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Query: UMLS:C0262471 (ENT)
 5,307 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The global epidemic of HIV infection remains appalling. By 2001, there were an estimated 1.4 million HIV-infected children, with 4.5 million deaths. In the UK, paediatric cases are clustered around population centres where there are high concentrations of infected immigrant adults, and to a lesser extent, areas where IV drug abuse is common. The highest incidence remains in London and the southeast. With the national redistribution of immigrant and refugee families, any doctor in any specialty may expect to be involved with children who are HIV positive, or have clinical AIDS. The majority of children are infected vertically, i.e. infection of the infant from an infected mother in the pre-, peri-, or post-natal periods. Rates of transmission vary from 15-20% in the developed countries. Children with HIV infection may have their primary presentation to ENT doctors, who should have appropriate thresholds for suspecting the diagnosis. The most common presenting features include persistent generalised lymphadenopathy, hepatosplenomegaly, chronic/recurrent diarrhoea, poor growth, and fever. Fifteen to twenty percent of untreated children will present with an AIDS-defining illness by 12 months, typically with Pneumocystis pneumonia at approximately 3-4 months of age. Seventy percent of perinatally infected children will exhibit some signs or symptoms by 12 months Without treatment, the median age to progression to AIDS is approximately 6 years, and 25-30% will have died by this age. The median age of death is approximately 9 years. Children may also present with repeated/unusual ear infections, sinus disease (inc. mastoiditis), tonsillitis, orbital/peri-orbital cellulitis, oral candidiasis, and dental infections. Infections with streptococcus pneumoniae and group A streptococcus are common, and often progress to severe systemic infection with an appreciable mortality. Infections may be due to unusual pathogens such as Pseudomonas, 'typical' and atypical Mycobacteria, Candida, Aspergillus, etc. Fungal infections of the sinuses (inc. Aspergillus and Rhizopus spp.) may be particularly devastating, with rapid spread to involve bone and the central nervous system. Another classical presentation, which may present to ENT doctors, is that of bilateral parotid enlargement, especially in children who are 'slow progressors', many of whom also have Lymphoid Interstitial Pneumonitis (LIP). A major attitudinal change has occurred due to advances in 3 main areas: (i) the multidisciplinary management of the infected mother (inc. counselling, antenatal screening, elective caesarean section, advising against breast feeding, etc.), (ii) the prevention of vertical transmission, using anti-retroviral therapy to the infected mother during pregnancy, and to the potentially infected infant in the first weeks of life, and (iii) major advances due to the advent of highly active anti-retroviral treatment. With effective use of these measures, transmission rates may be reduced to <2%. None of the measures though, affect a cure, and it will still be many years before the development of effective vaccines. ENT doctors may be referred children already known to be HIV-positive. Knowing how to talk to infected children (and their parents) is full of potential pitfalls, and requires careful forethought. Many infection-control policies have required considerable rethinking due to the AIDS epidemic. This has especially been the case with respect to needle-stick injuries, post-exposure prophylaxis, sterilization and re-use of equipment, and safe approaches to surgery.
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PMID:HIV infection in children--impact upon ENT doctors. 1466 74

A case of Wegener's granulomatosis in female aged 47 is described. Otological symptoms and signs connected with middle ear inflammation and masked mastoiditis about two months outstriped other signs particular from lower respiratory tract. The patient was surgically treated--antromastoidectomy was performed. After few days rapid worsening of patient's general state followed with hectic fever and inflammatory pulmonary changes. The patient was next treated in the Clinic of Pulmonary Diseases and Tuberculosis where the diagnosis of Wegener's granulomatosis was established on the basis of immunological findings (antibodies c-ANCA and PR3). The patient is treated from 9 months with cyclophosphamide and prednisone with improvement. The inability of ENT-surgeon in proper diagnosis and treatment in initial stage of the disease is stressed.
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PMID:[Otologic signs and symptoms as first manifestations of Wegener's granulomatosis with very severe clinical course--review of the literature and case report]. 1531 97

Acute mastoiditis is the most common complication of acute otitis media (AOM) and its early recognition and management still poses a challenge due to potentially serious consequences. The incidences of extracranial and intracranial suppurative complications of AOM in children have decreased significantly, yet they remain a serious clinical problem, especially when caused by bacteria resistant to antibiotics. The authors presented a case of rare AOM complication - zygomatic abscess with temporal myositis. A 6-year-old boy was admitted to the ENT Department with 4 weeks of ear pain, treated for AOM with cefuroxime axetyl and amoxicilline, with acute mastoiditis and subsequent abscess formation in zygomatic and preauricular region. The inflammatory process spread through anterior air cells to the zygomatic cells leading to a fistula formation in the zygomatic bone and breakthrough into the temporal muscle. The surgical procedures applied were: myringotomy with drainage, cortical mastoidectomy and revision of zygomatic area and treatment with antibiotics (ceftriaxon). Enterococcus faecalis and Streptococcus viridans were found in the culture of middle ear and mastoid effusion. After half a year of follow-up the child had a normal hearing. Severe complications of AOM are rare today. An early diagnosis in order to promote adequate management and prevent inherently suppurative complications is essential.
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PMID:Zygomatic abscess with temporal myositis - a rare extracranial complication of acute otitis media. 1576 97

A clinical course of mastoiditis according to recent literature data is characterized, therapeutic policy is discussed. The results of mastoidectomies made in the ENT clinic of the Moscow State Medical University in 2004-2007 are reviewed retrospectively.
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PMID:[Current features of a mastoiditis course]. 1816 83

Aspergillus mastoiditis is a very rare condition usually observed in immunocompromised patients. Masked mastoiditis is defined as a subclinical infectious inflammatory process of the mucosal lining and bony structures of the mastoid air cells with intact tympanic membranes. To our knowledge, our report of a masked Aspergillus mastoiditis occurring in a 71-year-old diabetic woman is only the second case of masked mastoiditis in the literature. Aggressive medical and surgical management are necessary to avoid a fatal outcome from this invasive infection.
B-ENT 2008
PMID:Aspergillus mastoiditis with intact tympanic membrane in immunocompetent host. 1850 21

Otogenic complications in children occur most commonly secondarily to acute otitis media. Intratemporal complications are predominant and mastoiditis is most frequently seen. Meningitis in the course of acute otitis media is the most common intracranial complication. Complications of chronic otitis media are rare today, but can be more difficult to diagnose, because antibiotics may mask symptoms and change clinical presentation. Antibiotic use, however, has not completely eradicated the otogenic complications and ENT doctors should remember about this possibility.
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PMID:[Complications of otitis media in children in the era of antibioticotherapy]. 1855 18

Acute otitis media (AOM) is one of the most common infections in children. Recently it was noticed that there is a marked increase in relapse of severe acute otitis media in children. There is also an increase in number of hospitalized children due to severe AOM, with etiological agent resistant to antibiotics. There is a rise of infections, caused by highly resistant Streptococcus pneumoniae, too. Authors retrospectively reviewed children hospitalized at the Children's ENT Department in Children's University Hospital in Bratislava, from January 2005 to December 2006, due to severe acute otitis media. They mainly focused on etiological agent, antibiotics resistance as well as alternatives of treatment and prevention of severe AOM. During 2 years, there were 76 children aged from 4 months to 14 years hospitalized with severe AOM. The most frequent etiological agent was Streptococcus pneumoniae in 37 cases; this was almost in 70% of cases resistant to routine antibiotics. In 7 cases there was mastoiditis, and mastoidectomy or antrotomy had to be done in 6 cases. To establish a diagnosis and start appropriate treatment it is necessary to identify etiological agent and its sensitivity. An increasing bacterial resistance is forcing us to prescribe antibiotics rationally. When severe AOM occurs, tympanotomy and insertion of ventilation tubes, exceptionally mastoidectomy, is often required (Fig. 13, Tab. 3, Ref. 18). Full Text (Free, PDF) www.bmj.sk.
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PMID:Severe acute otitis media in children. 1863 Aug 3

Only few epidemiological studies evaluate the role of ENT infections in meningitis. A retrospective review of data shows that the frequency of ENT infections is estimated at 25% in adults and children. Meningitis may occur during otological and nasosinusal infections. Acute otitis media and mastoiditis are the most common ear infections responsible for meningitis. Chronic otitis (cholesteatoma) are rarely involved. In case of acute rhinosinusitis, frequently responsible frontal and ethmoidal locations are investigated by nasal endoscopy and CT scan. A CSF leak originating mostly from anterior skull base or middle ear, either posttraumatic or spontaneous, may also be associated with meningitis. The management of ENT infections begins with antibiotics. Drainage may be discussed when identification of the bacteria is needed or if the medical treatment seems inefficient. In case of a CSF leak, closure of the defect is performed according to its location and size after evaluation by imaging (CT scan, MRI).
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PMID:[Diagnosis and management of ENT conditions responsible for acute community acquired bacterial meningitis]. 1941 28

Watchful waiting was recommended as an option for uncomplicated episodes of acute otitis media in Sweden in the year 2000. Concern was raised that these recommendations would lead to a higher incidence of acute mastoiditis. The aim of this study was to map the occurrence, treatment policy and the clinical course of mastoiditis before and after the new treatment recommendations were introduced. Included in the study were all patients (adults and children) who were admitted to two ENT departments in southern Sweden for acute mastoiditis from 1996 to 2005. A total of 42 cases of mastoiditis were identified: 23 during the first period of 1996-2000 and 19 during 2001-2005. Mastoidectomy was performed in 14 patients during the first period and in 8 during the second period. As much as 39% of mastoiditis patients received antibiotics before hospital care, but had no improvement. There was no indication that the number of patients with acute mastoiditis was increasing after new treatment recommendation of AOM. There was no increase in the occurrence of mastoidectomy. Severe complications of mastoiditis were rare. Although there were potentially threatening complications of mastoiditis in the study, these did not lead to sequelae. It is important to follow up the consequences when treatment recommendations of AOM are changed.
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PMID:Acute mastoiditis in southern Sweden: a study of occurrence and clinical course of acute mastoiditis before and after introduction of new treatment recommendations for AOM. 2061 27

Sinonasal and temporal bone infections may extend to the skull, skull base, meninges, pericerebral spaces, brain parenchyma, dural sinuses, deep cerebral or cortical veins, intracranial arteries and cranial nerves either via contiguous or hematogeneous spread. The site of infection dictates the sites of potential complications: orbital with ethmoid sinusitis, cavernous sinus thrombophlebitis and oculomotor palsies with sphenoid sinusitis, transverse sinus thrombophlebitis with mastoiditis and superior sagittal sinus thrombophlebitis with frontal sinusitis. All may result in brain abscess. Congenital and acquired defects of the skull and meninges, with or without associated meningocele or meningoencephalocele, perilymphatic fistulas, and some anomalies of the inner ear may predispose to the intracranial extension of ENT infections.
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PMID:[Intracranial complications from ENT infections]. 2209 48


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