We investigated whether it is possible to cure moderate pediatric acute otitis media without myringotomy by administering TFLX, a novel antibiotic agent.
1) From among 284 pediatric patients with acute otitis media, requiring treatment with the third choice medication during the period of this study in our hospital, 53 provided informed consent for treatment with TFLX.
2) TFLX 12 mg/kg was administered twice, in the morning and evening, to these 53 cases. Efficacy was assessed 3 ± 1 days after administration, and again at 5 ± 1 days. In addition, TFLX was discontinued in cases with a severity score of zero, at 3 ± 1 days after the start of administration.
3) At 3 ± 1 days and 5 ± 1 days after TFLX administration, a significant difference in score as compared with the previous TFLX administration indicated improvement. In addition, four cases had a score of zero at 3 ± 1 days among the 53 cases (7.5%) after TFLX administration, indicating rapid healing in response to TFLX.
4) At 5 ± 1 days after TFLX administration, assessment showed healing (score of 0 points) or improvement (redness of the eardrum only) in 48 of the 53 cases (90.6%).
5) Five of the 53 cases (9.4%) did not obtain sufficient improvement with TFLX administration and required myringotomy. Previously, all 53 cases would have required myringotomy. Thus, TFLX administration could potentially reduce myringotomy by approximately 90%.
6) We aimed to determine whether TFLX can reduce the need for myringotomy in pediatric acute secondary otitis media cases, and confirmed TFLX to be an effective antimicrobial agent for this purpose.
Otogenic intracranial complications, such as venous thrombosis, may occur successively in acute mastoiditis even in today’s era of antibiotics. We herein present a case of sigmoid sinus thrombosis secondary to mastoiditis. A 9-year-old boy was admitted to our hospital with persistent headaches after treatment for right acute otitis media at another hospital. The patient had no underlying disease, and there had been no recurrence of the otitis media so far. Magnetic resonance imaging (MRI) examination revealed hyperintensity in the right mastoid air cells, and magnetic resonance venography (MRV) examination showed a defect of the right sigmoid sinus. The patient was treated with anticoagulation therapy and insertion of a ventilation tube into the right ear. The patient survived without any permanent damage, and the sigmoid sinus has enlarged without undergoing mastoidectomy. Regarding otogenic intracranial complications including venous thrombosis, the frequency of onset has decreased due to the development of antibiotics. In some cases, however, detection of the disease is delayed because of the milder symptoms due to antibiotic use in recent years. It is necessary for otolaryngologists to consider intracranial complications particularly in cases with persistent headache after otitis media infection. Since the present patient was a child and frequent imaging was required, MRI/MRV examination without contrast dye and radiation exposure was effectively utilized in the follow-up of the disease.
Recently, drug resistant strains, penicillin resistant Streptococcus peumoniae (PRSP) and β-latamase- nonproducing ampicillin-resitant Haemophilus influenzae (BLNAR) and β-lactamase-producing ampicillin- resistant H. influenzae (BLPAR) cause the increase in intractable cases of acute otitis media (AOM) in children. We treated 88 intractable AOM in children (0–3 years old) who were treated with the prior antibiotics and consequently ineffective. Forty five cases were treated with standard dose (4 mg/kg/dose, twice a day) of Tebipenem pivoxil (TBPM-PI) and 43 cases were treated with high dose (6 mg/kg/dose, twice a day) of TBPM- PI.
S. pnemoniae was isolated in 29 cases and H. influenzae was isolated in 53 cases. 27 cases (93.1%) were PISP/PRSP and 45 cases (84.9%) were BLNAR/BLPAR. The clinical response rate in regular dose group was 84.4% and the rate in high dose group was 93.0% (n.s. independent t-test). Whereas, the medication period in high dose group was 5.1 days and it was shorter than 6.0 days in standard dose group (p < 0.01, independent t-test). In this study, we employed this severity classification by the scoring system to evaluate the efficacy of TBPM-PI. In the evaluation of scoring system, the score in the high dose group was significantly better than that in regular dose group in 3 days and 7 days later from starting of administration (p < 0.05, independent t-test). Each one patient in both groups experienced mild diarrhea in adverse drug reaction. This result suggested the high dose administration of TBPM-PI (6 mg/kg/dose) was useful in intractable cases of infant AOM.
In recent years, petrositis and petrous bone abscess subsequent to mastoiditis are rare diseases. Masked mastoiditis is considered to be a “treatment failure” of acute otitis media. The infection in the mastoid can progress into another intratemporal and intracranial complications. We present a 12-year-old boy with petrous bone abscess due to masked mastoiditis. He complained of right otalgia, headache and spiking fever and received antimicrobial treatment for 3 weeks. Then he complained of right abducens nerve and oculomoter nerve paralysis. MRI and CT showed right mastoiditis and abscess formation in the petrous apex and paravertebral space. He received intravenous antimicrobial treatment (ceftriaxone and vancomycine) and surgery (mastoidectomy and ventilation tube insertion). Mastoid cells and antrum were full of inflammatory granulation tissues, causing a considerable block at the level of aditus ad antrum. He recovered and discharged in excellent condition within 2 weeks after the treatment. Masked mastoiditis is a threatening disease that requires clinical awareness. Immediate mastoidectomy must be performed for masked mastoiditis in cases with severe otogenic intratemporal and intracranial complications.
Disturbance of visual function can result from causes such as cranial nerve disease, paranasal sinus disease, or malignant tumor. Accurate diagnosis and prompt treatment are important for disturbance of visual function, given the possibility of irreversible dysfunction. We report a case of malignant lymphoma of the paranasal sinus in which the initial symptoms and progress showed acute sinusitis-like symptoms. A 64-year-old man visited our hospital with a 3-day history of symptoms of right facial pain and swelling, fever, and diplopia. Blood examination showed findings of acute bacterial infection, and CT revealed right nasal and paranasal lesions. Endoscopic sinus surgery and transoral surgery were performed on the day of the first visit. Intraoperative findings included destruction of the infraorbital wall bone and exposure of the infraorbital nerve surrounded by tumor tissue. The pathological diagnosis was diffuse large B-cell lymphoma. Chemotherapy followed by surgical resection and anti-inflammatory treatment led to symptom improvement and remission. Medical staff should be aware that even acute inflammatory symptoms can be founded in other diseases such as malignant tumor.
We report a fifty eight year old man complained of a sore throat after swallowing of a fish bone. Even after the sore throat has disappeared, he complained a pharyngeal discomfort. No foreign body was detected by pharyngolaryngoscopy. A CT scan revealed an extrapharyngual foreign body, and complications of superior mediastinal abscess and esophageal submucosal abscess. The foreign body was removed and superior mediastinal abscess had been drainage by lateral neck incision. And esophageal submucosal abscess was drained by endoscopic mucosal incision. He was discharged without any complications. Lateral neck incision and endoscopic submucosal incision were a useful therapy for treating complications of superior mediastinal abscess and esophageal submucosal abscess.
Pyogenic spondylitis is one of the destructive infectious diseases of the spinal cord and bones. This disease is common after radiation therapy for head and neck malignancy, but the case of pyogenic spondylitis due to pharyngeal mucosa perforation after prolonged gastric tube placement was not reported. We present a case of a 70-year-old woman who suffered cervical pyogenic spondylitis after radiation and surgery for hypopharyngeal cancer about 30 years ago. Although the initial therapy had been successful, oropharyngeal cancer was diagnosed and tumor resection was performed. Two weeks after surgery, she suffered from cervical abscess and underwent incision and drainage from the submandibular space. After the second surgery, she complained of paresis of the upper limb and cervical pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed C5-6 pyogenic spondylitis and the patient underwent another surgery by an orthopedic surgeon. The perforation of the pharyngeal mucosa was detected during the operation and this was considered the cause of the cervical abscess. Gastric tube has been placed for 3 months and a half due to nutritional supplementation and pressure reduction inside the throat. While examining her previous CT scans, Forestier disease was identified. The front of the cervical spine and the gastric tube had been in contact for three and a half months due to Forestier disease, which led to the perforation of the pharyngeal mucosa. Streptococcus anginosus, which is intraoral indigenous bacteria, was detected in bacterial examination. This is the first report showing that prolonged gastric tube insertion is a risk for cervical abscess in head and neck malignancy with Forestier disease after radiation at the same site. The early introduction of gastric or intestinal fistula is one option in patients with Forestier disease undergoing treatment for head and neck malignancy.
We frequently encounter cases of fish bone migration, but rarely observe severe complications arising from them. Here, we report a case of a deep neck abscess secondary to cervical esophageal perforation that developed after a folk remedy for fish bone migration.
A 69-year-old woman visited our hospital complaining of pharyngeal pain that was persistent since the accidental ingestion of a sea bream bone followed by temporary reduction in the severity of the symptoms after swallowing a whole rice cake. The anterior neck was swollen. A blood test detected an inflammatory reaction, and computed tomography revealed a deep neck abscess with a pattern of gas production.
The patient underwent emergency surgical drainage on the day of the initial examination. Streptococcus milleri, S. mitis, and Prevotella spp., among others, were detected in the pus, indicating a mixed infection. After the surgery, administration of antibiotics and wound cleaning were continued, which resulted in an improvement in her status.
Although the incidence of a deep neck abscess secondary to accidental ingestion of a foreign body is only 0.3%, there is a possibility that severe complications arise from accidentally ingested foreign matter, as shown in the case presented here. We should also recognize that an erroneous folk remedy for accidental ingestion of a foreign object can also cause severe complications.