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Indian Pediatr 2021;58: 897 |
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Pediatric Head and Neck Infections at a
Tertiary Care Center
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P Naina,* Snigdha Elaprolu
Department of ENT, Christian Medical College,
Vellore, Tamil Nadu
Email:
[email protected]
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Recent reports have advocated the success of
conservative treatment over surgery in pediatric head and neck
infections [1-4]. A retrospective review of all children less
than 18 years admitted with head and neck infections was
conducted in our tertiary care center from 2015-2020.
Demographic data, sites of infection, microbiological results,
and treatment outcomes were recorded. Postoperative infections
were excluded from the study. All patients underwent a thorough
clinical assessment for ‘severe symptoms’, which included
stridor, inability to swallow, visual and intracranial symptoms,
and empirical antibiotics was started. In those without severe
symptoms, antibiotics were continued for 48 hours and child
reassessed. Computed tomography (CT) was done to assess the
extent of involvement. Well-formed abscesses in patients with
‘severe symptoms’ or failed medical therapy were surgically
drained. Intraoperative samples were sent for culture, and
antibiotics were changed depending on the sensitivity. Tissue
was sent for Mycobacterium tuberculosis culture, whenever
indicated.
Out of 38 patients admitted, deep neck space
infection (21, 55.2%) were most commonly seen, followed by
facial (13, 34.2%) and orbital (4, 10.5%), which is similar to
previous reports [3,4]. History of recurrent upper respiratory
tract infection was seen in majority of cases. Six of the facial
abscesses were secondary to pre-auricular sinus and otitis
externa, four had septal abscess and three had facial cellulitis.
All orbital infections were secondary to sinusitis. One child
was anemic, none were immunocompromised.
More than half the children (n=21) had
‘severe’ symptoms and majority (68%) required surgical drainage.
Only size of the abscess (>25 mm vs <25 mm) was significantly (P<0.001)
associated with requirement of surgical drainage (Table I).
The other factors such as age, gender, duration of symptoms or
site of abscess were not found to be statistically significant.
The predominant organism isolated was Staphylococcus aureus,
followed by Streptococcus spp. [5] and gram-negative
bacilli [4]. In 11 patients, M. tuberculosis culture was
done, but it was not positive.
Table I Factors Associated With Surgical Intervention in Children With Head and Neck Infection
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Factors |
Medical management
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Surgical management
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(n=12) |
(n=26) |
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Age (y)a
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5.2 ( 3.28) |
5.1 (4.49) |
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Female gender
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7 |
11 |
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Duration of symptoms (d)a
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4.2 (2.3) |
5.4 ( 3.1) |
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Duration of hospital stay (d) a,b,c |
5.5 (2.9) |
6.1 (5.3)
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Site of abscess |
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Deep neck infection |
8 |
13 |
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Facial infection |
3 |
10 |
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Orbital infection
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1 |
3 |
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Size of abscess
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<25 mm |
12 |
11 |
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>25 mmc |
0 |
15 |
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Data presented as no. (%) or amean (SD). bChild who
underwent tracheostomy was an outlier with a hospital
stay of 29 days. cP<0.001. |
One child needed a repeat drainage and one
child had persistent laryngeal edema necessitating an elective
tracheostomy, adding to their morbidity. CT was found to be a
useful modality (with a positive predictive value of 86.6%) in
evaluating abscesses, as also reported previously [5].
To conclude, deep neck space infections
formed the bulk of pediatric head and neck infections and
accounted for high morbidity. Majority of our cases required
surgical drainage, probably as most of our children presented
with severe symptom, which is against the recent trend towards
conservative management [1-4]. Size of the abscess was the sole
significant predictor for surgical drainage; although, it did
not increase the duration of hospital stay.
Ethics clearance: Institutional review
board, CMC, Vellore; No. IRB No. 13020/20 dated June 24, 2020.
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Antibiotic therapy for paediatric deep neck abscesses: A
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Increased incidence of head and neck abscesses in children.
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