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Endaural Endoscopic Atticoantrotomy Retrograde Mastoidectomy using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
Conservative management outcomes in acute pediatric mastoiditis
Jumana Diana Reda1,2, Per Caye-Thomasen3,4,5,6
1Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology, Entrance 6, 3rd Floor, Section 6033, Copenhagen, Denmark.
Background:
The aim of this study is to determine whether initial conservative surgical treatment of acute mastoiditis (AM) leads to an increase of morbidity, and to report on recent developments in epidemiology and microbiology.
Methods:
At the end of 2016, a new guideline for treatment of pediatric AM was introduced at our tertiary referral center. Mastoidectomy in case of a retroauricular abscess was changed to retroauricular needle aspiration or incision. All patients diagnosed with AM 2017-2021 were identified retrospectively in our patient file records and all relevant clinical data retrieved, including data on epidemiology and microbiology (n = 73; 26 with subperiosteal abscess).
Results:
Overall, the conservative management strategy led to resolved disease without further treatment in 94% of cases. Cases presenting with a subperiosteal abscess and receiving initial conservative surgical treatment healed in 92%, although 8% needed repeated aspiration or incision. Two children (8%) had secondary mastoidectomy due to disease progression. At 1.4%, complications were rare and the hospital stay short (mean 2.9 days). The incidence of AM was low during the Covid pandemic. Bacterial spectrum was comparable to earlier findings, resistance to penicillin/ampicillin slightly increased at 11%/33%.
Conclusion:
Conservative initial management of pediatric AM leads to favorable outcomes not inferior to a more aggressive approach including primary mastoidectomy in case of subperiosteal abscess. Complications are (as) rare and hospital stay shorter. Incidence of AM was lower during the Covid pandemic, but otherwise unchanged compared to previous years, despite intercurrent introduction of pneumococcal vaccines.
Insights
Conservative surgical treatment for acute mastoiditis (AM) in children shows favorable outcomes, with a high success rate and rare complications. This approach is as effective as more aggressive treatments, leading to shorter hospital stays.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Surgical Outcomes
Background:
- Acute mastoiditis (AM) is a serious middle ear infection.
- Assessing the impact of conservative surgical treatment on pediatric AM morbidity is crucial.
- Understanding current epidemiology and microbiology of AM is essential for effective management.
Purpose of the Study:
- To evaluate if initial conservative surgical treatment for pediatric acute mastoiditis (AM) increases morbidity.
- To update knowledge on the epidemiology and microbiology of AM.
- To compare outcomes of conservative management versus primary mastoidectomy.
Main Methods:
- Retrospective analysis of pediatric AM cases (n=73) from 2017-2021.
- Compared outcomes of conservative surgical treatment (needle aspiration/incision) with mastoidectomy.
- Data collected on epidemiology, microbiology, and treatment outcomes, including subperiosteal abscess cases (n=26).
Main Results:
- Conservative management resolved AM in 94% of cases; 92% of subperiosteal abscess cases healed with initial conservative treatment.
- Complications were rare (1.4%), with short hospital stays (mean 2.9 days).
- AM incidence decreased during the COVID-19 pandemic; bacterial resistance to penicillin/ampicillin was 11%/33%.
Conclusions:
- Initial conservative management of pediatric AM yields favorable outcomes, comparable to more aggressive surgical approaches.
- Conservative treatment is associated with rare complications and shorter hospitalizations.
- AM incidence was lower during COVID-19, with stable epidemiology despite vaccination programs.
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