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J Pediatr Infect Dis 2019; 14(02): 052-062
DOI: 10.1055/s-0038-1661331
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Acute Otologic Infections in Pediatric Patients

Courtney B. Tipton
1   The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Kristen L. Honsinger
2   Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, Ohio, United States
3   Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Michael S. Harris
2   Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, Ohio, United States
,
Prashant S. Malhotra
2   Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, Ohio, United States
3   Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, United States
› Author Affiliations
Further Information

Publication History

26 September 2017

29 March 2018

Publication Date:
06 July 2018 (online)

Also available at
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Abstract

This article summarizes significant acute infections involving the pediatric temporal bone. First, the management of acute otitis media (AOM) is discussed, including the medical and surgical management of invasive intracranial and extracranial complications associated with advanced disease. The clinical and radiographic findings, microbiology, and management of acute mastoiditis are discussed in greater detail, followed by the presentation and treatment of acute otitis externa (AOE). Finally, we discuss infectious considerations in auditory implants. The indications and use of both cochlear implants (CI) and bone conduction hearing implants have rapidly expanded in children, requiring greater understanding of managing infections in the context of these devices.

Keywords

otitis media - mastoiditis - otitis externa - subdural empyema - meningitis - cochlear implants - facial nerve paralysis - labyrinthitis
 

  • References

  • 1 Center for Disease Control and Prevention. National ambulatory medical care survey factsheet for pediatrics. Available at: https://www.cdc.gov/nchs/data/ahcd/namcs_2010_factsheet_pediatrics.pdf . Accessed Monday, January 2, 2017
    PubMedGoogle Scholar
  • 2 Soni A. Ear infections (otitis media) in children (0–17): use and expenditures, 2006. Statistical Brief #228. Agency for Healthcare Research and Quality. Available at: http://www.meps.ahrq.gov/mepsweb/data_files/publications/st228/stat228.pdf . Accessed on January 2, 2017
    PubMedGoogle Scholar
  • 3 Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989; 160 (01) 83-94
    CrossrefPubMedGoogle Scholar
  • 4 Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 2009; 302 (07) 758-766
    CrossrefPubMedGoogle Scholar
  • 5 Lieberthal AS, Carroll AE, Chonmaitree T. , et al. The diagnosis and management of acute otitis media. Pediatrics 2013; 131 (03) e964-e999
    CrossrefPubMedGoogle Scholar
  • 6 Tarlow M. Otitis media: pathogenesis and medical sequelae. Ear Nose Throat J 1998; 77 (6, Suppl): 3-6
    PubMedGoogle Scholar
  • 7 Bluestone CD. Clinical course, complications and sequelae of acute otitis media. Pediatr Infect Dis J 2000; 19 (5, Suppl): S37-S46
    CrossrefPubMedGoogle Scholar
  • 8 Marom T, Tan A, Wilkinson GS, Pierson KS, Freeman JL, Chonmaitree T. Trends in otitis media-related health care use in the United States, 2001-2011. JAMA Pediatr 2014; 168 (01) 68-75
    CrossrefPubMedGoogle Scholar
  • 9 Bowatte G, Tham R, Allen KJ. , et al. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr 2015; 104 (467) 85-95
    CrossrefPubMedGoogle Scholar
  • 10 Lubianca Neto JF, Hemb L, Silva DB. Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood. J Pediatr (Rio J) 2006; 82 (02) 87-96
    PubMedGoogle Scholar
  • 11 Ruohola A, Meurman O, Nikkari S. , et al. Microbiology of acute otitis media in children with tympanostomy tubes: prevalences of bacteria and viruses. Clin Infect Dis 2006; 43 (11) 1417-1422
    CrossrefPubMedGoogle Scholar
  • 12 Casey JR, Adlowitz DG, Pichichero ME. New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J 2010; 29 (04) 304-309
    CrossrefPubMedGoogle Scholar
  • 13 Bluestone CD, Stephenson JS, Martin LM. Ten-year review of otitis media pathogens. Pediatr Infect Dis J 1992; 11 (8, Suppl): S7-S11
    CrossrefPubMedGoogle Scholar
  • 14 Turner D, Leibovitz E, Aran A. , et al. Acute otitis media in infants younger than two months of age: microbiology, clinical presentation and therapeutic approach. Pediatr Infect Dis J 2002; 21 (07) 669-674
    CrossrefPubMedGoogle Scholar
  • 15 Shurin PA, Howie VM, Pelton SI, Ploussard JH, Klein JO. Bacterial etiology of otitis media during the first six weeks of life. J Pediatr 1978; 92 (06) 893-896
    CrossrefPubMedGoogle Scholar
  • 16 Heikkinen T, Thint M, Chonmaitree T. Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med 1999; 340 (04) 260-264
    CrossrefPubMedGoogle Scholar
  • 17 Heikkinen T, Silvennoinen H, Peltola V. , et al. Burden of influenza in children in the community. J Infect Dis 2004; 190 (08) 1369-1373
    CrossrefPubMedGoogle Scholar
  • 18 Rettig E, Tunkel DE. Contemporary concepts in management of acute otitis media in children. Otolaryngol Clin North Am 2014; 47 (05) 651-672
    CrossrefPubMedGoogle Scholar
  • 19 Rosenfeld RM, Schwartz SR, Pynnonen MA. , et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013; 149 (1, Suppl): S1-S35
    PubMedGoogle Scholar
  • 20 Munguia R, Daniel SJ. Ototopical antifungals and otomycosis: a review. Int J Pediatr Otorhinolaryngol 2008; 72 (04) 453-459
    CrossrefPubMedGoogle Scholar
  • 21 Schuknecht HF. Tuberculous otitis media and mastoiditis. In: Pathology of the Ear. 2nd ed. Philadelphia, PA: Lea and Febiger; 1993: 200
    Google Scholar
  • 22 Wu JF, Jin Z, Yang JM, Liu YH, Duan ML. Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis. Acta Otolaryngol 2012; 132 (03) 261-265
    CrossrefPubMedGoogle Scholar
  • 23 Ciorba A, Berto A, Borgonzoni M, Grasso DL, Martini A. Pneumocephalus and meningitis as a complication of acute otitis media: case report. Acta Otorhinolaryngol Ital 2007; 27 (02) 87-89
    PubMedGoogle Scholar
  • 24 Fria TJ, Cantekin EI, Eichler JA. Hearing acuity of children with otitis media with effusion. Arch Otolaryngol 1985; 111 (01) 10-16
    CrossrefPubMedGoogle Scholar
  • 25 Teele DW, Klein JO, Rosner BA. Otitis media with effusion during the first three years of life and development of speech and language. Pediatrics 1984; 74 (02) 282-287
    PubMedGoogle Scholar
  • 26 Klausen O, Møller P, Holmefjord A, Reisaeter S, Asbjørnsen A. Lasting effects of otitis media with effusion on language skills and listening performance. Acta Otolaryngol Suppl 2000; 543: 73-76
    CrossrefPubMedGoogle Scholar
  • 27 Teele DW, Klein JO, Chase C, Menyuk P, Rosner BA. ; Greater Boston Otitis Media Study Group. Otitis media in infancy and intellectual ability, school achievement, speech, and language at age 7 years. J Infect Dis 1990; 162 (03) 685-694
    CrossrefPubMedGoogle Scholar
  • 28 Rach GH, Zielhuis GA, van den Broek P. The influence of chronic persistent otitis media with effusion on language development of 2- to 4-year-olds. Int J Pediatr Otorhinolaryngol 1988; 15 (03) 253-261
    CrossrefPubMedGoogle Scholar
  • 29 Harsten G, Nettelbladt U, Schalén L, Kalm O, Prellner K. Language development in children with recurrent acute otitis media during the first three years of life. Follow-up study from birth to seven years of age. J Laryngol Otol 1993; 107 (05) 407-412
    CrossrefPubMedGoogle Scholar
  • 30 Wright PF, Sell SH, McConnell KB. , et al. Impact of recurrent otitis media on middle ear function, hearing, and language. J Pediatr 1988; 113 (03) 581-587
    CrossrefPubMedGoogle Scholar
  • 31 Paparella MM, Morizono T, Le CT. , et al. Sensorineural hearing loss in otitis media. Ann Otol Rhinol Laryngol 1984; 93 (6 Pt 1): 623-629
    CrossrefPubMedGoogle Scholar
  • 32 Park JH, Park SJ, Kim YH, Park MH. Sensorineural hearing loss: a complication of acute otitis media in adults. Eur Arch Otorhinolaryngol 2014; 271 (07) 1879-1884
    CrossrefPubMedGoogle Scholar
  • 33 Rahko T, Karma P, Sipilä M. Sensorineural hearing loss and acute otitis media in children. Acta Otolaryngol 1989; 108 (1–2): 107-112
    CrossrefPubMedGoogle Scholar
  • 34 Segal N, Givon-Lavi N, Leibovitz E, Yagupsky P, Leiberman A, Dagan R. Acute otitis media caused by Streptococcus pyogenes in children. Clin Infect Dis 2005; 41 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 35 Berger G. Nature of spontaneous tympanic membrane perforation in acute otitis media in children. J Laryngol Otol 1989; 103 (12) 1150-1153
    CrossrefPubMedGoogle Scholar
  • 36 Glynn F, Osman L, Colreavy M, Rowley H, Dwyer TP, Blayney A. Acute mastoiditis in children: presentation and long term consequences. J Laryngol Otol 2008; 122 (03) 233-237
    CrossrefPubMedGoogle Scholar
  • 37 Ghaffar FA, Wördemann M, McCracken Jr GH. Acute mastoiditis in children: a seventeen-year experience in Dallas, Texas. Pediatr Infect Dis J 2001; 20 (04) 376-380
    CrossrefPubMedGoogle Scholar
  • 38 Thompson PL, Gilbert RE, Long PF, Saxena S, Sharland M, Wong IC. Effect of antibiotics for otitis media on mastoiditis in children: a retrospective cohort study using the United kingdom general practice research database. Pediatrics 2009; 123 (02) 424-430
    CrossrefPubMedGoogle Scholar
  • 39 Tamir SO, Roth Y, Dalal I, Goldfarb A, Marom T. Acute mastoiditis in the pneumococcal conjugate vaccine era. Clin Vaccine Immunol 2014; 21 (08) 1189-1191
    CrossrefPubMedGoogle Scholar
  • 40 Luntz M, Brodsky A, Nusem S. , et al. Acute mastoiditis--the antibiotic era: a multicenter study. Int J Pediatr Otorhinolaryngol 2001; 57 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 41 Ghadersohi S, Young NM, Smith-Bronstein V, Hoff S, Billings KR. Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital. Laryngoscope 2017; 127 (10) 2321-2327
    CrossrefPubMedGoogle Scholar
  • 42 Golz A, Westerman ST, Gilbert LM, Joachims HZ, Netzer A. Effect of middle ear effusion on the vestibular labyrinth. J Laryngol Otol 1991; 105 (12) 987-989
    CrossrefPubMedGoogle Scholar
  • 43 Golz A, Angel-Yeger B, Parush S. Evaluation of balance disturbances in children with middle ear effusion. Int J Pediatr Otorhinolaryngol 1998; 43 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 44 Kumar A, Wiet R. Aural complications of otitis media. In: Gulya AJ, Minor LB, Poe DS. , eds. Glasscock-Shambaugh Surgery of the Ear. 6th ed. Shelton, CT: People's Medical Publishing House; 2010: 729-750
    Google Scholar
  • 45 Gaio E, Marioni G, de Filippis C, Tregnaghi A, Caltran S, Staffieri A. Facial nerve paralysis secondary to acute otitis media in infants and children. J Paediatr Child Health 2004; 40 (08) 483-486
    CrossrefPubMedGoogle Scholar
  • 46 Gower D, McGuirt WF. Intracranial complications of acute and chronic infectious ear disease: a problem still with us. Laryngoscope 1983; 93 (08) 1028-1033
    PubMedGoogle Scholar
  • 47 Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015; (09) CD004405
    PubMedGoogle Scholar
  • 48 Bizakis JG, Velegrakis GA, Papadakis CE, Karampekios SK, Helidonis ES. The silent epidural abscess as a complication of acute otitis media in children. Int J Pediatr Otorhinolaryngol 1998; 45 (02) 163-166
    CrossrefPubMedGoogle Scholar
  • 49 Ozkaya S, Bezircioglu H, Sucu HK, Ozdemir I. Combined approach for otogenic brain abscess. Neurol Med Chir (Tokyo) 2005; 45 (02) 82-85 , discussion 86
    CrossrefPubMedGoogle Scholar
  • 50 Dlamini N, Billinghurst L, Kirkham FJ. Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin N Am 2010; 21 (03) 511-527
    CrossrefPubMedGoogle Scholar
  • 51 Bales CB, Sobol S, Wetmore R, Elden LM. Lateral sinus thrombosis as a complication of otitis media: 10-year experience at the children's hospital of Philadelphia. Pediatrics 2009; 123 (02) 709-713
    CrossrefPubMedGoogle Scholar
  • 52 Kuczkowski J, Narozny W, Plichta L. Lateral sinus thrombosis as a complication of acute mastoiditis in children. Int J Pediatr Otorhinolaryngol 2010; 74 (04) 433-434
    CrossrefPubMedGoogle Scholar
  • 53 Kuczkowski J, Dubaniewicz-Wybieralska M, Przewoźny T, Narożny W, Mikaszewski B. Otitic hydrocephalus associated with lateral sinus thrombosis and acute mastoiditis in children. Int J Pediatr Otorhinolaryngol 2006; 70 (10) 1817-1823
    CrossrefPubMedGoogle Scholar
  • 54 Tomkinson A, Mills RG, Cantrell PJ. The pathophysiology of otitic hydrocephalus. J Laryngol Otol 1997; 111 (08) 757-759
    CrossrefPubMedGoogle Scholar
  • 55 Isaacman DJ. Otitic hydrocephalus: an uncommon complication of a common condition. Ann Emerg Med 1989; 18 (06) 684-687
    CrossrefPubMedGoogle Scholar
  • 56 Osborn AJ, Blaser S, Papsin BC. Decisions regarding intracranial complications from acute mastoiditis in children. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (06) 478-485
    CrossrefPubMedGoogle Scholar
  • 57 Roland PS, Stroman DW. Microbiology of acute otitis externa. Laryngoscope 2002; 112 (7 Pt 1): 1166-1177
    CrossrefPubMedGoogle Scholar
  • 58 Hajioff D. Otitis externa. Clin Evid 2004; (12) 755-763
    PubMedGoogle Scholar
  • 59 Rosenfeld RM, Schwartz SR, Cannon CR. , et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2014; 150 (1, Suppl): S1-S24
    CrossrefPubMedGoogle Scholar
  • 60 National Institute of Deafness and Other Communication Disorders. Implants. Available at: http://www.nidcd.nih.gov/health/hearing/pages/coch.aspx . Accessed December 27, 2016
    PubMed
  • 61 Eisenberg LS, Fisher LM, Johnson KC, Ganguly DH, Grace T, Niparko JK. ; CDaCI Investigative Team. Sentence recognition in quiet and noise by pediatric cochlear implant users: relationships to spoken language. Otol Neurotol 2016; 37 (02) e75-e81
    CrossrefPubMedGoogle Scholar
  • 62 Farinetti A, Ben Gharbia D, Mancini J, Roman S, Nicollas R, Triglia JM. Cochlear implant complications in 403 patients: comparative study of adults and children and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131 (03) 177-182
    CrossrefPubMedGoogle Scholar
  • 63 Anne S, Ishman SL, Schwartz S. A systemic review of perioperative versus prophylactic antibiotics for cochlear implantation. Ann Otol Rhinol Laryngol 2016; 125 (11) 893-899
    CrossrefPubMedGoogle Scholar
  • 64 Goldfinger Y, Natan M, Sukenik CN, Banin E, Kronenberg J. Biofilm prevention on cochlear implants. Cochlear Implants Int 2014; 15 (03) 173-178
    CrossrefPubMedGoogle Scholar
  • 65 Hirsch BE, Blikas A, Whitaker M. Antibiotic prophylaxis in cochlear implant surgery. Laryngoscope 2007; 117 (05) 864-867
    CrossrefPubMedGoogle Scholar
  • 66 Verschuur HP, de Wever WW, van Benthem PP. Antibiotic prophylaxis in clean and clean-contaminated ear surgery. Cochrane Database Syst Rev 2004; 3 (03) CD003996
    PubMedGoogle Scholar
  • 67 Rubin LG, Papsin B. ; Committee on Infectious Diseases and Section on Otolaryngology-Head and Neck Surgery. Cochlear implants in children: surgical site infections and prevention and treatment of acute otitis media and meningitis. Pediatrics 2010; 126 (02) 381-391
    CrossrefPubMedGoogle Scholar
  • 68 Luntz M, Teszler CB, Shpak T. Cochlear implantation in children with otitis media: second stage of a long-term prospective study. Int J Pediatr Otorhinolaryngol 2004; 68 (03) 273-280
    CrossrefPubMedGoogle Scholar
  • 69 Cunningham III CD, Slattery III WH, Luxford WM. Postoperative infection in cochlear implant patients. Otolaryngol Head Neck Surg 2004; 131 (01) 109-114
    CrossrefPubMedGoogle Scholar
  • 70 Kempf HG, Stöver T, Lenarz T. Mastoiditis and acute otitis media in children with cochlear implants: recommendations for medical management. Ann Otol Rhinol Laryngol Suppl 2000; 185: 25-27
    PubMedGoogle Scholar
  • 71 Rubin LG. Prevention and treatment of meningitis and acute otitis media in children with cochlear implants. Otol Neurotol 2010; 31 (08) 1331-1333
    CrossrefPubMedGoogle Scholar
  • 72 Daneshi A, Ajalloueyan M, Ghasemi MM. , et al. Complications in a series of 4400 paediatric cochlear implantation. Int J Pediatr Otorhinolaryngol 2015; 79 (09) 1401-1403
    CrossrefPubMedGoogle Scholar
  • 73 Afsharpaiman S, Amirsalari S, Ajalloueyan M, Saburi A. Bacterial meningitis after cochlear implantation among children without polyvalent conjugate vaccine: a brief report of an iranian cohort study on 371 Cases. Int J Prev Med 2014; 5 (08) 1067-1070
    PubMedGoogle Scholar
  • 74 Reefhuis J, Honein MA, Whitney CG. , et al. Risk of bacterial meningitis in children with cochlear implants. N Engl J Med 2003; 349 (05) 435-445
    CrossrefPubMedGoogle Scholar
  • 75 Biernath KR, Reefhuis J, Whitney CG. , et al. Bacterial meningitis among children with cochlear implants beyond 24 months after implantation. Pediatrics 2006; 117 (02) 284-289
    CrossrefPubMedGoogle Scholar
  • 76 Hoberman A, Greenberg DP, Paradise JL. , et al. Effectiveness of inactivated influenza vaccine in preventing acute otitis media in young children: a randomized controlled trial. JAMA 2003; 290 (12) 1608-1616
    PubMedGoogle Scholar
  • 77 Whitney CG. Cochlear implants and meningitis in children. Pediatr Infect Dis J 2004; 23 (08) 767-768
    CrossrefPubMedGoogle Scholar
  • 78 Centers for Disease Control and Prevention. Cochlear implants & meningitis vaccination. Available at: https://www.cdc.gov/vaccines/vpd/mening/hcp/dis-cochlear-gen.html . Accessed December 27, 2016
    PubMedGoogle Scholar
  • 79 Ozgur SK, Beyazova U, Kemaloglu YK. , et al. Effectiveness of inactivated influenza vaccine for prevention of otitis media in children. Pediatr Infect Dis J 2006; 25 (05) 401-404
    CrossrefPubMedGoogle Scholar
  • 80 Tharpe AM. Unilateral and mild bilateral hearing loss in children: past and current perspectives. Trends Amplif 2008; 12 (01) 7-15
    CrossrefPubMedGoogle Scholar
  • 81 Mohamad S, Khan I, Hey SY, Hussain SS. A systematic review on skin complications of bone-anchored hearing aids in relation to surgical techniques. Eur Arch Otorhinolaryngol 2016; 273 (03) 559-565
    CrossrefPubMedGoogle Scholar
  • 82 Wazen JJ, Wycherly B, Daugherty J. Complications of bone-anchored hearing devices. Adv Otorhinolaryngol 2011; 71: 63-72
    PubMedGoogle Scholar
  • 83 Falcone MT, Kaylie DM, Labadie RF, Haynes DS. Bone-anchored hearing aid abutment skin overgrowth reduction with clobetasol. Otolaryngol Head Neck Surg 2008; 139 (06) 829-832
    CrossrefPubMedGoogle Scholar
  • 84 Kraai T, Brown C, Neeff M, Fisher K. Complications of bone-anchored hearing aids in pediatric patients. Int J Pediatr Otorhinolaryngol 2011; 75 (06) 749-753
    CrossrefPubMedGoogle Scholar