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Intracranial complications of acute mastoiditis: Surgery not always necessary
Shadi Shinnawi1, Majd Khoury2, Mauricio Cohen-Vaizer1
1Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel.
Introduction:
Acute mastoiditis (AM) can rapidly become life-threatening with various intracranial complications. The standard care includes antibiotics, mastoidectomy, and drainage. Reports show varying preferences for conservative and surgical treatments, with a more conservative approach gaining popularity. In this study we aim to evaluate the presenting symptoms, management and outcomes of patients presenting with intracranial complications secondary to acute mastoiditis.
Methods:
Retrospective review for all children admitted for acute mastoiditis for 12 years period (January 2010-December 2021). Children who had mastoiditis associated with intracranial complications were included in the study. STROBE guidelines were followed in this study.
Results:
23 patients were diagnosed with acute mastoiditis with intracranial complications. The mean age was 2.1 years. The most common presenting sign was fever, followed by otalgia. The most common pathogens were Fusobacterium necrophorum and Streptococcus pneumoniae. The most common intracranial complication was sinus vein thrombosis (SVT) affecting 13 patients. Eventually, 10 patients underwent cortical mastoidectomy during 1-6 days upon admission, with an average of 3.2 days. During the follow-up period patients were monitored for clinical progression. Patients who did not show clinical improvement such as persistent fever, worsening symptoms, or the presence of neurological symptoms were treated surgically. The length of stay was an average of 15.5 days overall, with no significantly longer hospital stay in patients who were treated surgically compared to patients who were treated conservatively (17.1 days vs. 14.2 days, P = .26).
Conclusion:
Intracranial complications of acute mastoiditis remain a significant challenge. Selected patients with intracranial complications can be treated conservatively with close monitoring, without increasing the risk of immediate or long-term complications. Initial antimicrobial treatment should cover anaerobic bacteria, as it correlates with severe complications.
Insights
Acute mastoiditis with intracranial complications can be managed conservatively in selected pediatric patients. Close monitoring is key, and initial antibiotics should target anaerobic bacteria for severe cases.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Neurosurgery
Background:
- Acute mastoiditis (AM) can lead to life-threatening intracranial complications.
- Standard treatment involves antibiotics, mastoidectomy, and drainage, with a trend towards more conservative approaches.
- This study evaluates the presentation, management, and outcomes of pediatric patients with intracranial complications from AM.
Purpose of the Study:
- To analyze the clinical presentation of acute mastoiditis with intracranial complications in children.
- To assess the effectiveness of conservative versus surgical management strategies.
- To identify factors associated with severe outcomes and guide treatment decisions.
Main Methods:
- Retrospective review of pediatric patients admitted for acute mastoiditis between January 2010 and December 2021.
- Inclusion criteria: mastoiditis associated with intracranial complications.
- Study adherence to STROBE guidelines for observational studies.
Main Results:
- 23 pediatric patients diagnosed with acute mastoiditis and intracranial complications.
- Most common symptoms: fever and otalgia. Common pathogens: Fusobacterium necrophorum and Streptococcus pneumoniae.
- Sinus vein thrombosis (SVT) was the most frequent complication (13 patients). Conservative management showed no significant difference in hospital stay compared to surgical intervention.
Conclusions:
- Intracranial complications of acute mastoiditis present a significant clinical challenge.
- Selected pediatric cases can be managed conservatively with close monitoring, without increased risk.
- Antimicrobial therapy should include coverage for anaerobic bacteria due to their association with severe complications.
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