A clinico-pathological study on chronic otitis media in children

<p><strong>Background: </strong>Chronic suppurative otitis media (CSOM) is the commonest cause of persistent mild to moderate hearing impairment in children and young adults in developing countries and may have prevalence between 2 and 17% amongst children. The aim of this study was to compare clinico-pathological characteristics of safe (mucosal) and unsafe (squamous) diseases in children.</p><p><strong>Methods: </strong>An observational prospective study was done at ENT department of Jawaharlal Nehru medical college, AMU, Aligarh from over a period of one and half years. A total of 60 children evaluated as per inclusion and exclusion criteria, 30 in each group.</p><p><strong>Results: </strong>Majority of them belonged to rural background with ear discharge being the predominant complaint in all of them. Children with unsafe disease had more incidences of extracranial complications.</p><p><strong>Conclusions: </strong>Keeping in view the detrimental effects of hearing loss on social and educational development of children as the propensity of chronic otitis media to cause life threatening complications, urgent attention to this disease and awareness in public is warranted.</p>

Intracranial and extracranial complications of chronic otitis media and their management at a tertiary care center: a descriptive study

<p><strong>Background: </strong>In the pre-antibiotic era complications from otitis media occurred abundantly, accompanied by high morbidity and mortality. With availability of higher antibiotics, morbidity and mortality due to chronic otitis media (COM) has reduced, but still complications due to COM remain a significant problem in developing countries. The aim is to study clinical presentation, management and outcomes of intracranial and extracranial complications of COM. Study design is retrospective case series study.</p><p><strong>Methods:</strong> Patients admitted in department of otorhinolaryngology and head and neck surgery, S. Nijalingappa medical college and H.S.K hospital and research center, Bagalkot from May 2018 to April 2020 with COM associated with intracranial or extracranial complications were included in the study. Data of clinical presentation, associated complications, management, and follow-up were analyzed.</p><p><strong>Results:</strong> A total of 20 patients were reviewed during study period. Of these seventeen patients had extracranial (EC) complications, while one had intracranial (IC) complications and two had both. Otalgia, otorrhea and fever were the main presenting symptoms. The encountered IC complication were lateral sinus thrombophlebitis, cerebellar abscess. Among the EC complications most common were post-auricular subperiosteal abscess, lateral semicircular canal fistula and facial paralysis. Most commonly isolated organism was staphylococcus. Surgery was main modality of treatment.</p><p><strong>Conclusions:</strong> COM is still a significant problem in developing countries in spite of availability of antibiotics and early diagnosis is crucial in the management of complications associated. This study emphasizes the importance of early diagnosis and prompt treatment to limit the morbidity.</p>

Extracranial Complications of Traumatic Brain Injury: Pathophysiology—A Review

Moderate to severe traumatic brain injury is often associated with several extracranial organ complications, which increase the morbidity and mortality. Respiratory complications such as acute lung injury, pneumonia, and acute respiratory distress syndrome (ARDS) occur most commonly, but neurogenic pulmonary edema can be life threatening. Cardiovascular complications occur frequently. However, arrhythmia, cardiogenic shock, and neurogenic stunned myocardium, though occur infrequently, can be life threatening. Coagulation abnormalities and sepsis constitute serious complications that may result in multiorgan failure. These constitute independent risk factors for mortality. Endocrine abnormalities, gastrointestinal disruptions, and other complications occur less commonly. These extracranial complications develop as a result of altered neurogenic immune response, both central and peripheral responses. Brain tissue injury releases both proinflammatory mediators taking part in tissue reparative process and anti-inflammatory cytokines that propagate inflammation. In addition, release of massive amount of catecholamines after head injury results in proliferation of myeloid depressor cells in the circulation, release of reactive oxygen species, and release of immature neutrophils into the circulation. These anti-inflammatory mediators by complex mechanisms inhibit and decrease the number of T cells and cause apoptosis. This results in decreased production and release of cytokines and reduced lymphocyte activated killer cell cytotoxicity, resulting in impaired hypersensitivity reaction. Finally, the complex interplay of various factors leads to suppression of peripheral immune response and susceptibility for infection and sepsis, and causes extracranial organ system failure with increased morbidity and mortality.

Intra and extracranial complications of middle earths: literature review

Otitis media (OM) has several forms and among the main are otitis media (AOM), OM with effusion and chronic otitis media (COM) (cholesteatomatous or not). For the most part, the OM progressed well, but there are risks of complications and sequelae. These are divided into extra and intracranial, the first being the most common, but less lethal. Among the extracranial are: labyrinthine fistula, subperiosteal abscess, mastoiditis, temporozigomatic abscess, Bezold's abscess, parapharyngeal abscess, facial palsy, petrositis and labyrinthitis. Among the intracranial are: meningitis, epidural abscess, subdural empyema, brain abscess, the sigmoid sinus thrombophlebitis and otological hydrocephalus. The aim of this study is to identify the main complications of otitis media, distinguishing them from the incidence, degree of morbidity and mortality and analyze the development, management and treatment required for each entity. Brain abscess is the most common entity and subperiosteal abscess is the most common extracranial complication. Labyrinthine fistula occurs most often related to OMC. This has the physiopathology erosion of the bone covering the semicircular canal, usually the lateral semicircular canal. Labyrinthitis results from the spread of infection from the cochlear window membrane and can be presented in two ways: serous or suppurative labyrinthitis. The most common intracranial complication is meningitis, rarely associated with cholesteatoma and most often associated with AOM, of higher incidence in children. CT with contrast is the gold standard when you suspect any complications in patients with otitis media after undergoing a thorough history and physical examination. When the physician knows the possible complications and their signs and symptoms, the diagnosis is early and the prognosis best. Treatment of complications in general is based on patient hospitalization, myringotomy with culture and sensitivity, intravenous antibiotic therapy as early as possible and mastoidectomy in all cases related to COM or recurrent complications.

Complications of Acute Bacterial Rhinosinusitis in the Pediatric Population

Acute complicated sinusitis can occur in children and can lead to significant morbidity and mortality. While medical management is critical, it is important to provide multi-disciplinary care to involve surgical specialists. Since intracranial and extracranial complications can result from acute sinusitis, active communication among all these specialists is paramount to achieve the best patient outcomes. Children with these conditions are best managed at centers where appropriate pediatric medical and surgical subspecialty care is available.

Acute Otologic Infections in Pediatric Patients

This article summarizes significant acute infections involving the pediatric temporal bone. First, the management of acute otitis media (AOM) is discussed, including the medical and surgical management of invasive intracranial and extracranial complications associated with advanced disease. The clinical and radiographic findings, microbiology, and management of acute mastoiditis are discussed in greater detail, followed by the presentation and treatment of acute otitis externa (AOE). Finally, we discuss infectious considerations in auditory implants. The indications and use of both cochlear implants (CI) and bone conduction hearing implants have rapidly expanded in children, requiring greater understanding of managing infections in the context of these devices.

Study of demography and clinical profile of extracranial complications of chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> The complications of chronic suppurative otitis media (CSOM) are still prevalent in the developing countries like India. They pose a great challenge in the management. The objective of the study was to study the demographic pattern, symptomatology and pattern of extracranial complications of CSOM.</p><p class="abstract"><strong>Methods:</strong> Patients of both sexes presenting with extra cranial complications of chronic suppurative otitis media were included. A proforma drafted for the study of these patients was used. The patients were subjected to investigations to confirm the diagnosis. </p><p class="abstract"><strong>Results:</strong> In our study of 25 cases of extra cranial complications of CSOM, there were 14 females and 11 males.8 cases were in the age range of 11-20 years. Of the 25 cases, 22 belonged to the low income group and 3 to mid income group. Most common symptoms at presentation were otorrhoea, hearing loss, ear ache, postaural swelling and postaural discharge. Most cases were from rural area. Regarding extracranial complications, 10 cases (40%) had subperiosteal abscess, 4 (16%) mastoid fistula, 2 (8%) acute mastoiditis, 3 (12%) labyrinthine fistula, 2 (8%) facial palsy alone and 3 (12%) had multiple extracranial complications (facial palsy with mastoid fistula). Total facial palsy cases were 5 (20%).</p><p><strong>Conclusions:</strong> Most common age group affected were less than 20 yrs of age, females more affected than males, Low socio-economic group children were affected commonly. Ear discharge and ear pain were common presenting complaints. Subperiosteal abscess was most common extracranial complication followed by mastoid fistula, acute mastoiditis and facial palsy. </p>