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Infants under the age of six months with acute mastoiditis. A descriptive study of 15 years in Sweden
K Stenfeldt1, F Enoksson2, J Stalfors3
1Department of Otorhinolaryngology, Skåne University Hospital, Lund, Sweden.
Insights
Acute mastoiditis is rare in infants under six months. Most infants had preceding upper respiratory infections but presented with ear symptoms for only a few days, with no severe complications found.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Acute mastoiditis is a rare but serious infection of the mastoid bone.
- Infants under six months are particularly vulnerable due to their developing immune systems and anatomy.
Purpose of the Study:
- To determine the incidence, clinical presentation, and outcomes of acute mastoiditis in infants younger than six months in Sweden.
- To analyze the predisposing factors, treatment strategies, and complications associated with this condition in a vulnerable population.
Main Methods:
- A retrospective review of all infants aged 0-5 months diagnosed with acute mastoiditis between 1993 and 2007 was conducted.
- Data collected included clinical signs, preceding illnesses, treatment interventions, and patient outcomes.
Main Results:
- Seventeen cases of acute mastoiditis were identified in infants under six months.
- Most infants presented with retroauricular signs and had a preceding upper respiratory infection; 47% developed a subperiosteal abscess.
- Treatment involved intravenous antibiotics and surgical procedures such as myringotomy and mastoidectomy; Streptococcus pneumoniae was the most common pathogen.
Conclusions:
- Acute mastoiditis is exceptionally rare in infants under six months, with no identified predisposing diseases in this cohort.
- Despite potential severity, prompt antibiotic and surgical management effectively prevented severe complications in this study population.
- Early recognition and intervention are crucial for managing acute mastoiditis in young infants.
Objective:
To investigate the occurrence, clinical signs and outcome of acute mastoiditis in infants under the age of 6 months in Sweden between the years 1993-2007.
Methods:
All ENT departments in Sweden reported children 0-5 months treated for acute mastoiditis 1993-2007 and all records were reviewed. The clinical course and various characteristics were recorded.
Results:
Seventeen young infants with acute mastoiditis were identified. Three patients had suffered acute otitis media earlier, otherwise the children were previously healthy. Preceding the episode of acute mastoiditis, the children had an upper respiratory tract infection or fever for seven days in mean (median three days) and the mean number of days with ear-symptoms was three days (median two days). Three patients were treated with antibiotics prior to admittance. Almost all children presented with clear retroauricular signs with protruding ear and redness behind the ear. The children were hospitalised for six days (mean and median). Eight patients (47%) suffered from a subperiosteal abscess. All but one patient underwent surgery: myringotomy (13); incision or punction of the mastoid (5); mastoidectomy (3). Streptococcus pneumoniae was the most frequent bacterium identified in cultures. No intracranial complications or other severe complications were found.
Conclusion:
Acute mastoiditis is extremely rare in infants under the age of 6 months. The patients in this study did not have any predisposing diseases. An upper respiratory tract infection had preceded the episode of acute mastoiditis for some time in the majority of cases, but the time from first ear symptoms to hospitalization was very short. Acute mastoiditis is a potentially life-threatening disease, but the timely administration of intravenous antibiotics and surgical intervention prevented the occurrence of severe complications in these young infants.
