Document Type
Poster
Publication Date
4-13-2023
Abstract
Extracranial and intracranial complications of acute otitis media range from 0.69% to 5% and the mortality rate from intracranial complications can be as high as 8%. We present the case of a 7 year old with morbid obesity and well controlled asthma who presented with severe headache, tactile fevers, chills and neck stiffness. A CT of the neck showed right middle ear cavity and mastoid air cell effusion. Lab work was notable for left shifted leukocytosis and elevated inflammatory markers. Given his well appearance and complete response to ibuprofen, in a shared decision made with parents the lumbar puncture (LP) was deferred by the emergency department but he was admitted on empiric antibiotic management for meningitis. Following admission, the patient was found to have waxing and waning encephalopathy with intermittent and severe headache over the following 12 hrs with reduced hearing to finger rub on his right side. An LP performed on day 2 of antibiotic treatment showed no CSF pleocytosis with a negative Gram stain result. However, an MRI showed intracranial involvement with temporal bone opacification, dural thickening with enhancement and right internal auditory canal enhancement, along with possible septic thrombophlebitis. Further history was offered endorsing experience of right ear fullness which the patient tried to alleviate by inserting a toy wand into his ear canal. This event was followed by fever and the head /neck being held flexed and rotated with right ear down over the next 4 days while the parent applied topical ear drops. At this time the otolaryngologist plans for intratympanic steroids following an audiology evaluation while the patient remains on enoxaparin for 3 months and antimicrobial therapy for at least 2 weeks pending clinical resolution.
Recommended Citation
Grammens, Ryan W.; Marlina Ponce de Leon; Emily Funsten; Veronica Hutchison; and Parvathi Kumar. "Otitis Media with Intracranial Extension; Case Report." (2023). https://digitalrepository.unm.edu/hsc_2023_pediatric_research/24
Comments
Poster presented at Pediatric Research Forum