Related Experiment Video
Updated: Jan 17, 2026
Endaural Endoscopic Atticoantrotomy Retrograde Mastoidectomy using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
Management of acute mastoiditis in children: a retrospective analysis
Marella Reale1, Carlotta Montagnani2, Pietro Orlando3
1Otorhinolaryngology Unit, Head and Neck Department, Meyer Children's Hospital IRCCS, Florence, Italy.
Insights
Acute mastoiditis (AM) and complicated AM (CAM) are serious ear infection complications. Elevated CRP levels indicate higher CAM risk, while most AM cases are treated medically, unlike CAM which often requires surgery.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
Background:
- Acute mastoiditis (AM) is a common complication of acute otitis media (AOM).
- There is no established consensus on the diagnostic or therapeutic management of AM.
- AM can lead to severe complications if not promptly diagnosed and treated.
Purpose of the Study:
- To analyze the management of children with AM and complicated AM (CAM).
- To evaluate differences in clinical presentation and management between AM and CAM.
- To outline a potential diagnostic and therapeutic pathway for AM and CAM.
- To assess the incidence of AM over time.
Main Methods:
- Retrospective study of pediatric patients admitted for AM or CAM.
- Data collected from January 2016 to December 2023 at Meyer University Hospital- IRCCS, Florence.
- Analysis of clinical presentation, microbiological findings, management, and outcomes.
Main Results:
- Eighty-five patients (60% male, median age 4 years) were included.
- Pseudomonas aeruginosa was the most frequent pathogen in AM, Streptococcus pyogenes in CAM.
- Seventeen patients developed CAM; elevated CRP levels were associated with increased CAM risk (p=0.043).
- AM management was primarily medical (IV antibiotics); surgery was rare (1/68).
- CAM management frequently required surgery (76%), often mastoidectomy with abscess drainage.
- A significant increase in AM cases was observed during the study period, particularly in 2023.
Conclusions:
- AM and CAM are infrequent but potentially life-threatening AOM complications.
- A rise in AM cases in 2023 may be linked to the lifting of pandemic restrictions.
- Management of mastoiditis is heterogeneous, even within a single institution.
- Elevated CRP is the sole identified predictor of complicated mastoiditis.
- Guidelines are needed to support prompt diagnosis and effective management of AM and CAM.
Background:
Acute mastoiditis (AM) is the most common complication of acute otitis media (AOM) and could lead to serious complications if not diagnosed early and treated appropriately. Nowadays, there is no definitive consensus about the diagnostic algorithm and the optimal therapeutic management for patients with AM. The purpose of this study is to analyze the management of children admitted for AM and complicated AM (CAM) in a referral children's hospital, evaluating differences in clinical presentation and management to outline a diagnostic and therapeutic pathway. Moreover, the incidence over time was assessed.
Methods:
Retrospective study of children admitted for AM at Meyer University Hospital- IRCCS, Florence from January 2016 to December 2023.
Results:
Eighty-five patients were included in the study (60% male, median age 4 years), the microbiological examinations were carried out in 68% of them. The most frequent isolated pathogens were Pseudomonas aeruginosa in AM and Streptococcus pyogenes in CAM. Seventeen patients developed a CAM. An elevated CRP value is associated with an increased risk of CAM (p = 0.043). Management of patients with AM was mainly medical with intravenous antibiotics. Surgical intervention was required only in one case (1 out of 68). In contrast, surgical intervention was required in 76% of CAM cases (13 out of 17). The most common procedure was mastoidectomy combined to abscess drainage, according to the predominance of this complication in our study group. Only one patient had a recurrence leading to a second surgery. No significant statistical correlation was found between the occurrence of complications and younger age, personal history of otitis or leukocyte count. A significant increase in AM case was found during the study period.
Conclusions:
AM and CAM are infrequent but potentially life-threatening complications of AOM. A marked rise in AM cases was observed in 2023, likely due to the lifting of pandemic restrictions. A heterogeneous management of mastoiditis was observed, even within a single center. Elevated CRP levels are the only identified parameter associated with the complicated form. Pediatricians should be aware of the importance of a prompt diagnosis and guidelines should be developed to support effective management.
Related Concept Videos
01:26Tonsillitis II: Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.