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Published on: February 29, 2020
Acute mastoiditis in infants
Ivan Baljosevic1, Nikola Mircetic, Vladan Subarevic
1Department of Otorhinolaryngology, Mother and Child Health Institute, Radoja Dakica 6-8, 11070, Novi Beograd, Serbia and Montenegro. balos@net.yu
Insights
Optimal treatment for acute mastoiditis in infants involves a combination of antibiotics and surgery. Early diagnosis is crucial, especially in prolonged middle ear infections with worsening general symptoms.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
Background:
- Acute mastoiditis is a serious complication of acute otitis media, particularly in infants.
- Diagnosis can be challenging due to non-specific symptoms.
Purpose of the Study:
- To evaluate the effectiveness of combined antibiotic and surgical treatment for acute mastoiditis in infants.
- To identify common clinical presentations and causative microorganisms.
Main Methods:
- Retrospective study of 37 infants operated for acute mastoiditis between 2000-2004.
- Analysis of clinical symptoms, microbiological findings, and treatment outcomes.
- Tympanocentesis performed prior to surgery in all patients.
Main Results:
- Most common symptoms included blurred tympanic membrane, mastoid tenderness, fever, and weight loss.
- Streptococcus pneumoniae was the most frequent pathogen identified.
- Combined antibiotic and surgical treatment yielded positive outcomes in all cases.
Conclusions:
- The combination of antibiotic therapy and surgical intervention is the optimal approach for acute mastoiditis.
- Consider acute mastoiditis in differential diagnosis for persistent acute otitis media unresponsive to antibiotics, especially with systemic symptoms.
Abstract:
We present a retrospective study of 37 infants who were operated for acute mastoiditis during the period 2000-2004 in Mother and Child Health Care Institute, Belgrade, Serbia and Montenegro. About 23 patients (62.2%) were male and 14 (37.8%) were female. Acute mastoiditis developed just after the first infection of the middle ear in 26 patients (70.3%). All patients had local and general symptoms. The most common local symptoms were blurred tympanic membrane in all patients, painful tenderness of mastoid in 21 (57%) and redness of tympanic membrane in 13 (36%). General signs of infection were loss of body weight in 28 (75.7%) patients, fever in 21 (56.8%), vomiting in 19 (51.3%), diarrhea in 19 (51.3%) and severe anemia that requested red blood cell transfusion in 6 (16.2%). Suppuration did not appear in any of the patients. Tympanocentesis had been performed prior to surgery in all patients. The most frequently isolated causative microorganism was Streptococcus pneumoniae which was found in 12 (32.5%) patients, Staphylococcus aureus was found in 8 (21.5%) and Hemophilus influenzae in 2 (5.5%). In 15 (405%) patients there was no bacterial isolation. Eleven patients (29.7%) who had previously had acute otitis media were implanted ventilation tubes during the surgical intervention. All patients were treated with antibiotics prior and after the surgical intervention. The finding on mastoidectomy was positive in all cases. According to the results of our study the combination of antibiotic and surgical treatment is optimal in treating acute mastoiditis. Making a diagnosis of acute mastoiditis might not be easy since there are no specific symptoms. We emphasize that it should always be considered as a differential diagnosis in cases of prolonged acute otitis media with no improvement after 10 days of antibiotic treatment, especially when accompanied with weight loss and general condition worsening.
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