Læknablaðið : fylgirit - 01.06.2005, Side 26

ABSTRACTS / XXIX CONGRESS OF THE NORDIC ASSOCIATION OF OTOLARYNGOLOGY
tubes, but the number of tympanic membranes included this far is
too low for drawing any conclusions.
At five years postoperatively 30 percent of the ears still showed
signs of Eustachian tube dysfunction.
These results are preliminary and are based on 156 ears only.
At the meeting we will report a five-year follow-up of all ears
treated with ventilation tubes inserted at Vasterás central hospital
in paediatric patients during 1998 and 1999.
Abstract no.: 054
Acute Intratemporal and Intracranial Complications of Otitis
Media in Adults in Helsinki Hospital District
Leskinen K MD, Jero J MD, Department of Otolaryngology, Helsinki
University Central Hospital, Helsinki, Finland
Objective: To establish the clinical picture, diagnostic procedures,
current treatment and outcome of adult patients with acute intra-
temporal (ITC) and intracranial (ICC) complications of otitis
media (OM).
Study Design: A retrospective chart review with a sent questionnaire.
Patients: Adult patients treated for acute ITC and ICC of OM
over the past 10 years (1990-2000) in the study hospital.
Results: Thirty patients aged 16 to 75 years were treated. Seventy-
three percent (22/30) of the complications were intratemporal and
27% (8/30) were intracranial. Mastoiditis was complicated by sub-
periosteal abscess, labyrinthitis and facial paresis in 14% (3/22),
18% (4/22) and 27% (6/22), respectively. Fifty percent (4/8) of the
ICC cases were intracranial abscesses, 38% (3/8) were meningitis
and 12% (1/8) were sinus thrombosis. The ear disease behind the
acute complication was acute otitis media (AOM), chronic otitis
media (COM) and COM with cholesteatoma in 70% (21/30), 17%
(5/30) and 13% (4/30), respectively. Streptococcus pneumoniae
and Streptococcus pyogenes were the bacteria most often found
in the culture. Mastoidectomy was performed on 60% (18/30) of
the patients. Permanent hearing loss occured in 30% (9/30) of the
patients. One patient died for otogenic meningitis.
Conclusions: Severe complications of OM are rare in Finland.
Operative treatment was performed on patients with intracranial
complications and intratemporal abscesses. Complications of OM
are still associated with great morbidity, and their early recogni-
tion forms the basis for effective treatment.
Abstract no.: 055
Association of clinical signs and symptoms with pneumo-
coccal acute otitis media in children
Palmu A, Tampere School of Public Health, University of Tampere,
Kilpi T, National Public Health Institute, Karma P, Department of
Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
The purpose of this study was to assess the possible differences
in signs and symptoms of acute otitis media (AOM) between
the major otitis pathogens and between different pneumococcal
serotypes.
Altogether 831 children of the control group in the Finnish
Otitis Media Vaccine Trial were prospectively followed from 2-24
months of age in special study clinics. AOM was confirmed by
myringotomy and middle ear fluid aspirated for bacteriological
analyses. Clinical symptoms and signs were recorded using
structured questionnaires and case report forms.
During the follow-up, pneumococcus was culturable in 29.4%
of 1819 AOM events. Pneumococcal AOM was associated with
fever and earache more often than the events caused by other
bacteria. Among the 479 serotyped pneumococci, the most
common were 23F (21.7%), 19F (14.0%), 6B (12.9%) and 6A
(10.0%); the serotype coverage of the currently available 7-valent
conjugate vaccine was 61.2%. There were no major differences in
the clinical presentation of AOM caused by different serotypes
or groups.
So, the clinical presentation of AOM may become milder, if
the role of pneumococcus as a causative agent will decrease (e.g.
by vaccination). However, the potential changes in the serotype
distribution do not alter the clinical picture of pneumococcal
AOM.
Abstract no.: 056
Prediction of upper respiratory tract bacteria responsible
for acute otitis media in children
Margaretha Foglé-Hansson1, Ann Hermansson2, Peter White2
Dept of otorhinlaryngology, Head and Neck surgery, 'County Hospital,
Skövde, 2University Hospital in Lund, Sweden
Background: The bacteria causing AOM (acute otitis media) are
Streptococcus pneumoniae, Haemophilus influenzae (NTHi),
Moraxella catarrhalis and Streptococcus pyogenes. The aim of
this study was to see if it might be possible to decide the causative
bacterium by otomicroscopical appearance of the tympanic mem-
brane.
Material and methods: Children suffering from AOM were
included in this prospective study. The tympanic membrane was
photographed, a prediction of the causative bacterium was made,
a tympanocentesis performed and effusion taken for bacterial cul-
turing. A nasopharyngeal specimen was also taken for bacterial
culturing. Two different groups of bacteria were distinguished. S.
pneumoniae constituted one group as opposed to H. influenzae
(NTHi) and M. catarrhalis in the other.
Results: A total of 72 children were included in the study (38 boys
and 34 girls, mean age 29 months). A correct prediction was made
in 44/57, a false prediction in 13/57 (p=0.001). Cultures with no
growth (5/72) and cultures with multiple growths (10/72) were not
predictable.
Conclusion: Otomicroscopy performed by a skilled examinator
is an effective tool! A more thorough clinical examination of the
tympanic membrane in AOM might be an effective way to select
patients for antibiotic treatment without risking a rising number
of complications.
26 Læknablaðið/Fylgirit 51 2005/91