title: Intratemporal and intracranial complications of acute otitis media in a pediatric population.
abstract: OBJECTIVE
  To review all cases intratemporal and intracranial complications of acute otitis media (AOM) in infants and children from 1998 to 2013.
  
  
  METHODS
  Retrospective chart review of 109 consecutive patients admitted for complications of AOM during a 15-year period at a tertiary-care children's hospital. The main outcomes are: (1) complications of AOM, (2) bacteriology, (3) management strategies.
  
  
  RESULTS
  In our population, complications included mastoiditis (86.1%), subperiosteal abscess (38%), facial nerve palsy (16.7%), sigmoid sinus thrombosis (8.3%) and epidural abscess (7.4%). Other complications included post-auricular cellulitis, otic hydrocephalus and elevated intracranial pressure, internal jugular thrombosis, cranial nerve VI palsy and Gradenigo's syndrome, labyrinthine fistula, sensorineural hearing loss, and cerebellar infarct. Sixty-one patients (56%) received antibiotics prior to presentation. Cultures revealed Streptococcus pneumoniae in 36 patients (33.3%), other bacteria in 30 patients (27.8%), and "no growth" in 33 patients (30.5%). Nine patients (8.3%) did not undergo culture. Of the patients with S. pneumoniae, 20 cultures (55%) were found to be multidrug-resistant. Eleven patients (10.2%) were treated non-surgically, 31 (31%) were treated with myringotomy and intravenous antibiotics. Forty patients (97.5%) presenting with subperiosteal abscess required mastoid surgery. Thirteen of 18 (72.2%) patients with facial paralysis had full recovery. Eight of 10 (80%) patients with epidural abscess empyema required mastoid surgery and incision and drainage of the abscess.
  
  
  CONCLUSIONS
  Complications of AOM are uncommon, yet continue to have potentially serious consequences. The bacteriology in this population reveals an increasing trend of multi-drug resistant S. pneumoniae as the causative organism.
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Mattos
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Colman
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States.
authors.forename: Margaretha L
authors.initials: ML
authors.lastname: Casselbrant
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave., Pittsburgh, PA 15224, United States. Electronic address: David.Chi@chp.edu.
authors.forename: David H
authors.initials: DH
authors.lastname: Chi
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020330:Bell Palsy / Q000209:etiology; D001847:Bone Diseases / Q000209:etiology / Q000601:surgery; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D020802:Epidural Abscess / Q000209:etiology*; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008417:Mastoiditis / Q000209:etiology*; D008876:Middle Ear Ventilation; D010033:Otitis Media / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D011008:Pneumococcal Infections / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000209:etiology; D013701:Temporal Bone
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute otitis media; Complications; Intracranial; Intratemporal; Pediatric