4. Discussion
In the present study, we characterized the clinical course and the microbiologic findings of CAM in children. The study’s retrospective nature raises several possible limitations: 1. some clinical and laboratory data from the patient charts were incomplete or missing. 2. Several otolaryngologists and pediatricians treated the patients. Therefore, decisions related to the need for repeated imaging and the need for revision surgery might not have been uniform.
Most AM cases are managed conservatively, with myringotomy, intravenous antibiotics, and a careful follow-up, until resolution of the disease. Some patients may develop complications, either extra or intra-cranial; these cases are defined as CAM and treated surgically, while continuing systemic antibiotic treatment. The surgical management may differ between various medical centers and include myringotomy, placement of VT, and incision plus drainage of SPA, with or without cortical mastoidectomy. Patients presenting intracranial complications are most likely to undergo a mastoidectomy (8). In a series of 570 children published recently from Israel, reported a significant increase in AM cases that had an indication for surgical intervention during the years 2008-2017 (11% vs. 19% between the first and the last five years of the study respectively, P = 0.008) and described higher fever, leukocytes counts and CRP values in CAM compared to simple AM(9). A study from the UK (10), described 30 patients (aged 2 months to 15 years) with intracranial complications of AM. The most frequent complication was SST (73%), followed by a cerebral abscess (40%) and SPA (33%). Three (10%) patients had long-term sequelae (one developed secondary intracranial hypertension, the second a CSF leak that required placement of a ventriculo-peritoneal shunt, and the third with diplopia and residual mild visual obscuration); only one (3%) patient required additional surgical treatment. In a recent study from the United States, addressing the safety and post-operative adverse events encountered during the management of AM (11), 113 patients with AM requiring surgical treatment were analyzed. Four (3.1%) patients required readmission and 9 (6.9%) required unplanned subsequent operative procedures.