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The complexity of acute mastoiditis in Swedish children

Julia Arebro1, Rutger Bennet2, Margareta Eriksson2

  • 1Division of Otorhinolaryngology, Department of Clinical Science, Intervention and Technology Karolinska Institutet, 141 86, Stockholm, Sweden; Department of Otorhinolaryngology Head and Neck Surgery, Karolinska University Hospital, 141 86, Stockholm, Sweden.

International Journal of Pediatric Otorhinolaryngology
|April 12, 2025
PubMed

Insights

Acute mastoiditis (AM) diagnosis validity was assessed in children. The pneumococcal conjugate vaccine (PCV) introduction correlated with decreased AM incidence in infants, though some cases showed delayed recovery.

Area of Science:

  • Pediatric infectious diseases
  • Epidemiology
  • Otolaryngology

Background:

  • Acute mastoiditis (AM) is a rare complication of acute otitis media (AOM) in children.
  • Population-based studies are crucial for treatment strategies and vaccine effect evaluation.
  • Previous reports suggest overdiagnosis of AM, necessitating validity assessment.

Purpose of the Study:

  • To assess the validity of ICD-10 diagnoses for AM.
  • To identify differential diagnoses for suspected AM.
  • To map the incidence of AM and identify cases with delayed recovery.

Main Methods:

  • Retrospective review of hospitalized pediatric cases diagnosed with mastoiditis in Stockholm, Sweden (2003-2019).
  • Manual review of case records to verify AM diagnosis and collect data.
  • Analysis of diagnostic validity, incidence trends, and clinical recovery patterns.

Main Results:

  • 193 out of 275 ICD-10 diagnosed AM episodes were verified; 74 (26.9%) had alternative diagnoses.
  • AM incidence in children aged 0-1 years decreased post-pneumococcal conjugate vaccine (PCV) introduction.
  • Thirty-one cases had delayed recovery, including three with sigmoid sinus thrombosis. Differential diagnoses were often skin infections or otitis externa in older children.

Conclusions:

  • Chart validity assessment is essential for retrospective AM studies using ICD-10 codes.
  • PCV introduction has led to a reduction in AM cases among children under two years old.
Abstract

Keywords:
Acute mastoiditisAcute otitis mediaChildrenDifferential diagnosesICD-10Pneumococcal conjugate vaccine

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