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Intracranial complications of acute mastoiditis
C Go1, J M Bernstein, A L de Jong
1The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, One Baylor Plaza, SM 1727, Houston, TX, USA. cgo@bcm.tmc.edu
International Journal of Pediatric Otorhinolaryngology
|April 18, 2000
Summary
Oral antibiotic use did not increase otitic intracranial complications in children with acute mastoiditis. Persistent ear pain or discharge with neurological symptoms warrants further investigation for complications.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Neurosurgery
Background:
- Oral antibiotic use is common for acute otitis media and acute mastoiditis.
- The impact of oral antibiotics on the incidence and microbiology of otitic intracranial complications remains unclear.
Purpose of the Study:
- To determine the incidence of intracranial complications in children with acute mastoiditis.
- To identify risk factors associated with these complications.
- To characterize the causative pathogens.
Main Methods:
- Retrospective study of pediatric patients diagnosed with acute mastoiditis between July 1986 and June 1998.
- Analysis of patient demographics, clinical presentation, treatment, and outcomes.
- Review of microbiological data and imaging studies (contrast-enhanced CT).
Main Results:
- Eight out of 118 children (6.8%) developed intracranial complications, including sigmoid sinus thrombosis, epidural abscess, and meningitis.
- Seven of the eight patients had received oral antibiotics for an average of 10 days prior to admission.
- Commonly isolated organisms included Streptococcus pneumoniae and Proteus mirabilis; multi-drug resistant organisms were rare.
Conclusions:
- The incidence of otitic intracranial complications did not appear to increase.
- Persistent otalgia or otorrhea with neurological symptoms during oral antibiotic treatment are critical indicators of potential complications.
- Negative intraoperative cultures are frequent, and multi-drug resistant organisms are uncommon in these cases.