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Endaural Endoscopic Atticoantrotomy Retrograde Mastoidectomy using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
Post-operative clinical course in children undergoing mastoidectomy due to complicated acute mastoiditis
Oren Ziv1,2,3, Aviad Sapir4,5,6, Eugene Leibovitz7,2,3
1Department of Otolaryngology-Head and Neck Surgery, Ben-Gurion University, Beer-Sheva, Israel.
Insights
Post-mastoidectomy fever in children with complicated acute mastoiditis is common and typically benign for up to six days. Patients with multiple complications are more likely to develop fever and specific bacterial infections.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Infectious Diseases
Background:
- Complicated acute mastoiditis (CAM) requires surgical intervention.
- Understanding the post-operative course is crucial for pediatric care.
Purpose of the Study:
- To evaluate the immediate post-operative outcomes in pediatric patients with CAM after surgery.
- To compare outcomes between patients with single versus multiple complications.
Main Methods:
- Retrospective chart review of 33 pediatric patients with CAM who underwent mastoid surgery (2012-2019).
- Patients were divided into single complication group (SCG) and multiple complication group (MCG).
- Outcomes analyzed included post-operative fever (POF) and microbial cultures.
Main Results:
- Multiple complication group (MCG) patients had a higher incidence of post-operative fever (75%) compared to single complication group (SCG) patients (35.3%).
- Fever was generally benign, resolving within 6 days post-surgery.
- Fusobacterium necrophorum was more prevalent in MCG (77.8%), while Streptococcus pneumoniae was common in SCG (55.5%).
Conclusions:
- Post-mastoidectomy fever in CAM is common and usually benign in the first 5-6 days.
- MCG patients exhibit a higher propensity for developing post-operative fever.
- Distinct bacterial pathogens are associated with different complication groups in CAM.
Purpose:
To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment.
Methods:
A retrospective chart review of children diagnosed with CAM who underwent mastoid surgery during 2012-2019 in a tertiary care university hospital. 33 patients, divided into 2 groups: 17 patients with sub-periosteal abscess (SPA) alone-single complication group (SCG) and 16 patients with SPA and additional complications: sigmoid sinus thrombosis (SST), peri-sinus fluid/abscess, epidural/subdural abscess, and acute meningitis-multiple complications group (MCG).
Results:
33 patients belong to the SCG 17(51%) and 16(49%) belonged to the MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P = 0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P = 0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings; a total of 18 positive cultures were reported. Fusobacterium necrophorum counted for 8/18(44.5%) of all positive cultures, 7/9(77.8%) in the MCG vs. 1/9(11.1%) in the SCG, P = 0.004. Streptococcus pneumoniae was reported only in SCG (5/9, 55.5%, vs. 0/9, P = 0.008).
Conclusion:
Post-mastoidectomy fever due to CAM is not unusual and seems to be a benign condition for the first 5-6 days, following surgery. MCG patients are more prone to develop POF. F. necrophorum is more likely to be associated with MCG, and S. pneumoniae is common in SCG patients.
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