Suppurative Complications of Acute Otitis Media in the Era of Antibiotic Resistance
Jeffrey S. Zapalac, MD;
Kathleen R. Billings, MD;
Nathan D. Schwade, PhD;
Peter S. Roland, MD
Arch Otolaryngol Head Neck Surg. 2002;128:660-663.
Objective To review our experience with suppurative complications of acute otitis
media (AOM) in the era of antibiotic resistance, given a perceived increase
in the number of such cases in recent years requiring surgical intervention.
Design Retrospective review of pediatric patients presenting with suppurative
complications of AOM from January 1993 to June 2000.
Setting Academic tertiary care children's medical center.
Patients A total of 90 pediatric patients, ranging in age from 3 months to 16
years (mean age, 45 months).
Results A total of 104 suppurative complications of AOM occurred in 90 patients
over the 7.5-year study period. The incidence of noncoalescent, coalescent,
and total cases of mastoiditis and total number of suppurative complications
all increased over the study period, with coalescent outpacing noncoalescent
disease during the last 3 years of the study. A trend toward an increasing
number of cases requiring surgical intervention was noted during the study
period, corresponding to an increasing number of resistant Streptococcus pneumoniae isolates. Ten of 16 S pneumoniae isolates were resistant, primarily collected from younger children
ranging in age from 4 to 24 months (mean age, 11.9 months).
Conclusion The rising incidence of resistant S pneumoniae
corresponded to the increasing number of suppurative complications of AOM
during the study period and seemed to contribute to more aggressive infectious
processes requiring surgical intervention.
From the Department of Otolaryngology–Head and Neck Surgery,
The University of Texas Southwestern Medical Center, Dallas.
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