Intratemporal and intracranial complications of acute otitis media in a pediatric population

Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2161-4. doi: 10.1016/j.ijporl.2014.09.032. Epub 2014 Oct 6.


Objective: To review all cases intratemporal and intracranial complications of acute otitis media (AOM) in infants and children from 1998 to 2013.

Methods: Retrospective chart review of 109 consecutive patients admitted for complications of AOM during a 15-year period at a tertiary-care children's hospital. The main outcomes are: (1) complications of AOM, (2) bacteriology, (3) management strategies.

Results: In our population, complications included mastoiditis (86.1%), subperiosteal abscess (38%), facial nerve palsy (16.7%), sigmoid sinus thrombosis (8.3%) and epidural abscess (7.4%). Other complications included post-auricular cellulitis, otic hydrocephalus and elevated intracranial pressure, internal jugular thrombosis, cranial nerve VI palsy and Gradenigo's syndrome, labyrinthine fistula, sensorineural hearing loss, and cerebellar infarct. Sixty-one patients (56%) received antibiotics prior to presentation. Cultures revealed Streptococcus pneumoniae in 36 patients (33.3%), other bacteria in 30 patients (27.8%), and "no growth" in 33 patients (30.5%). Nine patients (8.3%) did not undergo culture. Of the patients with S. pneumoniae, 20 cultures (55%) were found to be multidrug-resistant. Eleven patients (10.2%) were treated non-surgically, 31 (31%) were treated with myringotomy and intravenous antibiotics. Forty patients (97.5%) presenting with subperiosteal abscess required mastoid surgery. Thirteen of 18 (72.2%) patients with facial paralysis had full recovery. Eight of 10 (80%) patients with epidural abscess empyema required mastoid surgery and incision and drainage of the abscess.

Conclusion: Complications of AOM are uncommon, yet continue to have potentially serious consequences. The bacteriology in this population reveals an increasing trend of multi-drug resistant S. pneumoniae as the causative organism.

Keywords: Acute otitis media; Complications; Intracranial; Intratemporal; Pediatric.

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use
  • Bell Palsy / etiology
  • Bone Diseases / etiology
  • Bone Diseases / surgery
  • Child, Preschool
  • Drug Resistance, Multiple, Bacterial
  • Epidural Abscess / etiology*
  • Facial Paralysis / etiology
  • Female
  • Hearing Loss, Sensorineural / etiology
  • Humans
  • Male
  • Mastoid / surgery
  • Mastoiditis / etiology*
  • Middle Ear Ventilation
  • Otitis Media / complications*
  • Otitis Media / drug therapy
  • Otitis Media / surgery
  • Pneumococcal Infections / complications*
  • Pneumococcal Infections / drug therapy
  • Retrospective Studies
  • Sinus Thrombosis, Intracranial / etiology
  • Temporal Bone


  • Anti-Bacterial Agents