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Advanced pediatric mastoiditis with and without intracranial complications

Jose P Zevallos1, Jeffrey T Vrabec, Robert A Williamson

  • 1Bobby R. Alford Department of Otolaryngology, Texas Children's Hospital, Houston, USA.

The Laryngoscope
|June 9, 2009
PubMed
Abstract

Insights

Pediatric advanced mastoiditis cases are rising. Intracranial complications were linked to a higher incidence of anaerobic bacteria, emphasizing the need for appropriate antibiotic coverage.

Area of Science:

  • Otolaryngology
  • Pediatric Infectious Diseases
  • Neurosurgery

Background:

  • Increasing incidence of advanced pediatric mastoiditis and intracranial complications.
  • Need to understand the role of bacteriology in complication development.

Purpose of the Study:

  • Review the bacteriology of advanced mastoiditis in pediatric patients.
  • Hypothesize that bacteriology differences explain intracranial complication development.

Main Methods:

  • Retrospective chart review of pediatric patients with coalescent mastoiditis requiring surgery (2002-2007).
  • Surgical specimens analyzed for pathology, Gram stain, aerobic, and anaerobic cultures.
  • Patients categorized by mastoidectomy alone or transtemporal craniotomy for intracranial complications.

Main Results:

  • 108 pediatric patients identified; 17% had intracranial complications.
  • Streptococcus pneumoniae was the most common organism.
  • Anaerobic isolates were significantly more frequent in patients with intracranial complications (29.4% vs. 5.7%, P=.015).

Conclusions:

  • Nearly a quarter of pediatric patients with coalescent mastoiditis had simultaneous intracranial complications.
  • Increased anaerobic organisms in complicated cases highlight the importance of anaerobic coverage.
  • Aggressive surgical management and infectious disease collaboration are crucial for advanced pediatric mastoiditis.

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