Acute mastoiditis in pediatric cochlear implant patients – a systematic review

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY
Sophia Marie Häußler , Arne Böttcher , Christian Stephan Betz , Katharina Stölzel , Friederike Meyer
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Abstract

Acute mastoiditis (AM) is a rare but potentially life-threatening condition in pediatric patients, particularly those with cochlear implants (CI) seem to be at higher risk for complications. The aim of this study is to propose a diagnostic and treatment algorithm by analyzing common symptoms, incidence, microbiology, and management of AM in pediatric CI patients. This systematic review includes 20 studies and four own cases, therefore 86 pediatric CI patients diagnosed with AM were enrolled. The research databases Pubmed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase und Google Scholar were searched with the terms „acute mastoiditis“ and „cochlear implant“ and „complications“. Inclusion criteria were pediatric patients with CI (<16 years of age) and AM in the CI ear. Exclusion criteria were redundant cases, cases with skin or wound infections.
The incidence of AM in this cohort was 1.7 %, with a mean age at the time of AM diagnosis of 45.9 months. Most cases occurred within the first year after CI surgery, with Streptococcus pneumoniae, Streptococcus pyogenes, and Haemophilus influenzae identified as the most common pathogens. Treatment predominantly involved intravenous antibiotics (i.v. AB), with ceftriaxone being the most commonly administered AB. Surgical interventions ranged from grommet insertion, incision and drainage to revision-mastoidectomy or in two cases (2.3 %) even explantation, depending on the severity and course of the infection. Radiological imaging was primarily performed if there was a clinical suspicion of subperiosteal abscess with the need of surgical intervention. Data collection was limited by the mostly retrospective study designs and therefore resulting in partially incomplete data. Based on the collected data we propose diagnostic criteria including swab results and radiological imaging to distinguish between mild and advanced AM leading to treatment recommendations, emphasizing early i.v. AB treatment and tailored surgical interventions to prevent complications and ensure favorable outcomes without the need for CI explantation.
儿童人工耳蜗患者急性乳突炎的系统回顾
急性乳突炎(AM)在儿科患者中是一种罕见但可能危及生命的疾病,特别是那些植入人工耳蜗(CI)的患者似乎有更高的并发症风险。本研究的目的是通过分析儿科CI患者AM的常见症状、发病率、微生物学和管理,提出一种诊断和治疗算法。本系统综述包括20项研究和4例自身病例,因此纳入了86例诊断为AM的儿童CI患者。检索研究数据库Pubmed、Cochrane图书馆、护理与相关健康文献累积索引(CINAHL)、Embase和谷歌Scholar,检索词为“急性乳突炎”、“人工耳蜗”和“并发症”。纳入标准为CI患儿(16岁)和CI耳AM。排除标准为重复病例、皮肤或伤口感染病例。该队列中AM的发病率为1.7%,AM诊断时的平均年龄为45.9个月。大多数病例发生在CI手术后的第一年,其中肺炎链球菌、化脓性链球菌和流感嗜血杆菌被确定为最常见的病原体。治疗主要包括静脉注射抗生素(iv AB),头孢曲松是最常用的AB。根据感染的严重程度和病程,手术干预措施包括从植入、切口和引流到修复-乳突切除术,或在两例(2.3%)病例中甚至是外植术。如果临床怀疑骨膜下脓肿需要手术干预,则主要进行影像学检查。数据收集受到大多数回顾性研究设计的限制,因此导致部分数据不完整。根据收集到的数据,我们提出了诊断标准,包括拭子结果和放射成像,以区分轻度和晚期AM,从而提出治疗建议,强调早期静脉注射AB治疗和量身定制的手术干预,以预防并发症,确保在不需要CI外植的情况下获得良好的结果。
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来源期刊
CiteScore
3.20
自引率
6.70%
发文量
276
审稿时长
62 days
期刊介绍: The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.
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