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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.
European Journal of Pediatrics
|May 1, 1990
Summary
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.