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.引言：人们普遍存在一种错误认知，认为慢性中耳炎（chronic otitis media, COM）与急性中耳炎（acute otitis media, AOM）引发的颅内并发症（intracranial complications, ICCs）属于过时疾病，或仅在发展中国家出现。尽管抗生素治疗水平已有显著提升，但此类并发症仍未绝迹。 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年间于某大型城区三级医院急诊就诊的全部中耳炎患者中，确诊为中耳炎相关颅内并发症的51例病例。 研究结果：其中80%的病例继发于慢性中耳炎，该群体的颅内并发症发生率为0.8%；剩余20%的病例由急性中耳炎引发。整体死亡率为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%，多数耳部疾病起病于儿童阶段。初始感染与继发性颅内并发症的诊断均存在显著延误。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、积脓症及耳源性脑积水分别占13%、8%及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：中耳炎相关颅内并发症虽不常见，但仍时有发生。此类病例需接受耗费高昂、操作复杂且周期漫长的住院治疗，且常遗留听力损失、神经后遗症，甚至导致死亡。对于慢性中耳炎患者，尤其是儿童群体，临床医师需充分警惕此类并发症的潜在风险，保持高度怀疑意识，以便在并发症发生前及时转诊至耳科专科接受诊疗。