Læknablaðið : fylgirit - 01.06.2005, Blaðsíða 27

ABSTRACTS / XXIX CONGRESS OF THE NORDIC ASSOCIATION OF OTOLARYNGOLOGY
Abstract no.: 057
Increased incidence of acute mastoiditis in lcelandic
children
Finnbogadóttir AF1, Petersen H1-2, Laxdal Þ1,3, Guðnason Þ1-3, Haraldsson
Á12
‘University of Iceland, Reykjavík, :Department of Ear, Nose, and
Throat, Landspítali University Hospital, Reykjavík, 3Children’s Hospital,
Landspítali University Hospital. Reykjavík
Background: Inappropriate antibiotic use exposes patients to
potential adverse events and increases the prevalence of antibi-
otic resistant bacteria. During the past years studies have indi-
cated that restricted use of antibiotics for acute otitis media may
be associated with increased incidence of mastoiditis. The main
aim of our study was to evaluate the epidemiology and treatment
of mastoiditis in Iceland the past 20 years and its correlation with
national antibiotic consumption in children.
Methods: Patients diagnosed with mastoiditis and admitted to the
largest Otorhinolaryngology and Pediatric departments in Iceland
during 1984-2002 were included. National information on antibiotic
consumption of children (Defined Daily Dosage; DDD) during
1989-2002 was correlated with the yearly incidence of mastoiditis.
Further information on diagnosis and treatment were obtained
from the hospital charts of children admitted 1999-2002.
Results: Eighty four patients were diagnosed with mastoiditis
during 1984-2002 and 52 of those were children (62%). Median
age of the children was 2 years and 8 months and 58% were boys.
Twenty eight children were diagnosed in 1999-2002, median age 2
years and 2 months. Fifteen children (54%) visited their general
practitioner within a week before admission and were diagnosed
as having acute otitis media. Antibiotics were prescribed in 73%
of visits. There was a significant negative correlation between
antibiotic consumption of children and incidence of mastoiditis
during the years 1989-2002 (r = -0,71 og p = 0,04).
Conclusions: Following changes in treatment guidelines for
various upper respiratory infections in children the antibiotic con-
sumption af children decreased. At the same time the incidence
of mastoiditis in children increased. Guidelines on appropriate
antibiotic prescribing for children should emphasize increased
awareness of possible serious complications, especially in young
children.
O-V OTOLOGY
Abstract no.: 058
Residual cholesteatoma and recurrences, a study of 446
consecutively operated patients during 16-years
Anders Kinnefors
Dept of otosurgery, Uppsala University hospital, Uppsala, Sweden
Preservation of the posterior bony canal is still one of the most
discussed subjects in cholesteatoma surgery today. In addition is
obliteration of the mastoid cavity necessary or not.
We started in May 1983 to document every surgical procedure
in cholesteatoma using a computer-based system. In this registry
also patients with reconstructed radical cavities were included.
The first registration is made when the patient is to be operated.
It includes audiometry, some relevant sick history, and actual local
status of the ear and finally the surgical procedure. Than we have
a control after 1,3, 6 and finally 9 years postoperatively.
As the material includes all my operated patients during this
period, the technique differs a little. I take down the posterior wall
as a rule and obliterate every case if possibly. So far (February
2005) about 320 patients is followed for 6 years and about 275 for
9 years out of 446.
During this period I have reoperated 6 patients for a residual
cholestatoma. If you look on the recurrent cholesteatomas
they are more frequent. Most of them (80-90%) occurs into the
obliterated cavity without any extension to the middle ear. One
other peculiar thing is also that this retraction pocket almost
never gives any suppuration, even if it is severely retinating. In
the 6 year control (320 operated ears) 15 patients are reoperated
for a recurrent cholesteatoma. Only one patient for a retraction
to the middle ear.
After 9 years (275 ears) 12 are operated, one with extension
to middle ear (the same patient as in the 6-year control). In this
last 9-year control there were 8 patients more with a less severe
retraction pocket to the middle ear, which not were needed to
operate. Maybe in the future 1-2 will need an operation?
Abstract no.: 059
Cholsteatoma Surgery and Total Reconstruction. The
Uppsala Concept
Lennart Edfedt
Dept of Otosurgery, Uppsala University Hospital, 751 85 Uppsala, Sweden
Techniques used in cholesteatoma surgery vary extensively in
surgical centres worldwide. Different canal wall up/down strate-
gies with various outcome are presented. Many authors have
published papers with unacceptable large number of residual
cholestatoma. Problems usually arise due to limited overview of
ímportant anatomical enclaves such as the tympanic sinus and
facial recesses with sub-optimal eradication of keratin/matrix.
Many still perform radical cavities sometimes due to difficulties to
completely remove keratin, which may be diffcult or even impos-
sible. ‘Canal wall down/no reconstruction technique’ offers many
advantages such as good surgical overview of important anatomi-
cal landmarks with a low risk for residual disease needing surgical
revision. It is easy to learn and less time-consuming. Disadvantages
are self-retaining cavitites often with recurrent infections. In addi-
tion, water non-resistency and suboptimal hearing results is less
favourable for the patient. Modern ear surgery introduced new
techniques leading to preserved anatomy, water resistency and
most often good hearing results. The so-called ‘total reconstruc-
tion concept’ used in Uppsala combines the advantages of both
techniques. For optimal overview a radical cavity and removal
of the posterior bony canal to the level of the facial canal (scele-
tonized) is performed. A meatoplasty is always made. Following
meticulous keratin removal the canal wall is reconstructed with
conchal or tragal cartilage and the mastoid cavity obliterated
with crushed bone chips, musculo/periosteal flap and fibrin glue.
Middle ear is reconstructed with temporal fascia and autologous
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