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Acute mastoiditis in infancy: the Soroka experience: 1990-2000
1Departments of Otolaryngology, Head and Neck Surgery, Soroka University Medical Center, Ben Gurion University of the Negev, BeerSheva, Box 151, 84101 Israel.
International Journal of Pediatric Otorhinolaryngology
|October 19, 2004
Summary
Acute mastoiditis (AM) is increasingly affecting infants, often following their first ear infection without prior antibiotics. Infants present with more severe symptoms, and Streptococcus pneumoniae remains a key pathogen, alongside a notable rise in Streptococcus pyogenes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Acute mastoiditis (AM) is a serious complication of acute otitis media (AOM).
- While historically rare in infants, recent literature indicates an increasing incidence of AM in this age group.
- This study investigates trends and characteristics of AM in infants.
Purpose of the Study:
- To analyze the incidence, clinical presentation, and microbiological findings of acute mastoiditis in infants.
- To compare infant AM cases with older patients.
- To identify trends in pathogens and treatment outcomes.
Main Methods:
- Retrospective review of 128 AM episodes from 1990-2002, with a focus on 26 episodes in 24 infants.
- Clinical data collection including presenting signs, prior AOM history, and treatment.
- Microbiological analysis of middle ear fluid cultures and imaging (CT scans).
Main Results:
- A significant increase in infant AM incidence was observed (P = 0.01).
- Common symptoms included post-auricular swelling and fever (77% each).
- Streptococcus pneumoniae was the most frequent pathogen (58%), followed by Streptococcus pyogenes (23%).
- CT scans revealed bone destruction in 14 patients; 3 infants had subperiosteal abscesses and 3 had lateral sinus thrombosis.
- Ten infants required mastoid surgery due to lack of response to antibiotics.
Conclusions:
- Infant AM incidence has significantly increased, though the cause is unclear.
- AM in infants often follows initial AOM without prior antibiotic treatment.
- Infants exhibit more severe clinical signs and symptoms compared to older patients.
- Streptococcus pneumoniae is the primary pathogen, with a higher prevalence of Streptococcus pyogenes than typically seen in AOM.