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[Acute mastoiditis in children: clinical and bacteriological study of 17 cases]
S Morinière1, P Lanotte, Z Celebi
1Unité d'ORL pédiatrique et de chirurgie cervico-faciale, Centre de pédiatrie, Gatien de Clocheville, CHU, Tours.
Objective:
Acute mastoiditis (AM) represents the most frequent complication of acute otitis media (AOM) in children. In the literature, its incidence is stable but with an impressive increase in pneumococci with reduced sensitivity to penicillin (PRSP). The aim of this study was to assess the incidence of AM in the area of Tours and the prevalence of PRSP.
Method:
This was a retrospective study of children admitted to the regional paediatric centre in the Tours area, between January 1994 and May 2001. The coded AM files were analysed, excluding all the sub-acute forms or those complicating a cholesteatoma. The criteria studied concerned the clinical signs on admission, the imaging data and the bacteriological samples and the results of treatment.
Results:
Seventeen children (8 boys, 9 girls) were admitted for an AM during the study period. Their mean age was of 3.2 years (range: 6 months to 13 years). In 24% of cases, the mastoiditis existed on admission and in 59% of cases it complicated an AMO already treated with antibiotics. In 3 cases (18%), the AM was complicated on admission with peripheral facial paralysis in one case and thrombosis of the lateral sinus in 2 cases. The germ responsible was identified in 14 cases (82%) with a predominance of pneumococci (11 cases). Eight were PRSP-type. Scan of the pars petrosa identified a subperiosteal abscess in 13 cases. Fourteen mastoidectomies were performed and the mean duration of antibiotic therapy was of 23 days. The outcome was always good.
Conclusion:
Over the past 7 years, the incidence of AM has been estimated at 1.2/100 000 children aged under 15 per year. The prevalence of PRSP is high but does not change the principles or the results of the treatment of AM.
Insights
Acute mastoiditis (AM) in children is a common complication of acute otitis media (AOM). Penicillin-resistant Streptococcus pneumoniae (PRSP) is prevalent but does not alter AM treatment outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Bacteriology
Context:
- Acute mastoiditis (AM) is the most frequent complication of acute otitis media (AOM) in children.
- Literature indicates a stable incidence of AM but a rise in penicillin-resistant Streptococcus pneumoniae (PRSP).
Purpose:
- To assess the incidence of AM in the Tours region.
- To determine the prevalence of PRSP in pediatric AM cases.
Summary:
- A retrospective study analyzed 17 pediatric AM cases (1994-2001).
- Pneumococci were the predominant pathogen (79%), with 8 cases of PRSP identified.
- Subperiosteal abscesses were common (76%), and all patients achieved good outcomes despite PRSP prevalence.
Impact:
- The estimated incidence of AM is 1.2 per 100,000 children/year.
- High PRSP prevalence does not impede effective AM treatment or alter outcomes.
- Highlights the importance of monitoring antibiotic resistance in pediatric AOM complications.
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