Document Detail


Inner ear and facial nerve complications of acute otitis media with focus on bacteriology and virology.
MedLine Citation:
PMID:  16698694     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONCLUSION: Among 20 patients with inner ear complications and/or peripheral facial palsy secondary to acute otitis media (AOM) a proven or probable bacteriological cause was found in 13 (65%). In seven patients (35%), a proven or probable viral cause was found. Only two of the patients (10%), with a proven bacterial AOM and a clinical picture of a purulent labyrinthitis in both, together with a facial palsy in one, had a substantial degree of dysfunction. Although the number of patients in this study is relatively low our findings show that inner ear complications and facial palsy due to AOM can be of both bacterial and viral origin. Severe sequelae were found only where a bacterial origin was proven. OBJECTIVES: Inner ear complications and/or peripheral facial palsy secondary to AOM are rare. The general understanding is that they are due to bacterial infections. However, in some of these patients there are no clinical or laboratory signs of bacterial infections and they have negative bacterial cultures. During recent years different viruses have been isolated from the middle ear or serologically proven in AOM patients and are thought to play a pathogenetic role. We suggest that in some cases of AOM complications from the inner ear and the facial nerve can be caused by viruses. The purpose of our study was to analyze infectious agents present in patients with inner ear complications and/or facial palsy arising from AOM. PATIENTS AND METHODS: The medical records of 20 patients who had inner ear complications and/or facial palsy following AOM ( unilateral in 18, bilateral in 2) between January 1989 and March 2003 were evaluated. Bacterial cultures were carried out for all patients. Sera from 12 of the patients were stored and tested for a battery of specific viral antibodies. In three patients, investigated between November 2002 and March 2003, viral cultures were also performed on samples from the middle ear and nasopharynx. RESULTS: Nineteen patients had inner ear symptoms. Eight of them had a unilateral sensorineural hearing loss and vertigo, three had vertigo as an isolated symptom and one, with bilateral AOM, had bilateral sensorineural hearing loss. Seven patients had a combination of facial palsy and inner ear symptoms (unilateral sensorineural hearing loss in three, unilateral sensorineural hearing loss and vertigo in two, bilateral sensorineural hearing loss and vertigo in one, with bilateral AOM, and vertigo alone in one). One patient had an isolated facial palsy. Healing was complete in 11 of the 20 patients. In seven patients a minor defect remained at follow-up (a sensorineural hearing loss at higher frequencies in all). Only two patients had obvious defects (a pronounced hearing loss in combination with a moderate to severe facial palsy (House-Brackman grade 4) in one, distinct vestibular symptoms and a total caloric loss in combination with a high-frequency loss in the other. Eight patients had positive bacteriological cultures from middle ear contents: Streptococcus pneumoniae in two, beta-hemolytic Streptococcus group A in two, beta-hemolytic Streptococcus group A together with Staphylococcus aureus in one, Staph. aureus alone in one and coagulase-negative staphylococci (interpreted as pathogens) in two. In the 12 patients with negative cultures, there was a probable bacteriological cause due to the outcome in SR/CRP and leukocyte count in five. In four patients serological testing showed a concomitant viral infection that was interpreted to be the cause (varicella zoster virus in two, herpes simplex virus in one and adenovirus in one.) In three there was a probable viral cause despite negative viral antibody test due to normal outcome in SR/CRP, normal leukocyte count, serous fluid at myringotomy and a relatively short pre-complication antibiotic treatment period.
Authors:
Dag Hydén; Britt Akerlind; Markus Peebo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta oto-laryngologica     Volume:  126     ISSN:  0001-6489     ISO Abbreviation:  Acta Otolaryngol.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-15     Completed Date:  2006-11-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370354     Medline TA:  Acta Otolaryngol     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  460-6     Citation Subset:  IM    
Affiliation:
Department of Otolaryngology, Linköping University Hospital, Linköping, Sweden. dag.hyden@lio.se
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MeSH Terms
Descriptor/Qualifier:
Adenovirus Infections, Human / complications,  diagnosis,  microbiology,  virology
Adolescent
Adult
Aged
Aged, 80 and over
Bacterial Infections / complications*,  diagnosis,  microbiology,  virology
Bacteriological Techniques
C-Reactive Protein / metabolism
Child
Diagnosis, Differential
Facial Paralysis / diagnosis,  etiology*,  microbiology,  virology
Female
Hearing Loss, Sensorineural / diagnosis,  etiology*,  virology
Herpes Simplex / complications,  diagnosis,  microbiology,  virology
Herpes Zoster Oticus / complications,  diagnosis,  microbiology,  virology
Humans
Leukocyte Count
Male
Meniere Disease / diagnosis,  etiology*,  microbiology,  virology
Middle Aged
Otitis Media with Effusion / complications*,  diagnosis,  microbiology,  virology
Otitis Media, Suppurative / complications*,  diagnosis,  microbiology,  virology
Pneumococcal Infections / complications,  diagnosis,  microbiology,  virology
Risk Factors
Staphylococcal Infections / complications,  diagnosis,  microbiology,  virology
Streptococcal Infections / complications,  diagnosis,  microbiology,  virology
Virus Cultivation
Chemical
Reg. No./Substance:
9007-41-4/C-Reactive Protein

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