4. Discussion
In the present study, we characterized the clinical course and the
microbiologic findings of CAM in children. The study’s retrospective
nature raises several possible limitations: 1. some clinical and
laboratory data from the patient charts were incomplete or missing. 2.
Several otolaryngologists and pediatricians treated the patients.
Therefore, decisions related to the need for repeated imaging and the
need for revision surgery might not have been uniform.
Most AM cases are managed conservatively, with myringotomy, intravenous
antibiotics, and a careful follow-up, until resolution of the disease.
Some patients may develop complications, either extra or intra-cranial;
these cases are defined as CAM and treated surgically, while continuing
systemic antibiotic treatment. The surgical management may differ
between various medical centers and include myringotomy, placement of
VT, and incision plus drainage of SPA, with or without cortical
mastoidectomy. Patients presenting intracranial complications are most
likely to undergo a mastoidectomy (8). In a series of
570 children published recently from Israel, reported a significant
increase in AM cases that had an indication for surgical intervention
during the years 2008-2017 (11% vs. 19% between the first and the last
five years of the study respectively, P = 0.008) and described higher
fever, leukocytes counts and CRP values in CAM compared to simple AM(9). A study from the UK (10),
described 30 patients (aged 2 months to 15 years) with intracranial
complications of AM. The most frequent complication was SST (73%),
followed by a cerebral abscess (40%) and SPA (33%). Three (10%)
patients had long-term sequelae (one developed secondary intracranial
hypertension, the second a CSF leak that required placement of a
ventriculo-peritoneal shunt, and the third with diplopia and residual
mild visual obscuration); only one (3%) patient required additional
surgical treatment. In a recent study from the United States, addressing
the safety and post-operative adverse events encountered during the
management of AM (11), 113 patients with AM requiring
surgical treatment were analyzed. Four (3.1%) patients required
readmission and 9 (6.9%) required unplanned subsequent operative
procedures.