Severe acute otitis media and mastoiditis caused by group A beta‐hemolytic streptococcus

Juha T. Laakso; Valtteri Rissanen; Eeva Ruotsalainen; Jarkko Korpi; Anu Laulajainen‐Hongisto; Ville Sivonen; Saku T. Sinkkonen

doi:10.1002/lio2.659

Laryngoscope Investigative Otolaryngology (Oct 2021)

Severe acute otitis media and mastoiditis caused by group A beta‐hemolytic streptococcus

Juha T. Laakso,
Valtteri Rissanen,
Eeva Ruotsalainen,
Jarkko Korpi,
Anu Laulajainen‐Hongisto,
Ville Sivonen,
Saku T. Sinkkonen

Affiliations

Juha T. Laakso: Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center Helsinki University Hospital and University of Helsinki Helsinki Finland
Valtteri Rissanen: Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center Helsinki University Hospital and University of Helsinki Helsinki Finland
Eeva Ruotsalainen: Division of Infectious Diseases, Department of Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
Jarkko Korpi: Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center Helsinki University Hospital and University of Helsinki Helsinki Finland
Anu Laulajainen‐Hongisto: Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center Helsinki University Hospital and University of Helsinki Helsinki Finland
Ville Sivonen: Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center Helsinki University Hospital and University of Helsinki Helsinki Finland
Saku T. Sinkkonen: Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center Helsinki University Hospital and University of Helsinki Helsinki Finland

DOI: https://doi.org/10.1002/lio2.659
Journal volume & issue: Vol. 6, no. 5
pp. 1158 – 1166

Abstract

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Abstract Objective To describe the characteristics, diagnostics, treatment, and outcome of severe acute otitis media (AOM) and acute mastoiditis (AM) caused by group A beta‐hemolytic streptococcus (GAS). Study design A retrospective cohort study. Methods The yearly incidence of inpatient care‐needing GAS AOM/AM patients in our hospital catchment area between 2002 and 2018 was investigated. A detailed analysis was performed for cases treated during the last GAS epidemic in 2017‐2018. Anamnesis, signs and symptoms, pure‐tone audiometry results, treatment, complications, and outcome were collected from medical charts. Patients responded to an otology‐specific health‐related quality of life survey (EOS‐16) 1.5 to 3 years after their treatment. Results The number of GAS infections peaks at approximately 7‐year intervals. During 2017 and 2018, altogether 37 patients (29 adults and 8 children) were hospitalized due to GAS AOM/AM. AM was diagnosed in 14 (38%) patients. The disease progression was typically very rapid. At presentation, all patients had severe ear pain, 68% tympanic membrane perforation and discharge, 43% fever, and 43% vertigo. In pure‐tone audiometry, there was usually a marked mixed hearing loss at presentation. There was a significant recovery in both air and bone conduction thresholds; the pure tone average improvement from presentation was 32.3 ± 14.8 dB. Rapid strep tests (RST) proved to be more sensitive than bacterial culture in identifying GAS as a cause of AOM/AM. Conclusion GAS AOM/AM has a rapid onset. Hearing loss usually includes a sensorineural component, which is usually reversible with adequate treatment. RST seems to be useful in detecting GAS from middle ear discharge. Level of Evidence 4.

Published in Laryngoscope Investigative Otolaryngology

ISSN: 2378-8038 (Online)
Publisher: Wiley
Country of publisher: United States
LCC subjects: Medicine: Otorhinolaryngology; Medicine: Surgery
Website: https://onlinelibrary.wiley.com/journal/23788038

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