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Surgical intervention for acute mastoiditis: 10 years experience in a tertiary children hospital
Sagit Stern Shavit1,2,3, Eyal Raveh4,5, Lirit Levi4,5
1Pediatric Otolaryngology Unit, Schneider Children's Medical Center, Petach Tikva, Israel. stern_sagit@hotmail.com.
Insights
Children with acute mastoiditis (AM) requiring surgery often present with high fever, elevated inflammatory markers, and sub-periosteal abscess. An increase in Fusobacterium infections may explain the rise in complicated AM cases needing surgical intervention.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Surgical Oncology
Background:
- Acute mastoiditis (AM) is a serious complication of acute otitis media in children.
- Surgical intervention is sometimes necessary for severe AM cases.
- Understanding the clinical course and factors influencing surgical needs is crucial for effective management.
Purpose of the Study:
- To evaluate the clinical course of children with acute mastoiditis (AM) who required surgical intervention.
- To compare the characteristics of surgically treated AM patients with those managed conservatively.
Main Methods:
- Retrospective review of clinical and biochemical data of surgically treated AM patients.
- Comparison with a cohort of conservatively managed AM patients from the same period.
- Analysis of patient demographics, presenting symptoms, laboratory values, causative pathogens, and treatment outcomes.
Main Results:
- 570 children admitted with AM between 2008-2017; 82 (14%) required surgery.
- Surgical group had higher rates of prolonged fever, otorrhea, sub-periosteal abscess, and elevated inflammatory markers (WBC, CRP) upon admission.
- Fusobacterium necrophorum was the predominant pathogen in the surgical group (50%), contrasting with Streptococcus group A in the conservative group (22%).
- Average IV antibiotic treatment duration was significantly longer in the surgical group (20 days vs. 5.6 days).
- A significant increase in Fusobacterium-related mastoiditis requiring surgery was observed since 2013.
Conclusions:
- Children with AM presenting with high fever, leukocytosis, elevated CRP, and sub-periosteal abscess often require early computed tomography (CT) and surgical intervention.
- The rising incidence of Fusobacterium infections may be contributing to an increase in complicated AM cases necessitating surgery.
- Prompt surgical management and targeted antibiotic therapy are essential for favorable outcomes in severe AM.
Purpose:
To evaluate the clinical course of children with acute mastoiditis (AM) who required surgical intervention.
Material And Methods:
Clinical and biochemical characteristics at the moment of hospital admission were reviewed for patients who required surgery for AM. Children who were successfully managed conservatively during the last 3 years of study were chosen as a comparison group.
Results:
During 2008-2017, 570 children were admitted with AM: 82(14%) underwent cortical mastoidectomy, including 31(38%) with decompression of epidural space and sigmoid sinus. The comparison group consisted of 167 children with AM who did not require surgery. The surgical group had a higher rate of acute otitis media before admission. At the time of hospital admission, the surgical group had a higher rate of prolonged fever, otorrhea, and sub-periosteal abscess. Their average temperature, WBC, neutrophil count, and CRP were significantly higher (39.2 vs. 37.9°. C, 20 K vs. 16.5 K, 67 vs. 55.8 percent, 17 vs. 8.8, respectively, p = 0.0001). Fusobacterium necrophorum was the most common pathogen in the surgical group (50%), and group A streptococcus in the comparison group (22%). Sub-periosteal abscess, sinus venous thrombosis, and epidural involvement were diagnosed in 95, 35, and 38 percent of patients, respectively. Average length of IV antibiotic treatment was 20 days in operated children, compared to 5.6 days in the comparison group (p = 0.0001). Since 2013, a significantly higher percentage of children were diagnosed with Fusobacterium mastoiditis (p = 0.0001) who required surgery (p = 0.008).
Conclusion:
In children with AM presenting with, high fever, leukocytosis, elevated CRP, and sub-periosteal abscess, early CT and surgical intervention were frequently required. The increase in Fusobacterium infection might be an explanation for the increase in complicated AM requiring surgery.
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