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Acute mastoiditis. Diagnosis and complications
Insights
Acute mastoiditis in children can often be treated with antibiotics and myringotomy, avoiding surgery. Close monitoring is crucial for those not improving within 48 hours.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Pediatric Surgery
Background:
- Acute mastoiditis is a serious bacterial infection of the mastoid bone.
- Prompt diagnosis and treatment are essential to prevent complications.
Purpose of the Study:
- To review the clinical presentation, treatment, and outcomes of acute mastoiditis in children.
- To evaluate the effectiveness of non-surgical management strategies.
Main Methods:
- Retrospective review of hospital records for 30 children diagnosed with acute mastoiditis over 12 years.
- Analysis of clinical findings, diagnostic imaging, microbiological data, and treatment outcomes.
Main Results:
- Common signs included abnormal tympanic membranes and postauricular swelling.
- Complications such as subperiosteal abscess and meningitis occurred in 13 children.
- 63% of children recovered without requiring mastoidectomy.
Conclusions:
- Children without meningitis or subperiosteal abscess may be initially treated with antibiotics and myringotomy.
- Mastoidectomy should be reconsidered for patients not responding to initial therapy within 24-48 hours.
Abstract:
Thirty children with acute mastoiditis were identified over a 12-year-period and their hospital records were reviewed retrospectively. All had abnormal tympanic membranes and 26 (87%) had swelling above or posterior to the ear that deviated the pinna. Findings on mastoid roentgenograms included clouding (n = 12) and osteitis (n = 7); six were normal. From 13 patients, bacteria were recovered from normally sterile sites and included Pneumococcus (n = 5), group A streptococcus (n = 3), Haemophilus (n = 2), and anaerobes (n = 3). Complications occurred in 13 children, including subperiosteal abscess (n = 7), meningitis (n = 4), osteitis (n = 7), facial palsy (n = 1), and subdural empyema and brain abscess (n = 1). Four of the six children with neurological complications had no external signs of acute mastoiditis on physical examination. Overall, 19 (63%) of the children recovered without mastoidectomy. We conclude that children without meningitis or subperiosteal abscess may be treated initially with antimicrobial therapy plus myringotomy. The need for mastoidectomy should be reassessed in children who fail to respond in 24 to 48 hours.