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Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm

Acute otitis media (AOM) is one of the most common ENT diseases in children. In the antibiotic/post-antibiotic era, facial paralysis is a very rare complication of AOM (0.004–0.005%). Despite the rarity of this complication, it should be known by all physicians for proper therapeutic management to a...

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Autores principales: Fichera, Piergabriele, Bruschini, Luca, Berrettini, Stefano, Capobianco, Silvia, Fiacchini, Giacomo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10660501/
https://www.ncbi.nlm.nih.gov/pubmed/37987335
http://dx.doi.org/10.3390/audiolres13060077
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author Fichera, Piergabriele
Bruschini, Luca
Berrettini, Stefano
Capobianco, Silvia
Fiacchini, Giacomo
author_facet Fichera, Piergabriele
Bruschini, Luca
Berrettini, Stefano
Capobianco, Silvia
Fiacchini, Giacomo
author_sort Fichera, Piergabriele
collection PubMed
description Acute otitis media (AOM) is one of the most common ENT diseases in children. In the antibiotic/post-antibiotic era, facial paralysis is a very rare complication of AOM (0.004–0.005%). Despite the rarity of this complication, it should be known by all physicians for proper therapeutic management to avoid serious sequelae. The aim of this review is to provide a management guide based on the current literature. Materials and Methods: Fifteen studies published between 2000 and 2022 were selected, including 120 patients (62 M/58 F) with an average age of 4.96 years old (range = 4 months–16 years; SD: 4.2). The paralysis frequently has a sudden onset and is of a severe grade (medium House–Brackmann (HB) score at onset: 4.68; SD: 0.5); however, it tends to have an almost complete recovery in most patients (88.49% HB 1 at follow-up). Results: Its first-line treatment must be based on the use of antibiotics (beta-lactam antibiotics as penicillins or cephalosporins). Corticosteroids should be used concomitantly for their anti-inflammatory and neuroprotective actions; however, there is no unanimity between authors about their application. Myringotomy, with or without ventilation tube insertion, is indicated in cases where the tympanic membrane is intact. Other kinds of surgery should be performed only in patients who have a worsening of their AOM symptoms or a worsening in HB score even with clinical treatment. Conclusions: The obtained data show that a conservative treatment can be sufficient for complete recovery in most patients, and it is preferred as the first-line therapy. Mastoidectomy should be performed only in patients with acute mastoiditis and without symptom improvement after a conservative approach. There are insufficient data in the current literature to provide clear selection criteria for patients who need to undergo mastoidectomy with facial nerve decompression. The choice of this treatment is based on an individual center expertise. Further studies are needed to clarify the role of corticosteroids and the role of facial nerve decompression in this clinical scenario.
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spelling pubmed-106605012023-11-08 Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm Fichera, Piergabriele Bruschini, Luca Berrettini, Stefano Capobianco, Silvia Fiacchini, Giacomo Audiol Res Systematic Review Acute otitis media (AOM) is one of the most common ENT diseases in children. In the antibiotic/post-antibiotic era, facial paralysis is a very rare complication of AOM (0.004–0.005%). Despite the rarity of this complication, it should be known by all physicians for proper therapeutic management to avoid serious sequelae. The aim of this review is to provide a management guide based on the current literature. Materials and Methods: Fifteen studies published between 2000 and 2022 were selected, including 120 patients (62 M/58 F) with an average age of 4.96 years old (range = 4 months–16 years; SD: 4.2). The paralysis frequently has a sudden onset and is of a severe grade (medium House–Brackmann (HB) score at onset: 4.68; SD: 0.5); however, it tends to have an almost complete recovery in most patients (88.49% HB 1 at follow-up). Results: Its first-line treatment must be based on the use of antibiotics (beta-lactam antibiotics as penicillins or cephalosporins). Corticosteroids should be used concomitantly for their anti-inflammatory and neuroprotective actions; however, there is no unanimity between authors about their application. Myringotomy, with or without ventilation tube insertion, is indicated in cases where the tympanic membrane is intact. Other kinds of surgery should be performed only in patients who have a worsening of their AOM symptoms or a worsening in HB score even with clinical treatment. Conclusions: The obtained data show that a conservative treatment can be sufficient for complete recovery in most patients, and it is preferred as the first-line therapy. Mastoidectomy should be performed only in patients with acute mastoiditis and without symptom improvement after a conservative approach. There are insufficient data in the current literature to provide clear selection criteria for patients who need to undergo mastoidectomy with facial nerve decompression. The choice of this treatment is based on an individual center expertise. Further studies are needed to clarify the role of corticosteroids and the role of facial nerve decompression in this clinical scenario. MDPI 2023-11-08 /pmc/articles/PMC10660501/ /pubmed/37987335 http://dx.doi.org/10.3390/audiolres13060077 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Fichera, Piergabriele
Bruschini, Luca
Berrettini, Stefano
Capobianco, Silvia
Fiacchini, Giacomo
Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm
title Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm
title_full Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm
title_fullStr Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm
title_full_unstemmed Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm
title_short Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm
title_sort acute otitis media and facial paralysis in children: a systemic review and proposal of an operative algorithm
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10660501/
https://www.ncbi.nlm.nih.gov/pubmed/37987335
http://dx.doi.org/10.3390/audiolres13060077
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