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Acute mastoiditis in children in Sweden 1993-2007--no increase after new guidelines

Anita Groth1, Frida Enoksson, Ann Hermansson

  • 1Strama Skåne, Grynmalaregatan 1, S-22353 Lund, Sweden. groth.medical@telia.com

International Journal of Pediatric Otorhinolaryngology
|September 28, 2011
PubMed

Insights

The incidence of acute mastoiditis in children did not rise in Sweden after new guidelines for acute otitis media were introduced. However, cases increased in infants under two years old, who were not impacted by the guidelines.

Area of Science:

  • Pediatrics
  • Otolaryngology
  • Infectious Diseases

Background:

  • New guidelines for acute otitis media (AOM) in Sweden (2000) introduced "watchful waiting" for uncomplicated cases in children aged 2-16 years.
  • The potential impact of these guidelines on the incidence and characteristics of acute mastoiditis (AM) in children required investigation.
  • Previous trends in AOM management may influence secondary infections like AM.

Purpose of the Study:

  • To determine if the incidence and characteristics of acute mastoiditis in children changed in Sweden post-2000 guideline implementation.
  • To analyze trends in AM among different pediatric age groups in relation to the "watchful waiting" policy for AOM.
  • To assess changes in prehospital antibiotic use, symptom duration, hospital stay, complications, and mastoidectomies following the new guidelines.

Main Methods:

  • Retrospective review of all acute mastoiditis cases (0-16 years) treated in Swedish Ear, Nose, and Throat departments from 1993-2007.
  • Data were analyzed by comparing the 7.5 years before and 7.5 years after the 2000 guideline introduction.
  • Cases involving cholesteatoma were excluded; defined criteria for acute mastoiditis were applied.

Main Results:

  • A total of 577 children met the inclusion criteria; the overall incidence of acute mastoiditis did not increase post-guidelines.
  • Acute mastoiditis remained most common in children under two years; this age group showed an increased proportion after 2000.
  • No significant changes were observed in prehospital antibiotic use, symptom duration, hospital stay, complications, or mastoidectomies.

Conclusions:

  • The introduction of "watchful waiting" for AOM did not lead to an increased incidence of acute mastoiditis in Swedish children overall.
  • A notable increase in acute mastoiditis was observed exclusively in children younger than two years, who were not subject to the "watchful waiting" guideline.
  • The severity of acute mastoiditis, as indicated by clinical characteristics and outcomes, remained unchanged during the study period.
Abstract

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