Complications of otitis media - a potentially lethal problem still present

ABSTRACT INTRODUCTION: It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. OBJECTIVE: This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM). METHODS: Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. RESULTS: 80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. CONCLUSION: ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.研究背景与引言：目前存在一种错误却广为流传的认知，认为慢性中耳炎（chronic otitis media, COM）与急性中耳炎（acute otitis media, AOM）所引发的颅内并发症（intracranial complications, ICCs）属于过时疾病，或仅见于发展中国家。尽管抗生素治疗水平已有所提升，但此类并发症仍持续存在。 研究目的：本文旨在分析中耳炎（otitis media, OM）主要颅内并发症的发生情况、临床特征及病程转归。 研究方法：本研究为回顾性队列研究，纳入22年间于某大型市区三级医院急诊就诊的全部中耳炎患者中，确诊为中耳炎相关性颅内并发症的51例病例作为研究对象。 研究结果：80%的病例继发于慢性中耳炎，该群体中颅内并发症的发生率为0.8%；剩余20%的病例由急性中耳炎引发。整体病死率为7.8%，听力损失发生率达90%，永久性神经后遗症发生率为29%。患者中男性占比61%，多数耳部疾病首发于儿童阶段。初始感染与继发性颅内并发症的诊断延迟问题均较为突出。颅内并发症类型包括：脑脓肿与脑膜炎占比78%，侧窦血栓形成（lateral sinus thrombosis）、脓胸（empyema）及耳源性脑积水（otitic hydrocephalus）分别占13%、8%与1%。本研究共实施27例神经外科手术与43例耳科手术，另有2例患者因病情危重无法接受手术干预。 研究结论：中耳炎相关性颅内并发症虽较为罕见，但仍时有发生。此类病例需接受高成本、复杂且长期的住院治疗，且常遗留听力损失、神经后遗症甚至导致死亡。临床医师需尤其重视慢性中耳炎患儿的此类并发症风险，保持高度警惕，以便在并发症出现前及时转诊至耳科专科进行诊疗。