International journal of pediatric otorhinolaryngology最新文献

Background: Chronic suppurative otitis media is predominantly caused by aerobic bacterial infections, complicated by antibiotic-resistant strains and biofilm formation. This study aims to identify the aerobic bacterial pathogens in chronic suppurative otitis media among children and assess their antibiotic susceptibility patterns. The potential link between biofilm formation and antibiotic resistance is also evaluated.

Methods: A cross-sectional study was conducted on 457 children with chronic suppurative otitis media. Middle ear discharge samples were collected and aerobic bacteria were isolated and identified using standard microbiological methods. Antibiotic susceptibility was determined by the agar dilution method, and biofilm formation was assessed using the microtiter plate assay.

Results: Of the 457 cases, 89.72 % were monomicrobial infections. The most prevalent Gram-negative bacterium was Pseudomonas aeruginosa (35.71 %), while Staphylococcus aureus (26.27 %) was the leading Gram-positive pathogen. Pseudomonas aeruginosa demonstrated high resistance, with 96.77 % resistant to cefuroxime and 92.26 % to amoxicillin/clavulanic acid. Similarly, Staphylococcus aureus showed significant resistance to ampicillin (83.33 %) and amoxicillin (78.07 %). A strong correlation (p < 0.001) was observed between biofilm formation and antibiotic resistance, with Gram-negative bacteria resisting an average of 4.24 ± 1.769 antibiotics and Gram-positive bacteria resisting 5.13 ± 1.535 antibiotics.

Conclusion: A high prevalence of antibiotic-resistant pathogens has been observed in children with chronic suppurative otitis media, with a significant association between biofilm formation and antibiotic resistance.

Acute suppurative thyroiditis (AST), a rare yet potentially life-threatening infection, comprises less than 1 % of neck pathologies and requires prompt treatment. Symptoms range from neck pain and fever to dysphagia and possible abscess formation. Broad-spectrum antibiotics are the primary treatment; however, surgical drainage may be necessary for abscesses to prevent systemic infection. Following acute management, identifying underlying anomalies such as branchial arch defects that predispose to recurrence is crucial. Diagnostic tools like barium swallow or transnasal fiberoptic laryngoscopy aid in this identification process. Recurrent AST or left-sided neck abscesses often prompt investigation for fourth branchial arch anomalies like pyriform sinus fistula, which may require surgical correction to prevent future infections. This paper presents the case of a 5-year-old with left torticollis, odynophagia, and fever, previously treated for a deep neck abscess with antibiotics. Ultrasound and CT scans revealed a left thyroid lobe abscess, confirmed by barium swallow to be associated with a pyriform sinus fistula. Supported by a literature review, this case highlights the importance of a systematic approach to AST management to guide clinicians in effectively treating this uncommon condition.

Introduction: Despite the reported auditory deficits and developmental challenges in children with unilateral microtia and aural atresia (UMAA), there remains a lack of consensus on early intervention with bone conduction hearing aids (BCHAs) to restore binaural hearing due to the uncertain clinical benefits and intolerability of the conventional devices. Previous studies investigating the auditory benefits under binaural hearing condition were limited and demonstrated controversial opinions in heterogenous patient groups with various devices. Our study aimed to evaluate the audiological performance, including monoaural and binaural hearing, and subjective satisfaction of the ADHEAR system, a novel adhesive BCHA, in experienced pediatric users with UMAA.

Methods: Twelve children, with a mean age of 9.08 years and previous experience using the ADHEAR system averaging 2.76 years, were included in our final analysis. Auditory performance of monoaural hearing with the affected ears was assessed by sound-field audiometry, speech recognition threshold (SRT), word recognition score (WRS) in quiet and noise. Auditory performance of binaural hearing was assessed by SRT in quiet and noise, along with a virtual sound localization test. Subjective satisfaction was measured with questionnaires.

Results: Monoaural hearing of the affected ears improved in sound-field audiometry (by 18.44 dB HL), SRT (by 17.08 dB HL) and WRS (by 27.00 % in quiet and 30.50 % in noise). Binaural hearing improved in SRT in quiet (by 1.17 dB HL), remained no significant difference in noise and enhanced in sound localization test (reduction of RMS error by 5.96°). The questionnaires indicate satisfying experiences despite skin reactions encountered.

Conclusions: In children with UMAA under long-term and routine use of the ADHEAR system reveals not only enhancement of audiological performance in the affected ears but also demonstrates potential benefits in speech recognition and sound localization under binaural hearing condition. Users generally expressed satisfaction with the device, while skin reaction is more noticeable in humid subtropical climate.

Objectives: Tinnitus is a common otologic complaint which can range from bothersome to debilitating. Imaging is frequently utilized to rule out tumors, fractures, and other causes but can also cause significant medical and economic burden for patients. Furthermore, the pediatric population may require sedation for imaging. This study explored how commonly imaging was performed in pediatric patients with isolated tinnitus and whether imaging results affected clinical care.

Methods: A retrospective case series of 266 patients aged 0-22 years diagnosed with tinnitus at a tertiary children's hospital was performed. Patients with otologic complaints other than tinnitus were excluded. Logistic regression, Wilcoxon rank-sum tests, and log-rank survival analysis were used for statistical analysis.

Results: The mean age of tinnitus diagnosis was 13.4 years (IQR 10.8-16.7), 221/266 (83.1 %) of patients were white, and 139/266 (52.3 %) were male. In the 108 with details available, 29 (26.9 %) had pulsatile tinnitus. Twenty-one of two-hundred and sixty-six (7.9 %) had a history of migraines and 24/266 (9.0 %) had a history of psychiatric diagnosis. Seventy-four out of two-hundred and sixty-six (27.8 %) of patients completed CT and/or MRI imaging. Eleven out of forty-four (14.9 %) of those who underwent imaging had abnormal findings, and only 1 MRI and 1 CT showed new abnormal findings. Of note, the abnormal MRI and CT were of the same patient, and the CT was obtained as part of a trauma survey. Of the 64 patients with follow-up, 47 % of patients noted resolution of tinnitus. Patients with pulsatile tinnitus and a history of migraines were more likely to obtain imaging (OR = 8.14, 6.17; p < 0.001, <0.001, respectively). History of sinusitis, head/ear trauma, psychiatric diagnosis, and pulsatile tinnitus was not correlated with new abnormal imaging.

Conclusions: In pediatric patients with isolated tinnitus, imaging very rarely reveals new abnormalities which can impact clinical care. Additional research is needed to optimize resource utilization and identify cohorts of pediatric patients with tinnitus in whom imaging can be deferred.

Objective: To present our experience with off-label MED-EL Bonebridge implantation in pediatric patients younger than 12 years of age and compare outcomes to pediatric patients 12 years and older.

Methods: Pediatric patients who underwent Bonebridge implantation were included in a retrospective cohort study and were categorized by off-label use (<12 years) and ≥12 years at time of bone conduction implantation (BCI). Hearing outcomes were collected after implant activation, which was typically 4-8 weeks post-implantation. Mann-Whitney U tests were performed to assess for differences between audiometric outcomes. Significance was set at p < 0.05.

Results: Twenty patients (25 implants) < 12 years of age and 17 patients (23 implants) ≥12 years of age underwent BCI. Pre-BCI speech recognition threshold (SRT) was better for the older patient group (median 50 dB) than the younger patient group (median 60 dB). Post-BCI SRT, however, was significantly lower in the younger patient group (median 22.5 dB) as compared to the older patient group (median 35 dB), (p < 0.001, Z = 3.1). The two groups performed similarly on age-appropriate wordlists presented at 50 dB HL in aided conditions (p > 0.05, -1

Conclusion: Pediatric patients younger than 12 years showed similar or better audiometric benefit from off-label Bonebridge implantation when compared to older patients. Pediatric patients younger than 12 years can be considered Bonebridge implant candidates if clinically indicated; Bonebridge implantation in this age group appears safe and technically feasible.