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      Complicaciones de la otitis media con parálisis del sexto par craneal contralateral en pediatría Translated title: Cranial complications of otitis media with paralysis of the contralateral sixth cranial pair in pediatrics


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          La otitis media es una infección frecuente en la infancia, la cual puede producir complicaciones, incluidas las neurológicas graves, en cuatro de cada 100 niños en países en desarrollo.

          Se presenta el caso de una niña de nueve años sin antecedentes de enfermedad que consultó por otitis media derecha, otorrea, síndrome de hipertensión intracraneal y parálisis del VI nervio craneal contralateral a la lesión. La tomografía computarizada de cráneo y la resonancia magnética cerebral revelaron otomastoiditis crónica, apicitis petrosa, y trombosis de los senos transverso y sigmoide, el bulbo yugular y la vena yugular interna derecha. Recibió tratamiento antibiótico y quirúrgico.

          Este caso refleja el espectro de complicaciones intracraneales y extracraneales asociadas con la otitis media aguda en la era antibiótica. El examen físico permite la detección precoz de la hipertensión intracraneal, con signos como el papiledema y la parálisis del VI par contralateral como hallazgo inusual.


          Otitis media is a frequent infection during childhood. Complications may be present in up to 4 of 100 children including serious neurological complications, particularly in developing countries.

          We report the case of a 9-year-old girl with no disease history who presented with otitis media, otorrhea, intracranial hypertension syndrome, and paralysis of the VI cranial nerve contralateral to the lesion. A computed tomography scan of the skull and a brain magnetic resonance imaging revealed chronic otomastoiditis, petrous apicitis, and thrombosis of the transverse and sigmoid sinus, the jugular bulb, and the right internal jugular vein. She received antibiotics and surgical treatment.

          This case shows the spectrum of intra and extracranial complications associated with acute otitis media in the antibiotic era. The physical examination allows early identification of intracranial hypertension with signs such as papilledema and sixth contralateral nerve palsy as an unusual finding.

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          Epidemiology of acute otitis media in children of Latin America and the Caribbean: a systematic review and meta-analysis.

          Acute otitis media (AOM) is one of the most common childhood diseases requiring antimicrobial prescription in pre-school children. This systematic review aimed to estimate the AOM incidence, bacterial etiology and use of resources in children aged <6 years in Latin America and the Caribbean (LA&C). A systematic search using keywords otitis or middle ear and inflammation was performed for articles published during 1988-2008 in MEDLINE, Cochrane Library, EMBASE, LILACS, generic and academic internet searches, Ministries of Health, PAHO, regional proceedings, reference lists and consulting experts. Pairs of reviewers independently selected articles and assessed their methodological quality with a checklist of essential items from the STROBE statement according to pre-specified criteria. Studies involving immune-competent children with AOM were considered. Arcsine transformations were used for proportion meta-analyses. Annual AOM incidence in four studies in children aged <5 years ranged from 1,171-36,000 episodes/100,000 children. Meta-analysis on etiology and pneumococcal serotypes included 18 studies and 125, 519 children with AOM from six LA&C countries. Meta-analysis per serotype showed that Streptococcus pneumoniae (32.4%; 95%CI=27.1-38.0%) and Haemophilus influenzae (26%; 95%CI=19.5-33.1%), including non-typeable H. influenzae (18.3%; 95%CI=9.5-33.1%) were the most prevalent. The most commonly observed pneumococcal serotype was 19F (24.0%; 95% CI 17.0-32.0%). Data on use of health resources were scarce. Streptococcus pneumoniae and H. influenzae were the most frequent AOM bacterial pathogens, consistent with the international literature from other regions. Future studies on AOM incidence and health resources usage will help better define the impact of this disease. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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            The Six Syndromes of the Sixth Cranial Nerve

            The sixth cranial nerve runs a long course from the brainstem to the lateral rectus muscle. Based on the location of an abnormality, other neurologic structures may be involved with the pathology related to this nerve. Sixth nerve palsy is frequently due to a benign process with full recovery within weeks, yet caution is warranted as it may portend a serious neurologic process. Hence, early diagnosis is often critical for some conditions that present with sixth nerve palsy. This article outlines a simple clinical approach to sixth nerve palsy based on its anatomy.
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              Complications of otitis media – a potentially lethal problem still present Translated title: Complicações das otites média – um problema potencialmente letal ainda presente

              Introduction It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. Objective This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM). Methods Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. Results 80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. Conclusion ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur. Introdução É uma crença comum, porém errônea, que complicações intracranianas (CICs) de otite média tanto aguda (OMA) quanto crônica (OMC) sejam doenças do passado ou de países em desenvolvimento. No entanto, esses problemas continuam, apesar de melhorias na terapia antimicrobiana. Objetivo Analisar a ocorrência, as características clínicas e a evolução das principais CICs secundárias às otites médias (OM). Método Estudo de coorte retrospectivo de 51 pacientes com CIC secundárias a OM, provenientes do pronto-socorro de um Hospital Universitário ao longo de um período de 22 anos. Resultado No total, 80% dos casos de CICs foram secundários a OMC, cuja incidência foi de 0,8%, e apenas 20% foram secundárias a OMA. A letalidade foi de 7,8%, perda auditiva em 90%, com sequela neurológica permanente em 29%. Dentre os pacientes, 61% eram do sexo masculino. Na maioria, o início da doença otológica tinha ocorrido durante a infância. A demora no diagnóstico, tanto da infecção primária como da complicação secundária, foi significativa. CICs, incluindo abscesso cerebral e meningite, corresponderam a 78%, e trombose do seio lateral, empiema e hidrocefalia otítica em 13%, 8% e 1% dos casos, respectivamente. Foram realizados 27 procedimentos neurocirúrgicos e 43 cirurgias otológicas. Dois pacientes não apresentavam condições clínicas para a intervenção cirúrgica. Conclusão CICs de OM, embora incomuns, ainda ocorrem. Esses casos exigem tratamento hospitalar oneroso, complexo e de longo prazo, e frequentemente resultam em perda auditiva, sequelas neurológicas e mortalidade. É importante estar ciente dessa potencialidade especialmente em crianças com OMC e manter um alto índice de suspeita, encaminhar para avaliação otológica e antecipar a ocorrências de tais complicações.

                Author and article information

                Instituto Nacional de Salud
                15 June 2021
                June 2021
                : 41
                : 2
                : 218-224
                [1 ] original Departamento de Medicina Física y Rehabilitación, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia normalizedUniversidad del Valle orgdiv1Departamento de Medicina Física y Rehabilitación orgdiv2Hospital Universitario del Valle orgnameUniversidad del Valle Cali, Colombia
                [2 ] original Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia normalizedUniversidad Icesi orgdiv1Facultad de Ciencias de la Salud orgnameUniversidad Icesi Cali, Colombia
                [3 ] original Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana, Cali, Colombia normalizedPontificia Universidad Javeriana orgdiv1Facultad de Ciencias de la Salud orgnamePontificia Universidad Javeriana Cali, Colombia
                [4 ] original Neurología Infantil, Departamento de Pediatría, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia normalizedUniversidad del Valle orgdiv1Neurología Infantil, Departamento de Pediatría, Hospital Universitario del Valle orgnameUniversidad del Valle Cali, Colombia
                Author notes
                [* ] Correspondencia: Luz Miriam Leiva, Departamento de Medicina Física y Rehabilitación, Hospital Universitario del Valle, Calle 5 No 36-08, primer piso, Cali, Colombia Teléfono: (572) 620 6000, extensión 1541 luz.leiva@ 123456correounivalle.edu.co

                Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

                : 03 August 2020
                : 03 December 2020
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 15, Pages: 7
                Reporte De Caso

                otitis media,hipertensión intracraneal,mastoiditis,petrositis,trombosis de seno intracraneal,enfermedades del nervio motor ocular externo,intracranial hypertension,sinus thrombosis, intracranial,abducens nervus diseases


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