Paediatric Imaging
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain in On Call Radiology, 2015
In the acute setting, the major complications of AOM include meningitis or mastoiditis, which may lead to epidural abscess and venous sinus thrombosis. These entities can result in significant morbidity and mortality if not diagnosed and treated. Epidural abscess and venous sinus thrombosis are discussed separately elsewhere (see Chapter 3: Neurology and non-traumatic spinal imaging, Intracranial abscess and subdural empyema and Cerebral venous sinus thrombosis). Meningitis is a neurological emergency requiring rapid diagnosis and treatment. In general, diagnosis is made on history and clinical examination in conjunction with CSF cultures. There is an occasional role for imaging in cases where there is a suspicion of intracranial abscess. Mastoiditis occurs when infection in the middle ear spreads into the adjacent mastoid air cells. This often presents as erythema, swelling and pain over the mastoid/post-auricular region. In cases of complicated AOM, involvement of the ENT/neurosurgical teams is advised.
Infections of the Respiratory Tract
Keith Struthers in Clinical Microbiology, 2017
The middle ear, mastoid cavity and sinuses are connected either directly or indirectly to the nasopharynx. The ciliated respiratory epithelium, which lines the sinuses and Eustachian tube, pushes mucus out of these structures and trapped organisms are removed. In middle ear and sinus infection it is likely that viruses such as RSV invade this epithelium, destroy the cells and compromise the mucociliary function, allowing bacteria to enter sterile areas (Figure 8.6a). Although disease of the mastoid is uncommon, it is important to recognize this condition. Bacteria can spread from the middle ear to the mastoid cavity via the aditus. Because of the proximity of the mastoid cavity to the middle cranial fossa, lateral venous sinus and jugular bulb, mastoiditis can have serious complications (Figure 8.6b, c).
General Paediatrics
Timothy G Barrett, Anthony D Lander, Vin Diwakar in A Paediatric Vade-Mecum, 2002
In otitis media, otoscopy shows a red tympanic membrane with loss of the light reflex. The membrane may bulge outwards, suggesting increased middle ear pressure, or perforate, discharging blood or pus. This often coexists with tonsillitis, which impairs pressure equalization by blocking the Eustachian tube. The cardinal sign of otitis externa is pain on moving the pinna. Mastoiditis can present as earache, or occur as a rare complication of otitis media. Tenderness over the mastoid bone is an indication for urgent ENT referral, as infection can progress to cerebral abscess formation.
Outcome of nasopharyngeal carcinoma in Finland: A nationwide study
Published in Acta Oncologica, 2018
Miia Ruuskanen, Reidar Grenman, Ilmo Leivo, Tero Vahlberg, Antti Mäkitie, Kauko Saarilahti, Tuija Wigren, Merja Korpela, Leena Voutilainen, Petri Koivunen, Heikki Irjala, Heikki Minn
Unfortunately, in one-third of the cases detailed information about late toxicity was not available, and thus, data regarding toxicity have to be considered as incomplete. The severe adverse effects reported included osteoradionecrosis in four cases, peripheral neuropathy in three cases and both abducens nerve and recurrent laryngeal nerve palsies in one patient. Ear problems were reported in 33 cases (17%), and three patients needed a mastoidectomy to treat chronic mastoiditis. Mild dysphagia was common but severe swallowing complications also occurred. One patient remained permanently dependent on percutaneous endoscopic gastrostomy and three patients required repeated dilatations for esophageal strictures. Two patients had late onset laryngeal edema, which necessitated a tracheostomy. Twenty patients (20%) developed a second primary cancer of which only two were detected within the irradiated volume: one in the soft palate 15 years later and another in the nasopharynx 17 years later.
Application of inner ear MRI after intravenous gadolinium injection in SSNHL
Published in Acta Oto-Laryngologica, 2023
Feng Zhou, Zilin Wang, Yichao Huang, Xi Chen
In this study, the abnormal results of gadolinium contrast magnetic resonance of the inner ear are mainly related to hydrops of the membranous labyrinth and abnormal internal auditory canal, which shows that gadolinium contrast magnetic resonance of the inner ear can be used as an index to detect the cause of sudden deafness. Among the eight patients with abnormal inner ear magnetic resonance imaging, there were seven females and one male. Their average age was 43.6 ± 16.0. At present, no literature has clearly pointed out that there is a certain relationship between age or gender and the incidence rate of sudden hearing loss. However, the interval between onset and treatment, age, the degree of hearing loss, and the presence of vertigo both affect the therapeutic effect and prognosis of sudden hearing loss to some extent [4,10]. Therefore, before the cause was confirmed by gadolinium contrast magnetic resonance of the inner ear, each patient was temporarily treated with oral or tympanic injection of steroids [11]. In this study, two patients with mastoiditis on MRI were considered as aseptic inflammation combined with their medical history, clinical manifestations, and ear endoscopic findings. This type of patient is usually self-healing, so we do not give them other special treatment.
Hypertrophic pachymeningitis associated with antineutrophil cytoplasmic antibody-associated vasculitis: a case series of 15 patients
Published in Scandinavian Journal of Rheumatology, 2019
T Sakairi, N Sakurai, M Nakasatomi, H Ikeuchi, Y Kaneko, A Maeshima, Y Nojima, K Hiromura
In a median follow-up period of 43 months (IQR 31–52 months; range 5–89 months) after diagnosis of HPM, four patients (27%) had HPM relapse (0.07 relapses per person-year) (Figure 4A). The median duration from onset to relapse was 17 months (IQR 13–21 months; range 10–25 months). Of these patients, one patient had both cranial and spinal HPM, and the others showed HPM confined to the cranial dura. All four patients presented with cranial nerve dysfunction; one patient with spinal HPM showed sensory disturbance in the trunk and both legs (Figure 4A). Mastoiditis was observed in two patients, and sinusitis and high systemic fever in one patient each. All four patients were treated with increased corticosteroids, and three patients were administered immunosuppressants (azathioprine for two patients and intravenous CYC for one patient), which resulted in complete or partial remission of neural symptoms (Figure 4A). Two patients (13%) died during the study period, one from pneumonia and the other from sudden death with unknown cause (0.04 deaths per person-year) (Figure 4A).
Related Knowledge Centers
- Antibiotic
- Mucous Membrane
- Otitis Media
- Skull
- Temporal Bone
- Mastoid Cells
- Mastoid Antrum
- Mastoid Part of The Temporal Bone
- Multidrug-Resistant Bacteria
- Signs & Symptoms