array:23 [ "pii" => "S0001651923000638" "issn" => "00016519" "doi" => "10.1016/j.otorri.2023.04.003" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1190" "copyright" => "Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2024;75:17-22" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0001651923000651" "issn" => "00016519" "doi" => "10.1016/j.otorri.2023.04.005" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1192" "copyright" => "Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2024;75:23-30" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ARTÍCULO ORIGINAL</span>" "titulo" => "Variación de la impedancia eléctrica a lo largo de cinco años postimplantación y relación con el umbral de confort máximo (MCL) en adultos portadores de implante coclear" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "23" "paginaFinal" => "30" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Variation of electrical impedance over 5 years post-implantation and relationship with the maximum comfort level (MCL) in adults with cochlear implants" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1227 "Ancho" => 1508 "Tamanyo" => 52311 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlación entre impedancia y MCL (umbral de confort máximo) en electrodos medios en T2. Coeficiente <span class="elsevierStyleItalic">r</span> de correlación de Pearson r = -0,24 y <span class="elsevierStyleItalic">test</span> de nulidad (valor p) p = 0,033.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Clara Espina González, Antonio Morant Ventura, Ignacio Pla Gil, María Aragonés Redó, Tomás Pérez Carbonell, Jaime Marco Algarra" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Clara" "apellidos" => "Espina González" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Morant Ventura" ] 2 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Pla Gil" ] 3 => array:2 [ "nombre" => "María" "apellidos" => "Aragonés Redó" ] 4 => array:2 [ "nombre" => "Tomás" "apellidos" => "Pérez Carbonell" ] 5 => array:2 [ "nombre" => "Jaime" "apellidos" => "Marco Algarra" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173573524000061" "doi" => "10.1016/j.otoeng.2024.01.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573524000061?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651923000651?idApp=UINPBA00004N" "url" => "/00016519/0000007500000001/v1_202401170604/S0001651923000651/v1_202401170604/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0001651923000249" "issn" => "00016519" "doi" => "10.1016/j.otorri.2023.01.002" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1181" "copyright" => "Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2024;75:8-16" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ARTÍCULO ORIGINAL</span>" "titulo" => "Resultados oncológicos del tratamiento de rescate en pacientes con carcinomas de orofaringe tratados con radioterapia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "8" "paginaFinal" => "16" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Oncological results of salvage treatment in patients with oropharynx carcinoma treated with radiotherapy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3065 "Ancho" => 1675 "Tamanyo" => 273983 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Supervivencia específica a partir de la cirugía de rescate en función de la extensión local de la recidiva (A) o del estatus de los márgenes de resección (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Xavier León, Eduard Neumann, Anna Holgado, Rosselin Vásquez, Albert Pujol, Miquel Quer" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Xavier" "apellidos" => "León" ] 1 => array:2 [ "nombre" => "Eduard" "apellidos" => "Neumann" ] 2 => array:2 [ "nombre" => "Anna" "apellidos" => "Holgado" ] 3 => array:2 [ "nombre" => "Rosselin" "apellidos" => "Vásquez" ] 4 => array:2 [ "nombre" => "Albert" "apellidos" => "Pujol" ] 5 => array:2 [ "nombre" => "Miquel" "apellidos" => "Quer" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651923000249?idApp=UINPBA00004N" "url" => "/00016519/0000007500000001/v1_202401170604/S0001651923000249/v1_202401170604/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Acute mastoiditis in cochlear implanted children: A single-centre experience" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "17" "paginaFinal" => "22" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Andrea Ciorba, Virginia Fancello, Beatrice Sacchet, Michela Borin, Nicola Malagutti, Chiara Bianchini, Francesco Stomeo, Stefano Pelucchi" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Andrea" "apellidos" => "Ciorba" ] 1 => array:4 [ "nombre" => "Virginia" "apellidos" => "Fancello" "email" => array:1 [ 0 => "virginia.fancello@unife.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Beatrice" "apellidos" => "Sacchet" ] 3 => array:2 [ "nombre" => "Michela" "apellidos" => "Borin" ] 4 => array:2 [ "nombre" => "Nicola" "apellidos" => "Malagutti" ] 5 => array:2 [ "nombre" => "Chiara" "apellidos" => "Bianchini" ] 6 => array:2 [ "nombre" => "Francesco" "apellidos" => "Stomeo" ] 7 => array:2 [ "nombre" => "Stefano" "apellidos" => "Pelucchi" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La mastoiditis aguda en niños con implante coclear: experiencia de un solo centro" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1111 "Ancho" => 2176 "Tamanyo" => 128430 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Timing of AM episodes (Pt = patient).</p> <p id="spar0001" class="elsevierStyleSimplePara elsevierViewall">AM: Acute mastoiditis; CI: Cochlear implant.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Nowadays, cochlear implants (CIs) are commonly used for the treatment of paediatric patients with profound sensorineural hearing loss, and the proportion of those implanted at a young age, when they are more prone to developing acute otitis media, is also increasing in spite of previous decades.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The reported incidence of otitis media in children with CI ranges between 31–61% before surgery and 28% after surgery,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with acute mastoiditis (AM) being the most common complication.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Acute Mastoiditis (AM), also known as otomastoiditis, is a suppurative infection of the temporal bone mastoid cells. Most children with AM are under the age of two and have a medical history of acute otitis media. At this age, the immune system is still immature, especially in terms of providing a good antibody response against encapsulated bacteria endowed with polysaccharide antigens, such as <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>, the most frequently isolated pathogen in AM (25% of cases).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to reduce infection-related morbidity, as well as the emotional and financial costs of an explant, a prompt diagnosis and appropriate treatment are crucial.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Aim of this paper is to describe the cases of AM occurred among young patients with CI currently in followed up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Retrospective study. Medical records of all paediatric patients with a CI, implanted between January 1st 2002 and December 31st 2022, in follow up since one year at least, were searched aiming to identify those who developed AM. The search was performed at our University Hospital, a tertiary care centre.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Data collected included demographic features, implant type and side, time between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">All children with CI affected by AM were hospitalized and treated with intravenous broad-spectrum antibiotic, according to our hospital protocol (ceftriaxone IV according to body weight).</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our cohort, mastoidectomy and/or mastoidectomy revision were performed in those with clinical/radiologic evidence of subperiosteal abscess.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients were discharged after a clear clinical improvement and normalization of the inflammatory markers (average hospitalization days were 7 +/− 3).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was conducted in compliance with the Helsinki Declaration (2008); the research did not affect patient care in any way, since only patient data were retrieved and reviewed. Moreover, patients and their families gave their consent for the treatment of the medical data at the time of surgery.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 439 paediatric patients (541 ears) treated by CI, and having a minimum of one year follow-up, have been identified, from January 1st 2002 to January 31st 2022.</p><p id="par0060" class="elsevierStylePara elsevierViewall">All subjects had a diagnosis of bilateral profound sensorineural hearing loss. Aetiology of hearing loss was infective in one case (congenital Rubella infection plus primary CMV infection). Two other children presented risk factors for hearing loss, such as hyperbilirubinemia at birth and parental consanguinity. Other relevant comorbidities of the studied group were autism spectrum disorder (ASD) (two children), in one case associated to primary combined immunodeficiency (CID) (see also <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">AM affected six (1.3%) children (4 females and 2 males), with 1.1% involvement of the overall implanted ears. In total, 9 episodes (2.05 %) were recorded, as three patients reported two infections. Five children were regularly vaccinated according to their age schedule, therefore including vaccination against <span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">Haemophilus influenzae</span>.</p><p id="par0070" class="elsevierStylePara elsevierViewall">One child resulted not vaccinated against <span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">H. influenzae</span> (see also <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">One child only had a right CI, which was involved by the infection. Five infants had bilateral CI; three were implanted simultaneously and two sequentially (at 6 months and 90 months on average after the first CI). Five had a Cochlear CI and one an Advance Bionics CI.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The surgery was uncomplicated in all cases and no abnormal findings were reported in any case.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Patients mean age at bilateral, or first implantation, was 25 months (range 15–48 months), while the mean age at the first mastoiditis was 38.8 months (range 18–74 months); the time interval between surgery and mastoiditis was 13.8 months (range 3–30 months). Mastoiditis developed on the side of the first implant in both cases of sequential CI (see also <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The second episode of AM occurred in the same ear of the first episode, at an average age of 66 months (range 52–83 months), 32 months from surgery (range 21–40 months), and 11.3 months from the first episode (range 9–15 months) (see also <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0095" class="elsevierStylePara elsevierViewall">The child with unilateral CI experienced two episodes of mastoiditis, both involving the implanted ear.</p><p id="par0100" class="elsevierStylePara elsevierViewall">There was no AM in the immediate postoperative period, with the earliest occurring 3 and 4 months after CI surgery, respectively. Moreover, one patient experienced two episodes of acute otitis media in the month prior to the onset of AM.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The culture examination, performed in 4 cases during surgery, yielded a negative result in 2. <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> was found in one sample, possibly due to contamination. Another patient tested positive for <span class="elsevierStyleItalic">S. pneumoniae</span>, a pathogen that is frequently responsible for otitis media in paediatric patients.</p><p id="par0110" class="elsevierStylePara elsevierViewall">C-Reactive Protein (CRP) levels were elevated in 5 children (average value 6.14 mg/dl, range 3.69–10.34 mg/dl, normal values < 0.5 mg/dl), while the patient with CID-type immune-deficiency had a CRP level of 0.47 mg/dl (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Both the first and second episodes of AM were treated by empiric intravenous antibiotics at the time of admission.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In height cases, patients were treated at our Hospital while in one case the patient was treated abroad by surgery. Ceftriaxone was administrated in all cases for 6 days (range of 4–9 days) and steroids were administrated only in 3 cases.</p><p id="par0125" class="elsevierStylePara elsevierViewall">During the first AM episode, two of six patients were successfully treated by intravenous antibiotic therapy with a complete clinical resolution, and no surgery was necessary. Mastoidectomy, under general anaesthesia, was performed in four cases with periosteal abscesses.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In children affected by a second episode of AM, intravenous antibiotic therapy was pivotal in two cases, while surgery was required in one case.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In all the reported events, medical and/or surgical treatment allowed all patients to preserve CI functionality.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In case of surgery, we did not observe damage to the electrode in any case; none of the children developed complications such as facial nerve palsy, meningitis, or septicaemia, and there were no intracranial complications.</p><p id="par0145" class="elsevierStylePara elsevierViewall">After discharge, antibiotic therapy was administered, per os, at home, for an additional week, on average.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The mean follow-up period of CI children with AM is 6 years and 2 months (range 3 and 3 months to 13 years and 2 months).</p><p id="par0155" class="elsevierStylePara elsevierViewall">Following the AM episode, 2 patients (33%), reported recurrent episodes of uncomplicated acute otitis media.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">Early treatment of bilateral profound sensorineural hearing loss with CI has currently become a standard practice, resulting in an increased rate of children implanted at a younger age, when most prone to AM episodes. AM management in children with CI can be complex, in relation to the social, emotional, and its economic implications. In these young patients, the correct and constant CI functioning is essential for language development and learning.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">In our experience, AM resulted having an incidence of 1.3%, over a 20-years period, in all CI children; this data is consistent with the current literature rates of 1–4.7%, while the overall annual incidence of AM in children aged 0–14 is 1.2–6.1/100.000.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Our findings are similar to other available experiences. Kempf et al. (2000) reported on 366 children undergoing CI surgery<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">9</span></a>; of these, five were affected by AM, and were all surgically treated.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In another study of 234 children that received a CI between 1993 and 2003, 11 developed AM in the implanted ear; of these, three had a subperiosteal abscess surgically managed. The remaining cases were successfully treated with intravenous ceftriaxone. The implant has been preserved in all cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Lin analyzed 186 paediatric patients with CI for a follow-up period ranging from 1 to 15 years. Only one of these infants developed AM, treated by surgery and by two weeks of intravenous antibiotic treatment.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">10</span></a> A systematic review performed in 2014 by Zawawi et al. highlighted the importance of early, aggressive pharmacological and, if necessary, surgical therapy for the preservation of the implant with overall favourable results.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">11</span></a> To avoid electrode contamination, the preferred treatment did not include a myringotomy with ventilation tube in the presented series, even if in the literature there is a wide practice variation for grommets management in CI patients.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">12</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Infection, especially in the immediate post-operative period, can also be due to surgical wound dieresis; as already reported, in this case, a mastoidectomy with CI removal is indicated.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">13</span></a> However, we did not register this type of event in the reported series.</p><p id="par0180" class="elsevierStylePara elsevierViewall">When possible, identify individual, familiar and environmental risk factors for the development of AM is important. Thus, communication deficits, which are common in children with autism spectrum disorders (ASD), can delay the diagnosis of acute otitis media and thus contribute to the development of a more severe infection. A retrospective study, performed among healthy children and those affected by ASD, showed that the former reported an increased rate of acute otitis media, otitis media with effusion and otorrhea. Also, the risk of developing AM and undergoing mastoidectomy was also more than doubled in those affected by ASD.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">14</span></a> ASD children are frequently non-cooperative when having their ears examined, which makes it much more difficult to detect infections. Aggressiveness and self-harm, associated to communication deficits can mask, delay and complicate diagnoses such as acute otitis media and AM in this group.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">15</span></a> In our court of patients, two AM cases were also affected by ASD. In one case the early AM diagnosis allowed to establish a prompt intravenous antibiotic therapy, and also a prompt resolution. In the second case, with a history of recurrent otitis media and of primary immune deficiency type CID (combined immunodeficiency), there were two AM episodes. Primary immunodeficiencies (PIDs)<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">16</span></a> are a heterogeneous group of over 180 disorders, which are classified according to the component of the immune system affected and include the combined immunodeficiency (CID) of T and B lymphocytes. The increased susceptibility to infections is a feature shared by all PIDs. This immune weakness may have increased the child’s susceptibility to recurrent otitis and AM, also causing a rapid progression of the infection, which also required surgical in both cases (see also <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S. pneumoniae</span> is considered the predominant pathogen in children with AM, particularly under 2 years of age, and it has also been identified in one culture test of the present series. <span class="elsevierStyleItalic">Streptococcus pyogenes</span>, <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">H. influenzae</span> are also responsible of AM.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Though, the role of <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> is still controversial; some authors consider it as one of the predominant pathogens, while others consider it as a contaminant.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">17</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Preventing recurring episodes of acute otitis media, particularly in CI children, is crucial in order to reduce infective events and therefore AM episodes. Pneumococcal vaccination, as well as vaccination against <span class="elsevierStyleItalic">H. influenzae</span> type B, which is also responsible for AM, can be considered important preventive means. Among our patients, 5/6 had received the anti-pneumococcal and anti- <span class="elsevierStyleItalic">H. influenzae</span> vaccination before they underwent CI, while 1/6 is still not vaccinated, and showed a positive ear swab for <span class="elsevierStyleItalic">S. pneumoniae</span> during the AM episode.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">Acute mastoiditis in children with CI is relatively uncommon. In our experience there was no necessary of CI explant in any case either treated medically or surgically.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Also, according to the literature, early parenteral antibiotic treatment is mandatory. Surgery may be required to resolve the infection quickly and completely, as well as to reduce the risk of contamination or compromise of the CI, particularly in case of periosteal abscesses. Furthermore, in the future, it would be also interesting to assess whether a widespread use of specific vaccines could limit the incidence of otitis media complications.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">Authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2075184" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1770777" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2075183" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1770776" "titulo" => "Parablas clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-12-03" "fechaAceptado" => "2023-04-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1770777" "palabras" => array:3 [ 0 => "Acute mastoiditis" 1 => "Cochlear implant" 2 => "Deafness" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Parablas clave" "identificador" => "xpalclavsec1770776" "palabras" => array:3 [ 0 => "Mastoiditis aguda" 1 => "Implante coclear" 2 => "Sordera" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3–30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1–4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La mastoiditis aguda (MA) es la complicación más común de la otitis media aguda y afecta principalmente los niños menores de dos años; los datos actuales sobre su prevalencia en pacientes pediátricos con implante coclear (IC) son aún escasos. El manejo adecuado de la MA en los niños con IC es crucial para evitar las implicaciones (económicas y emocionales) de un explante. El objetivo de este articulo es describir los casos de MA ocurridos en pacientes jóvenes con IC en seguimiento en nuestro servicio, también para evaluar su prevalencia, posibles factores predisponentes, curso clínico y estrategias terapéuticas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo. Se realizaron búsquedas en las historias clínicas de todos los pacientes pediátricos con IC, que tenían al menos un año de seguimiento, con el objetivo de identificar a aquellos que desarrollaron la MA, desde el 1 de enero de 2002 hasta el 31 de enero de 2022.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se recopilaron y analizaron los siguientes datos: características demográficas, tipo de implante y lado, intervalo entre cirugia del IC y MA, tratamiento, exámenes de laboratorio, evolución clínica, antecedentes vacunales, enfermedades asociadas.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La MA fue desarrollada por seis (1,3%) de los 439 niños con IC (541 oídos implantados).</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">En total se registraron 9 episodios (2,05 %), ya que tres pacientes reportaron dos infecciones consecutivas. El intervalo de tiempo promedio entre la cirugía del IC y el primer o único diagnóstico de la MA fue de 13,8 meses (rango 3-30 meses). Además, 3/6 de los pacientes tenían antecedentes de otitis media aguda recurrente; 2/6 un trastorno del espectro autista, asociado a una inmunodeficiencia combinada en un caso. Todos los pacientes fueron hospitalizados y tratados de inmediato con terapia antibiótica intravenosa; 4/6 también se sometieron a una mastoidectomía. El IC no fue explantado en ningún caso de esta serie.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Durante un período de 20 años, la tasa de MA en los niños con IC fue del 1,3 %, lo que es consistente con las tasas actuales de la literatura del 1 al 4,7 %. Todos los casos fueron tratados con éxito, preservando la integridad del dispositivo. Según nuestra experiencia, la antibioterapia parenteral precoz y, en su caso, el tratamiento quirúrgico fueron adecuados para erradicar la infección.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1111 "Ancho" => 2176 "Tamanyo" => 128430 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Timing of AM episodes (Pt = patient).</p> <p id="spar0001" class="elsevierStyleSimplePara elsevierViewall">AM: Acute mastoiditis; CI: Cochlear implant.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1513 "Ancho" => 1569 "Tamanyo" => 168316 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Possible AM risk factors in the studied cohort of patients.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Relevant medical history \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vaccination \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- ASD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (including <span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">H. influenzae</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- CID \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Recurrent otitis media \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Adenoidectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Recurrent skin infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Recurrent bronchiolitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- ASD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (including <span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">H. influenzae</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Hyperbilirubinemia at birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Congenital Rubella plus CMV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Admission for upper respiratory tract infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Not relevant medical history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (including <span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">H. influenzae</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Two episodes of bilateral acute otitis media one month before the AM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (including <span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">H. influenzae</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Admission for purulent acute otitis media (culture positive for <span class="elsevierStyleItalic">S. pneumoniae</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (including <span class="elsevierStyleItalic">S. pneumoniae</span> and <span class="elsevierStyleItalic">H. influenzae</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3436610.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Relevant medical history of CI children affected by AM.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CRP level (mg/dl) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Culture test \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Subperiosteal abscess \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not available<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not available<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not available<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2nd admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0,47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8,85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Streptococcus pneumoniae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2nd admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus epidermidis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not available \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2nd admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3436611.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Treated abroad.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical-laboratory findings during AM episodes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cochlear implants in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.B. Waltzman" 1 => "W.H. Shapiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/108471389900400402" "Revista" => array:7 [ "tituloSerie" => "Trends Amplif" "fecha" => "1999" "volumen" => "4" "numero" => "4" "paginaInicial" => "143" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25425894" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The management of acute mastoiditis in children with cochlear implants: saving the device" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.A. Osborn" 1 => "S.L. Cushing" 2 => "K.A. Gordon" 3 => "A.L. James" 4 => "B.C. Papsin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1179/1754762813Y.0000000049" "Revista" => array:7 [ "tituloSerie" => "Cochlear Implants Int" "fecha" => "2013" "volumen" => "14" "numero" => "November (5)" "paginaInicial" => "252" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23998418" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute mastoiditis in children with a cochlear implant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Raveh" 1 => "D. Ulanovski" 2 => "J. Attias" 3 => "Y. Shkedy" 4 => "M. Sokolov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2015.12.016" "Revista" => array:7 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2016" "volumen" => "81" "numero" => "February" "paginaInicial" => "80" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26810295" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical and medical complications following cochlear implantation: comparison of two surgical approaches" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Migirov" 1 => "A. Yakirevitch" 2 => "J. Kronenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000091817" "Revista" => array:6 [ "tituloSerie" => "ORL J Otorhinolaryngol Relat Spec" "fecha" => "2006" "volumen" => "68" "numero" => "4" "paginaInicial" => "213" "paginaFinal" => "219" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute mastoiditis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Cassano" 1 => "G. Ciprandi" 2 => "D. Passali" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.23750/abm.v91i1-S.9259" "Revista" => array:7 [ "tituloSerie" => "Acta Biomed" "fecha" => "2020" "volumen" => "91" "numero" => "February (1-S)" "paginaInicial" => "54" "paginaFinal" => "59" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32073562" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute mastoiditis in an Italian pediatric tertiary medical center: a 15-year retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Balsamo" 1 => "C. Biagi" 2 => "M. Mancini" 3 => "I. Corsini" 4 => "R. Bergamaschi" 5 => "M. Lanari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13052-018-0511-z" "Revista" => array:6 [ "tituloSerie" => "Ital J Pediatr" "fecha" => "2018" "volumen" => "44" "numero" => "June (1)" "paginaInicial" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29914542" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute Otitis Media and Acute Coalescent Mastoiditis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Mansour" 1 => "J. Magnan" 2 => "K. Nicolas" 3 => "H. Haidar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/978-3-319-72962-6_2" "Revista" => array:5 [ "tituloSerie" => "Middle Ear Diseases" "fecha" => "2018" "volumen" => "28" "paginaInicial" => "85" "paginaFinal" => "113" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive functioning in deaf children using cochlear implants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Almomani" 1 => "M.O. Al-Momani" 2 => "S. Garadat" 3 => "S. Alqudah" 4 => "M. Kassab" 5 => "S. Hamadneh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12887-021-02534-1" "Revista" => array:6 [ "tituloSerie" => "BMC Pediatr" "fecha" => "2021" "volumen" => "21" "numero" => "February (1)" "paginaInicial" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33568086" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0031" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mastoiditis and acute otitis media in children with cochlear implants: recommendations for medical management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.G. Kempf" 1 => "T. Stöver" 2 => "T. Lenarz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0003489400109s1210" "Revista" => array:6 [ "tituloSerie" => "Ann Otol Rhinol Laryngol Suppl" "fecha" => "2000" "volumen" => "185" "paginaInicial" => "25" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11140991" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0045" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of otitis media-related diseases in children with a cochlear implant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Y.S. Lin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00016480801901741" "Revista" => array:7 [ "tituloSerie" => "Acta Otolaryngol" "fecha" => "2009" "volumen" => "129" "numero" => "3" "paginaInicial" => "254" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19132635" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0050" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute mastoiditis in children with cochlear implants: is explanation required?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Zawawi" 1 => "I. Cardona" 2 => "O.V. Akinpelu" 3 => "S.J. Daniel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0194599814536686" "Revista" => array:7 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2014" "volumen" => "151" "numero" => "September (3)" "paginaInicial" => "394" "paginaFinal" => "398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24898070" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0055" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation tubes and cochlear implants: what do we do?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.J. Kennedy" 1 => "C. Shelton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.mao.0000169792.30330.18" "Revista" => array:7 [ "tituloSerie" => "Otol Neurotol" "fecha" => "2005" "volumen" => "26" "numero" => "May (3)" "paginaInicial" => "438" "paginaFinal" => "441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15891646" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0060" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complication rate of minimally invasive cochlear implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.D. Stratigouleas" 1 => "B.P. Perry" 2 => "S.M. King" 3 => "C.A. Syms" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Otology Head Neck Surgery" "fecha" => "2006" "volumen" => "135" "numero" => "3" "paginaInicial" => "383" "paginaFinal" => "386" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0065" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Otitis media and related complications among children with autism spectrum disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Adams" 1 => "A. Susi" 2 => "C.R. Erdie-Lalena" 3 => "G. Gorman" 4 => "E. Hisle-Gorman" 5 => "M. Rajnik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10803-015-2689-x" "Revista" => array:7 [ "tituloSerie" => "J Autism Dev Disord" "fecha" => "2016" "volumen" => "46" "numero" => "May (5)" "paginaInicial" => "1636" "paginaFinal" => "1642" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26739355" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0070" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of children with autism spectrum disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.M. Myers" 1 => "C.P. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2007-2362" "Revista" => array:7 [ "tituloSerie" => "Pediatrics" "fecha" => "2007" "volumen" => "120" "numero" => "5" "paginaInicial" => "1162" "paginaFinal" => "1182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17967921" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0075" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Should newborns be screened for immunodeficiency? Lessons learned from infants with recurrent otitis media" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Y. Yilmaz-Demirdag" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11882-011-0221-8" "Revista" => array:7 [ "tituloSerie" => "Curr Allergy Asthma Rep" "fecha" => "2011" "volumen" => "11" "numero" => "6" "paginaInicial" => "491" "paginaFinal" => "498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21901305" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0080" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hansen’s acute mastoiditis in children: a 10 years retrospective and validated multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Anthnsen" 1 => "K. Hostmark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/INF.0b013e31828abd13" "Revista" => array:7 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "2013" "volumen" => "32" "numero" => "5" "paginaInicial" => "436" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23380667" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00016519/0000007500000001/v1_202401170604/S0001651923000638/v1_202401170604/en/main.assets" "Apartado" => array:4 [ "identificador" => "5852" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Artículos originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00016519/0000007500000001/v1_202401170604/S0001651923000638/v1_202401170604/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651923000638?idApp=UINPBA00004N" ]
Información de la revista
Compartir
Descargar PDF
Más opciones de artículo
Original article
Acute mastoiditis in cochlear implanted children: A single-centre experience
La mastoiditis aguda en niños con implante coclear: experiencia de un solo centro
Andrea Ciorba, Virginia Fancello
, Beatrice Sacchet, Michela Borin, Nicola Malagutti, Chiara Bianchini, Francesco Stomeo, Stefano Pelucchi
Autor para correspondencia
ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy