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Acute mastoiditis in infants younger than 6 months: is an alternative treatment protocol needed?
Meirav Sokolov1,2, Sharon Tzelnick3,4, Sagit Stern3,4
1Department of Otorhinolaryngology and Head and Neck Surgery, Schneider Children's Medical Center of Israel and Rabin Medical Center, Beilinson Campus, 49202, Petah Tikva, Israel. Meirav.Sokolov@gmail.com.
Insights
Acute mastoiditis (AM) in infants under 6 months presents similarly to older children, with notable differences in pre-auricular swelling and bilateral acute otitis media (AOM). Streptococcus pneumoniae is the primary pathogen in younger children, suggesting a unified treatment approach for all age groups.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Conflicting reports exist regarding the incidence and severity of acute mastoiditis (AM) in younger versus older children.
- Understanding the clinical and microbiological aspects of AM in infants is crucial for appropriate management.
Purpose of the Study:
- To describe the occurrence, clinical features, and microbiology of AM in children 6 months or younger.
- To compare these aspects with those in an older cohort of children diagnosed with AM.
Main Methods:
- Retrospective review of medical files for children hospitalized with AM between 2001 and 2016.
- Children were categorized into two groups: 6 months or younger, and older than 6 months.
- Diagnosis of AM required clinical signs of acute otitis media (AOM) plus specific physical findings.
Main Results:
- Fifty patients were in the younger age band and 335 in the older group.
- Bilateral AOM (28% vs. 14.9%) and pre-auricular/zygomatic swelling (8% vs. 0.02%) were significantly more common in children under 6 months.
- Streptococcus pneumoniae was the most frequent pathogen in younger children (38%), while Group A Streptococcus (GAS) was most common in older children (20.6%).
Conclusions:
- Acute mastoiditis in infants under 6 months shares many characteristics with older children.
- Key differences include a higher incidence of pre-auricular swelling and bilateral AOM in infants.
- The most common pathogen in infants is Streptococcus pneumoniae, and treatment strategies should be consistent across age groups.
Objectives:
Several studies have reported that younger children suffer from increased incidence and more severe episodes of acute mastoiditis (AM) than older children, whereas other researchers have found the opposite. The aim of our study was to describe the occurrence, clinical, and microbiological aspects of AM in children 6 months or younger, and compare them with the results in an older reference age band.
Methods:
The medical files of children hospitalized with a diagnosis of AM during 2001-2016 were retrospectively reviewed. Diagnosis of AM was based on the presence of clinical signs of acute otitis media (AOM) accompanied by two or more of the following: auricle protrusion, retro-auricular erythema, swelling, and local tenderness. Children were divided into two age bands, 6 months or younger, and older than 6 months.
Results:
Fifty patients in the young age band and 335 in the older reference age band were included. Bilateral AOM was identified in 14 (28%) children under 6 months, and 50 (14.9%) in the reference age band (p < 0.001). Fever, mean WBC, and CRP values were similar in both age bands; 4 (8%) children under 6 months had pre-auricular/zygomatic area swelling, as compared to 1(0.02%) in the reference age band (p < 0.001). Complication rates (subperiosteal abscess, sinus vein thrombosis, and epidural abscess) were similar in both age bands. All children were treated with myringotomy and IV antibiotics. Cortical mastoidectomy with the insertion of ventilation tube was performed in 10 (20%) children in the younger age band and 58(17.3%) in the reference age band. Streptococcus pneumoniae was the most common (38%) isolated bacteria in the younger age band, and Group A streptococcous (GAS) (20.6%) in the reference age band.
Conclusions:
AM in children 6 months or younger has similar presentation and characteristics as in older children. Pre-auricular swelling and bilateral AOM are more typical in the younger age band; Streptococcus pneumoniae is the most common pathogen in the younger children. We suggest that the treatment approach should be the same for both groups.
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