Descending Necrotizing Mediastinitis: aetiopathogenesis, diagnosis, treatment and quality of life in the long-term

Introduction Descending Necrotizing Mediastinitis (DNM) is a serious form of mediastinitis mostly requiring an interdisciplinary and protracted treatment. The aim of this study is to analyze the course of disease as well as previous illnesses having an impact on complications and mortality. Furthermore we measured long-term consequences of DNM on dysphagia and quality of life.

Methods Retrospective data analysis of patients treated at the department of Otolaryngology and Head and Neck Surgery of University Hospital Freiburg between 1997 and 2018. Recording data of patients and diseases as well as clinical courses. Besides sending two questionnaires to detect health-related quality of life (SF-36, EAT-10).

Conclusions 88 patients were included (58 % men, mean age 54,7 years). Most frequent pathogen of these polymicrobial infections were Streptococcus spp. (52 %). 75 % of the patients underwent multiple surgeries, at an average 4,3 times. 74 patients (84 %) received intensive care. Median intensive care residence time was 7 days. 51 % were suffering pre-existing comorbidities associated with reduced tissue oxygenation (e.g. diabetes). Most common complication was pleural effusion (45 %). 23 % of the patients suffered from sepsis respectively pneumonia. The mortality rate was 14 %. 8 of 12 interviewees are affected by dysphagia at the time of the survey. Mental and physical health as parameters of quality of life are above-average referred to a comparison group of healthy probands.

Conclusion DNM is a severe disease requiring an immediate initiation of surgical and conservative treatment. Although quality of life usually isn´t impaired permanently, dysphagia may often be an issue.

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Publication History

Article published online:
10 June 2020