Ghadersohi Saied, Young Nancy M, Smith-Bronstein Virginia, Hoff Stephen, Billings Kathleen R
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.
Laryngoscope. 2017 Oct;127(10):2321-2327. doi: 10.1002/lary.26365. Epub 2016 Oct 31.
OBJECTIVES/HYPOTHESIS: To describe the presentation and management of acute complicated mastoiditis in children.
Retrospective case series.
An analysis of pediatric patients with acute complicated mastoiditis treated at an urban, tertiary care children's hospital from 2007 to 2014 was performed.
Forty-eight patients presented with a total of 67 complications of acute mastoiditis. Mean age at presentation was 4.8 years (range = 0.1-15.3 years). The most common complications were subperiosteal abscess (n = 22, 45.8%), epidural abscess (n = 16, 33.3%), and sigmoid sinus thrombosis (n = 14, 29.2%). The most common pathogens isolated included Streptococcus pneumoniae (n = 14, 29.2%) and group A streptococcus (n = 10, 20.8%). Multidrug resistance was not associated with complication type. Surgical management included myringotomy ± tympanostomy tube placement in 46 (95.8%) patients (the only surgery in 10), drainage of subperiosteal abscess without mastoidectomy in 18 (37.5%) patients, and mastoidectomy in 21 (43.8%) total patients. Patients presenting with intracranial complications were the most likely to undergo a mastoidectomy. Anticoagulation was used in the management of nine of 14 (64.3%) patients presenting with sigmoid sinus thrombosis. Neurosurgical interventions (n = 7, 14.6% patients) were primarily performed to manage increased intracranial pressure.
Subperiosteal abscess was the most common complication of acute mastoiditis, and when occurring as the sole complication was successfully managed with antibiotics and surgical intervention that did not include mastoidectomy. Epidural abscess and sigmoid sinus thrombosis were more prevalent than reported in prior series and were managed more aggressively. These patients were more likely to need neurosurgical interventions.
目的/假设：描述儿童急性复杂性乳突炎的临床表现及治疗方法。
回顾性病例系列研究。
对2007年至2014年在一家城市三级儿童专科医院接受治疗的急性复杂性乳突炎儿科患者进行分析。
48例患者共出现67例急性乳突炎并发症。就诊时的平均年龄为4.8岁（范围为0.1 - 15.3岁）。最常见的并发症为骨膜下脓肿（n = 22，45.8%）、硬膜外脓肿（n = 16，33.3%）和乙状窦血栓形成（n = 14，29.2%）。分离出的最常见病原体包括肺炎链球菌（n = 14，29.2%）和A组链球菌（n = 10，20.8%）。多重耐药与并发症类型无关。手术治疗包括46例（95.8%）患者行鼓膜切开术±鼓膜置管（其中10例仅行此手术），18例（37.5%）患者在不行乳突根治术的情况下引流骨膜下脓肿，21例（43.8%）患者行乳突根治术。出现颅内并发症的患者最有可能接受乳突根治术。14例出现乙状窦血栓形成的患者中有9例（64.3%）在治疗中使用了抗凝治疗。神经外科干预（n = 7，14.6%患者）主要用于处理颅内压升高。
骨膜下脓肿是急性乳突炎最常见的并发症，当作为唯一并发症出现时，通过抗生素及不包括乳突根治术的手术干预可成功治疗。硬膜外脓肿和乙状窦血栓形成比以往报道更为常见，且治疗更为积极。这些患者更有可能需要神经外科干预。
4。《喉镜》，127:2321 - 2327，2017年。
