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[Acute Mastoiditis in Children: a series of 38 Cases]
Insights
Acute mastoiditis remains a serious complication of middle ear infections, with diagnosis sometimes delayed by atypical presentations or antibiotic resistance. Early suspicion of cholesteatoma is crucial, especially with Gram-negative bacteria.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Microbiology
Context:
- Acute mastoiditis is a significant complication of middle ear infections in children.
- Retrospective review of 38 pediatric cases from 1988-2001.
- Understanding diagnostic challenges and treatment outcomes.
Purpose:
- To analyze clinical, radiological, and therapeutic findings in pediatric acute mastoiditis.
- To identify common pathogens and complications.
- To evaluate treatment strategies and outcomes.
Summary:
- Diagnosis of acute mastoiditis was often based on retroauricular signs but delayed in 42% of cases due to inappropriate antibiotics or atypical presentations.
- Strengths of the study include retrospective analysis of clinical, radiological, and therapeutic findings in 38 children.
- Common pathogen was Streptococcus pneumoniae (57%), with 13% penicillin-resistant strains. Lateral sinus thrombophlebitis occurred in 8% of cases. Cholesteatoma was identified in 4 children, often with Gram-negative infections.
Impact:
- Highlights the persistent challenge of acute mastoiditis despite antibiotic advancements.
- Emphasizes the need for prompt diagnosis and appropriate treatment to prevent complications.
- Suggests increased suspicion for cholesteatoma in cases involving Gram-negative bacteria or older children.
Objective:
We reviewed retrospectively the clinical, radiological and therapeutic findings in 38 infants and children with acute mastoiditis.
Material And Methods:
From 1988 to 2001, 38 children (mean age 36 months) were treated for acute mastoiditis and periostitis or retroauricular abscess.
Results:
Diagnosis was usually made on the basis of typical retroauricular signs (60% of the cases), but was sometimes delayed owing to inappropriate antibiotics in 16 cases (42%) or atypical presentation in 3 (8%). Twenty-four children (70%) had no otolaryngological history. Pneumococci were isolated in most of the cases (n=15, 57%) with 13% having penicillin-resistant pneumococci. Lateral sinus thrombophlebitis was the most frequent complication, observed in 3 children (8%). Mastoiditis revealed congenital or acquired cholesteatoma in 4 children, who were all four infected with Gram-negative bacteria. Intravenous antibiotic therapy was associated with antroatticotomy in 36 children.
Conclusion:
Despite emergence of new antibiotic resistance, the annual rate of mastoiditis has remained unchanged, remaining a serious complication of middle ear acute otitis. Cholesteatoma should be suspected in case of Gram-negative bacteria or in older children.