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Acute mastoiditis in children: review of the current status
J Spratley1, H Silveira, I Alvarez
1Division of Pediatric Otorhinolaryngology, Department of Otorhinolaryngology, Hospital de S. João, University of Porto Medical School, 4202-451, Porto, Portugal. j.spratley@mail.telepac.pt
Insights
Pediatric acute mastoiditis, a complication of otitis media, may be increasing. Early diagnosis and management are crucial to prevent severe outcomes in children.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
Background:
- Acute mastoiditis is a common intratemporal complication of otitis media.
- Management remains challenging due to potential serious consequences.
Purpose of the Study:
- Evaluate recent pediatric acute mastoiditis experience.
- Determine if incidence is changing over time.
Main Methods:
- Retrospective review of pediatric acute mastoiditis cases (July 1993 - June 1998).
- Diagnostic criteria included postauricular swelling, erythema, auricular protrusion, and otitis media evidence.
Main Results:
- 43 patients studied; 40% were infants. Incidence increased in recent years.
- 56% received prior antibiotics. 26/43 recovered with antibiotics and myringotomy; others needed surgery.
- Streptococcus pneumoniae and Streptococcus pyogenes were common pathogens. Complications occurred in 13.9%.
Conclusions:
- Pediatric acute mastoiditis remains a dangerous infection despite antibiotics.
- The incidence may be increasing. Early diagnosis is vital for management and prevention of complications.
Background:
acute mastoiditis is the most common intratemporal complication of otitis media. Its management is still a challenge due to potentially serious consequences. This study was designed to evaluate the recent experience with pediatric acute mastoiditis at our institution and to determine if the incidence of this entity is changing over time.
Material And Methods:
retrospective review of records of children with acute mastoiditis treated at the hospital of the Medical School at the University of Porto, Portugal, between July 1993 and June 1998. Criteria for the diagnosis of acute mastoiditis were postauricular swelling and erythema, protrusion of the auricle, and evidence of co-existent or recent otitis media.
Results:
43 patients fulfilled the entry criteria. Most were boys (69%). Ages ranged from 8 months to 14 years and 4 months; infants represented 40% of the total. Acute mastoiditis was the first recognized sign of otitis media in 48% of patients. More recent years of the study saw an increase in the number of children referred with acute mastoiditis. Upon admission, 56% were under antibiotic treatment, with an average intake of 5.8 days. All patients were hospitalized; 26 cases recovered after intravenous antibiotics plus myringotomy, and the rest required an additional surgical procedure. The most common organisms recovered from cultures were Streptococcus pneumoniae and Streptococcus pyogenes. In our series, associated complications occurred in 13.9%; facial paralysis in one, and involvement of the central nervous system in five.
Conclusions:
pediatric acute mastoiditis continues to be a potentially dangerous infection in the antibiotic era. The incidence of this complication may be increasing recently in the community studied. Great care is required of clinicians to reach an early diagnosis in order to promote adequate management and prevent inherently severe complications.