[Diagnosis and treatment of intracranial and extracranial complications of acute suppurative otitis media in children].

Objective:To summarize the different diagnostic and treatment approaches and prognostic characteristics of intracranial and extracranial complications of acute suppurative otitis media in children, and to provide a reference for clinical diagnosis. Methods:Data from 36 children with acute otitis media complicated by intracranial and extracranial complications, admitted to our department from January 2015 to November 2023, were reviewed. One patient with purulent meningitis died of acute cerebral hernia in the PICU; the others received surgery based on their condition, along with antibiotics and glucocorticoids as indicated. All were followed for ≥6 months. Age, medical history, treatment regimen, and outcomes were analyzed. Results:Among the 36 children, 18 with postauricular subperiosteal abscess and 2 with temporal abscess were all cured. Tympanostomy tubes were removed at 3-6 months without perforation sequelae. Four cases of perisigmoid sinus abscess all recovered. Three cases of sigmoid sinus thrombophlebitis were cured; among them, 1 showed partial recanalization of the sigmoid sinus during follow-up, while the other 2 did not achieve recanalization. Among the 3 cases of peripheral facial palsy, 2 recovered completely, and 1 recovered to grade II facial nerve function during follow-up. Of the 2 cases of sensorineural hearing loss, 1 underwent cochlear implantation and 1 received conservative treatment. One case of subdural abscess recovered, and 1 case of subdural abscess complicated with cerebellar abscess also recovered. Conclusion:Complications of acute otitis media in children are diverse and present with various manifestations. During diagnosis and treatment, emphasis should be placed on imaging examinations to detect lesions in a timely manner. Adequate and full-course antibiotic therapy should be administered; when necessary, restricted antibiotics such as linezolid may be selected based on drug susceptibility testing. Depending on the patient's general condition, timely mastoidectomy should be performed when complications arise, with a strategy of atticotomy, posterior tympanotomy, and tympanostomy tube placement to reestablish mastoid and tympanic cavity drainage. Among the surgical approaches, posterior tympanotomy helps preserve the ossicular chain while maintaining drainage. In addition, collaborative diagnosis and treatment involving neurology and neurosurgery should be emphasized.