Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France.
Service d'ORL Pédiatrique, Hôpital Necker, Centre Hospitalier et Universitaire, Paris, France.
Clin Otolaryngol. 2020 Mar;45(2):182-189. doi: 10.1111/coa.13478. Epub 2019 Dec 10.
To evaluate in children the clinical severity and evolution of otogenic lateral sinus thrombosis (OLST) due to Fusobacterium necrophorum compared with other bacterial otogenic thrombosis and propose a specific management flowchart for Fusobacterium OLST.
A retrospective multicentre cohort study.
Four French ENT paediatric departments.
A total of 260 under 18 years old admitted for acute mastoiditis were included. Initial imaging was reviewed to focus on complicated mastoiditis and 52 OLST were identified. Children were then divided into two groups according to bacteriological results: 28 in the "OLST Fusobacterium group" and 24 in the "OLST other bacteria group".
There was a significant association between F necrophorum and OLST (P < .001). When compared to the OLST other bacteria group, children in the OLST Fusobacterium group were significantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation: higher CRP (113 mg/L vs 175.7 mg/L, P = .02) and larger subperiosteal abscess (14 mm vs 21 mm, P < .01). Medical management was also more intensive in the OLST Fusobacterium group than in the OLST other bacteria group: increased number of conservative surgeries (66.7% vs 92.9%, P = .03) and longer hospital stay (13.7 days vs 19.8 days, P = .02). At the end of follow-up, the clinical course was good in both groups without any neurological sequelae.
Thrombotic complications are very frequent in case of Fusobacterium mastoiditis and clinicians should be aware of the initial severity of the clinical presentation. Under appropriate management, the clinical course of Fusobacterium OLST is as good as that of other bacterial otogenic thrombosis.
评估儿童中由败毒梭菌引起的耳源性外侧窦血栓形成（OLST）的临床严重程度和演变，并与其他细菌性耳源性血栓形成进行比较，提出败毒梭菌 OLST 的特定管理流程图。
回顾性多中心队列研究。
法国 4 个耳鼻喉儿科部门。
共纳入 260 名 18 岁以下因急性乳突炎入院的患者。回顾初始影像学以关注复杂乳突炎，共确定 52 例 OLST。然后根据细菌学结果将儿童分为两组：28 例“OLST 梭菌组”和 24 例“OLST 其他细菌组”。
败毒梭菌与 OLST 之间存在显著关联（P<0.001）。与 OLST 其他细菌组相比，OLST 梭菌组的儿童年龄明显较小（61 个月 vs 23 个月，P<0.01），临床表现更严重：CRP 更高（113mg/L vs 175.7mg/L，P=0.02），骨膜下脓肿更大（14mm vs 21mm，P<0.01）。OLST 梭菌组的医疗管理也比 OLST 其他细菌组更密集：更多的保守手术（66.7% vs 92.9%，P=0.03）和更长的住院时间（13.7 天 vs 19.8 天，P=0.02）。在随访结束时，两组的临床病程均良好，无任何神经后遗症。
败毒梭菌乳突炎时血栓并发症非常常见，临床医生应注意初始临床表现的严重程度。在适当的管理下，败毒梭菌 OLST 的临床病程与其他细菌性耳源性血栓形成一样良好。
