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Complications of Acute Streptococcal Otitis Media: A Resurgence

Severe invasive infections caused by group A streptococcus (GAS) have been reported with increasing frequency since 1985. This recent resurgence of aggressive GAS infections recalls an entity now rarely seen in otolaryngology, acute necrotizing otitis media (ANOM). We report two cases of acute otitis media (AOM) due to GAS resulting in life-threatening intratemporal and extratemporal complications. Both patients were treated with oral antibiotics for AOM. A lateral semicircular canal fistula and epidural abscess subsequently developed in our first patient; acute streptococcal meningitis developed in our second patient. In both cases, mastoidectomy and drainage were performed, and intravenous antibiotics were administered, with resolution of infection. The bacteriology, pathophysiology, and appropriate treatment of AOM, ANOM, and severe invasive GAS infections will be reviewed.