doiSerbia

Meningoencephalitis as a complication of acute otitis media in a 11-year-old child

Dudvarski Zoran (Faculty of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Otorhinolaryngology and Maxillofacial Surgery, Belgrade)
Arsović Nenad (Faculty of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Otorhinolaryngology and Maxillofacial Surgery, Belgrade)
Ješić Snežana (Faculty of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Otorhinolaryngology and Maxillofacial Surgery, Belgrade)
Nešić Vladimir (Faculty of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Otorhinolaryngology and Maxillofacial Surgery, Belgrade)
Međo Biljana (Faculty of Medicine, Belgrade + University Children's Hospital, The Intensive Care Unit, Belgrade)
Nikolić Dimitrije (Faculty of Medicine, Belgrade + University Children’s Hospital, Department of Neurology, Belgrade)

Introduction. Acute otitis media is a very common disease in the early childhood age, with typical symptoms such as otalgia and fever. Otogenic complications are divided into extracranial and intracranial. Although the introduction of antibiotics has significantly reduced the incidence of intracranial complications, they are still present. Clinical picture usually develops fast, with the predominance of neurologic symptoms. Case outline. An 11-year-old boy was admitted to a tertiary health care children’s hospital because of fever, agitation, altered behavior and disorder of consciousness. Based on the anamnesis, clinical examination, CT, MRI, and lumbar puncture, it has been established that it is a case of meningoencephalitis as complications of acute otitis media. Besides intense antibiotic and symptomatic therapy, surgical treatment too was conducted as well. Firstly, mastoidectomy with the implantation of ventilation tube was done, followed by radical tympanomastoidectomy, because there was no improvement. The treatment was followed by numerous complications, such as toxic hepatitis, mycoplasma pneumoniae infection, and hemolytic anemia. The treatment lasted for 71 days, and the patient was discharged from the hospital in a good general condition, without the focal motor failure. Conclusion. Meningoencephalitis is unusual and rare complication of acute otitis media that requires urgent diagnostic procedure and multidisciplinary approach to the treatment. Surgical treatment of the ear that caused complications should not be postponed, and the choice of surgical method must be adapted to each patient individually. Hospital treatment of these patients is often prolonged and auditory and neurological sequelae are substantial and require long-term treatment.

Keywords: acute otitis media, intracranial complications, children