningitis caused by acute otitis and re-exacerbation of chronic otitis at the University Hospital of Verona and Modena was performed, and a systematic review regarding acute otitis media-related meningitis in accordance with the PRISMA 2020 statement was then conducted. Results: From the clinical chart analysis, 16 patients with surgical indications according to our decision-making flow chart were reviewed, with most of them undergoing surgery within 7 days of admission (n = 13, 81%). The systematic review ultimately utilized 24 studies (16 case reports and 8 case series) published between 1990 and 2023, with the overall analysis involving a total of 181 patients. Conclusion: The primary treatment for acute bacterial meningitis relies on antibiotic therapy, with surgical intervention being employed in the event of complications and when the initial treatment is not effective within 48 h. The objective of surgery is to sterilize the tympanic and mastoid cavity, thereby eradicating the suspected infective foci and managing any eventual intracranial complications. Full article

Background: The COVID-19 pandemic has notably affected the epidemiology of various infectious diseases. The imposed public health measures and disruptions in vaccination programs have potentially altered the patterns of these diseases post pandemic. Objective: To investigate the change in epidemiology of otorhinolaryngological infectious diseases in adult and pediatric patients after the COVID-19 pandemic and the relaxation of public health measures. Methods: A retrospective cohort study was conducted at a large tertiary university otolaryngology department in the south of Germany, examining admissions with specific ICD-10 diagnoses from 2019 to 2023. Data were seasonally categorized and statistically analyzed. Results: A total of 1728 inpatient cases were analyzed. There was a significant increase in otorhinolaryngological infections in the post-pandemic winter of 2022, particularly of peritonsillar abscesses, acute tonsillitis and acute mastoiditis. No significant post-pandemic spike in mononucleosis was observed. The duration of hospitalization was shorter in 2022, and the median age of patients did not change significantly pre- versus post-pandemic. Conclusions: The study indicates a significant post-pandemic rise in otorhinolaryngological infections. Remarkably, the typical “dip” in infections during the summer months was not observed in the post pandemic years, possibly reflecting the impact of the termination of non-pharmaceutical interventions. Mononucleosis was the only infection not following this pattern. Full article

Acute mastoiditis, a complication of otitis media, poses significant challenges in diagnosis and treatment, particularly in pediatric populations. This study aims to comprehensively evaluate the demographic characteristics, clinical features, and prognostic factors associated with acute mastoiditis in pediatric patients in Saudi Arabia. Analysis of a multicenter dataset was conducted to assess demographic variables, symptomatology, disease course, and predictors of acute mastoiditis in pediatric patients. Significant associations were found between demographic variables (age group, gender, nationality) and acute mastoiditis risk. Symptomatology analysis revealed consistent frequencies of otalgia across age groups and genders. Disease course analysis highlighted a mean duration from symptom onset to diagnosis of 14.11 days, with frequent complications like mastoid abscess and meningitis. Predictor identification identified symptoms (otalgia, fever, otorrhea), duration of illness, and complications as significant predictors of disease severity. These findings contribute valuable insights into the epidemiology and clinical management of acute mastoiditis, informing targeted interventions to improve patient outcomes. Full article

Acute otitis media (AOM) is one of the most common ENT diseases in children. In the antibiotic/post-antibiotic era, facial paralysis is a very rare complication of AOM (0.004–0.005%). Despite the rarity of this complication, it should be known by all physicians for proper therapeutic management to avoid serious sequelae. The aim of this review is to provide a management guide based on the current literature. Materials and Methods: Fifteen studies published between 2000 and 2022 were selected, including 120 patients (62 M/58 F) with an average age of 4.96 years old (range = 4 months–16 years; SD: 4.2). The paralysis frequently has a sudden onset and is of a severe grade (medium House–Brackmann (HB) score at onset: 4.68; SD: 0.5); however, it tends to have an almost complete recovery in most patients (88.49% HB 1 at follow-up). Results: Its first-line treatment must be based on the use of antibiotics (beta-lactam antibiotics as penicillins or cephalosporins). Corticosteroids should be used concomitantly for their anti-inflammatory and neuroprotective actions; however, there is no unanimity between authors about their application. Myringotomy, with or without ventilation tube insertion, is indicated in cases where the tympanic membrane is intact. Other kinds of surgery should be performed only in patients who have a worsening of their AOM symptoms or a worsening in HB score even with clinical treatment. Conclusions: The obtained data show that a conservative treatment can be sufficient for complete recovery in most patients, and it is preferred as the first-line therapy. Mastoidectomy should be performed only in patients with acute mastoiditis and without symptom improvement after a conservative approach. There are insufficient data in the current literature to provide clear selection criteria for patients who need to undergo mastoidectomy with facial nerve decompression. The choice of this treatment is based on an individual center expertise. Further studies are needed to clarify the role of corticosteroids and the role of facial nerve decompression in this clinical scenario. Full article

Background: Chronic otitis media is recurrent infection of the middle ear and mastoid air cells in the setting of perforation of the tympanic membrane. Risk factors for chronic otitis media include predisposing characteristics such as gender, allergies, Eustachian tube dysfunction, history of acute otitis media, and upper respiratory tract infection. The purpose of this study was to evaluate the potential relationship between chronic otitis media and epitympanic recess volume. Materials and Methods: A total of 197 patients with chronic otitis media had their epitympanic recess volume compared to the epitympanic volume of 99 healthy controls. The epitympanic recess volume was measured via the 3D volumetric measurement tool of the local PACS. Epitympanic recess volume measurement was performed using axial sections in a plane starting from the level of the malleus head–anvil body in the craniocaudal direction to the tegmen tympanum. Results: It was shown that patients with bilateral involvement had an epitympanic recess volume of 75.00 mm³, compared to 72.30 mm³ in those with unilateral chronic otitis media. The healthy control group’s median value for the epitympanic recess was 74.73 mm³. Conclusions: Epitympanic volume values did not differ substantially between patients with chronic otitis media and healthy persons, and epitympanic volume was not recognized as a predisposing factor (p = 0.686). Full article

Acute mastoiditis (AM) is the most common complication of acute otitis media (AOM) and is one of the most severe acute bacterial diseases in infants and children. In some geographic areas, the incidence of AM is increasing, and the causative role of some bacterial pathogens could be greater than previously thought. In this paper, the results of a study that evaluated the epidemiology and microbial etiology of paediatric AM in Umbria, which is a region of central Italy, are reported. This is a retrospective study of patients aged 0–14 years with AM admitted to the pediatric wards of the hospitals of Umbria, Italy, between June 1 and September 30 in four consecutive years (2015–2018). A total of 108 children were enrolled. The prevalence of AM in males during the four years of analysis was significantly higher than that in females at 63% (95% confidence intervals [CI]: 0.54–0.72). The most frequently affected age groups were 5–9 years (45.4%) and 10–14 years (31.5%), with statistically significant differences in comparison with children aged <1 year (5.6%, 95% CI: 0.01–0.10) and 1–4 years (17.6%, 95% CI: 0.10–0.25). In most cases (64, 59.3%), AM was associated with spontaneous tympanic membrane perforation (STP). The culture of the middle ear fluid revealed the presence of Pseudomonas aeruginosa in 56 cases (51.6%). The mean incidence rates of pediatric AM in Umbria during the study increased significantly with time, as it was 18.18/100,000 children/year in 2015–2016 and 29.24/100,000 children/year in 2017–2018 (CI difference: +2.5 – +19.9, p < 0.05). The incidence rates of Pseudomonas aeruginosa detection in pediatric AM associated with STP significantly increased with time. The incidence was 6.06/100,000 children/year in 2015–2016 and 18.61/100,000 children/year in 2017–2018 (CI difference: +6.1 – +19.0, p < 0.001). This study demonstrated the high and increasing incidence of AM in the Umbria region during the summer months and the frequent detection of P. aeruginosa as an etiologic agent of the disease in the presence of STP. Confirmation of these results with a larger study population, in different settings, and throughout the whole year is needed to define the first-line approach of AM with STP in pediatrics. Full article

Traumatic cervicomediastinal emphysema resulting from isolated head trauma is a rare occurrence. Herein, we describe a patient who sustained a closed mastoid injury after being struck with a batted baseball, resulting in acute extensive cervicomediastinal emphysema. Upon further assessment, the patient's aerodigestive tract was determined to have remained intact and unaffected by the injury. The source of soft-tissue air originated from the fractured mastoid. This case demonstrates the protective properties of a well-pneumatized mastoid. Furthermore, we elucidate the pathway by which the mastoid air entered and spread into the surrounding soft tissues of the neck and into the chest. Full article

Lemierre syndrome is defined by septic thrombophlebitis of the internal jugular vein caused by Fusobacterium. Historically, these infections originate from the oropharynx and typically are seen in older children, adolescents and young adults. More recently, otogenic sources in younger children have been described with increasing frequency. We present a case of a two-year old, who initially developed an otitis media with perforation of the tympanic membrane and went on to develop mastoiditis and non-occlusive thrombosis of the venous sinus and right internal jugular vein. Fusobacterium necrophorum was grown from operative cultures of the mastoid, ensuing computed tomography scan revealed occlusion of the internal jugular vein and the patient was successfully treated with clindamycin, ciprofloxacin and enoxaparin. This case demonstrates the importance of considering Fusobacterium in otogenic infections and the consideration of Lemierre syndrome when F. necrophorum is identified. Full article