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Acute mastoiditis: clinical, microbiological, and therapeutic aspects
D Nadal1, P Herrmann, A Baumann
1Department of Pediatrics, University of Zürich, Kinderspital, Switzerland.
Insights
Acute mastoiditis in children often presents with local symptoms, but systemic signs like fever are less common. Early antibiotic trials are effective, potentially avoiding surgery in many cases.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Acute mastoiditis is a serious complication of acute otitis media.
- Early diagnosis and management are crucial to prevent complications.
Purpose of the Study:
- To review the clinical presentation, management, and outcomes of acute mastoiditis in children.
- To evaluate the effectiveness of antibiotic therapy versus surgical intervention.
Main Methods:
- Retrospective chart review of 73 children with acute mastoiditis over 16 years.
- Analysis of clinical symptoms, microbiological data, and treatment outcomes.
Main Results:
- Retro-auricular swelling, tenderness, and erythema were common presenting signs.
- Subperiosteal abscesses and CNS involvement occurred in a significant minority of patients.
- Antibiotic therapy alone was successful in 33% of cases, with higher bacterial isolation rates from local sites than blood.
Conclusions:
- A 48-hour intravenous antibiotic trial is a reasonable initial approach for acute mastoiditis without abscess or CNS involvement.
- Myringotomy with ventilation tube insertion is indicated for concurrent otitis media with effusion.
- Prompt surgical intervention should be considered if conservative management fails.
Abstract:
The charts of 73 children (31 girls, 42 boys) aged 4 months to 14 years (mean 4.5 years) with acute mastoiditis managed during a 16-year period were reviewed. Of the patients 36% were less than 24 months old. Retro-auricular swelling was described in 63 of the 73 children, tenderness in 59, erythema in 58, and protrusion of the auricle in 45. A pathological tympanic membrane was noted in 33% of the patients and fever in only 29%. Apart from local inflammation, the most frequent complaints and symptoms were otalgia (n = 42), recent upper respiratory tract infections (n = 22), and fever alone (n = 22). A subperiosteal abscess was found in 36 patients, and CNS involvement in 5. Nearly half of the patients (48%) were on antibiotic therapy at admission. The isolation rates in bacterial cultures from subperiosteal aspirated (81%) and from mastoid mucosa (68%) were considerably higher than from blood cultures (14%) and were not influenced by previously administered antibiotics. Pneumococci (9/32) and Staphylococcus epidermidis (6/32) were the agents most often isolated. The incidence of the bacteria isolated from patients pre-treated with antibiotics differed from the incidence in patients not previously treated. In 24 patients (33%) the lesion healed with antibiotic therapy without mastoid surgery. Myringotomy and the insertion of a ventilation tube is indicated initially, if acute otitis media with effusion is found. In the absence of a subperiosteal abscess and of CNS involvement, a 48-hour trial of intravenous antibiotic therapy, directed also against staphylococci, is justified before mastoid surgery is considered.