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[Acute external mastoiditis in children: report of a series of 48 cases]
M François1, T Van den Abbeele, P Viala
1Service ORL, hôpital Robert-Debré, faculté Xavier-Bichat, 48, boulevard Sérurier, 75019 Paris, France. martine.francois@rdb.ap-hop-paris.fr
Insights
Penicillin-resistant Streptococcus pneumoniae is common in childhood acute mastoiditis, impacting treatment decisions. Clinical examination and CT scans are crucial for differentiating periostitis from mastoid abscess.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Context:
- Acute mastoiditis is a serious complication of acute otitis media in children.
- The rise of antibiotic-resistant bacteria presents challenges in managing pediatric infections.
- Diagnostic imaging plays a vital role in assessing the severity and guiding treatment.
Purpose:
- To investigate the influence of penicillin-resistant pneumococci on childhood acute mastoiditis incidence.
- To evaluate the diagnostic utility of laboratory and imaging studies in acute mastoiditis management.
Summary:
- A retrospective review identified 48 children with acute mastoiditis between 1993 and 2000.
- Streptococcus pneumoniae was the most common pathogen (71% resistant to penicillin).
- Clinical presentation and CT scans differentiated periostitis from mastoid abscess, guiding treatment (medical vs. surgical).
Impact:
- Highlights the prevalence of antibiotic resistance in pediatric mastoiditis.
- Emphasizes the importance of microbiological data and advanced imaging in clinical decision-making.
- Informs treatment strategies for acute mastoiditis in the era of antimicrobial resistance.
Design:
To determine the impact of the emergence of penicillin-resistant strains of pneumococci on the frequency of acute mastoiditis in children, and to assess the importance of laboratory and imaging studies in the treatment of acute mastoiditis.
Method:
Retrospective review of the medical records of children with postauricular swelling and otoscopic signs of acute otitis media from January 1993 through December 2000.
Results:
Forty-eight children aged three months to 14 years (median 17 months) were identified. The number of cases was almost the same from one year to another. All children had bacteriological examinations. The mastoid pus and the otorrhea was sterile in 22 cases. The most frequent pathogen was Streptococcus pneumoniae (17 cases), which was resistant to penicillin in 71% of cases. The initial body temperature, the number of polymorphonuclears and the CRP were not different between the group of 18 children with periostitis, which required medical treatment alone, and the group of 30 children who had a mastoid abscess which required surgery. The difference between periostitis and mastoid abscess was seen on clinical examination and CTscan.