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Published on: May 23, 2021
Contemporary management of acute mastoiditis in children: Insights from a U.S. national database
Osama Hamdi1, Laylaa Ramos1, Taylor Jamil1
1Department of Otolaryngology, University of Colorado, 12631 E 17th Ave, B205, Aurora, CO, 80045, USA.
Insights
Conservative management is common for pediatric acute mastoiditis, with surgery needed in less than 40% of cases. Complications strongly predict the need for surgery, aligning with trends toward less invasive treatments.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Surgical Outcomes Research
Background:
- Acute mastoiditis (AM) is a severe complication of acute otitis media.
- Historically, mastoidectomy was standard, but conservative approaches like IV antibiotics and PET placement are increasingly favored.
- Limited U.S. pediatric data exists on current management trends.
Purpose of the Study:
- To analyze current management trends for pediatric acute mastoiditis in the U.S.
- To identify predictors of surgical intervention and complications.
- To evaluate the effectiveness of conservative versus surgical management.
Main Methods:
- Retrospective review of pediatric patients diagnosed with AM (2010-2021) using CPT and ICD-10 codes.
- Data analyzed via PearlDiver database, assessing demographics, treatments, timing, and complications.
- Multivariate logistic regression used to identify predictors of surgery.
Main Results:
- Surgical intervention occurred in 36.8% of patients; intracranial complications in 13.7%.
- Older age decreased surgery odds, while under-immunization and AM complications increased them.
- Intracranial complications were the strongest predictor for mastoidectomy; higher income correlated with fewer complications and surgeries.
Conclusions:
- Non-operative management is the most common approach for pediatric AM in the U.S.
- Complications of AM are the primary driver for surgical intervention.
- Findings support a national trend towards conservative management of pediatric acute mastoiditis.
Objective:
Acute mastoiditis (AM) is a serious complication of acute otitis media. While historically managed with mastoidectomy, recent trends support conservative treatment, including intravenous (IV) antibiotics and pressure equalization tube (PET) placement. International studies demonstrate high success with these approaches, but U.S. pediatric data remains limited.
Methods:
Pediatric patients diagnosed with AM identified via Current Procedural Terminology (CPT®) coding and International Classification of Diseases (ICD-10) between January 2010 and October 2021 were reviewed using PearlDiver, a private analytics database. Patient demographics, treatments, intervention timing, complication rates, and predictors of surgery were assessed using multivariate logistic regression.
Results:
The mean patient age was 6.46 years, with 57.5% male. Surgical intervention occurred in 36.8%, including 1784 PETs, 347 subperiosteal abscess drainages, and 530 mastoidectomies. Median time to surgery was 1 day. Intracranial complications (e.g., abscess, meningitis, defined by ICD codes) occurred in 13.7%. Older age was linked to lower odds of surgery (p < 0.001), while under-immunization and complications of AM increased surgical likelihood (both p < 0.001). Intracranial complications were the strongest predictor of mastoidectomy (p < 0.0001). Higher family income correlated with fewer complications and lower mastoidectomy rates.
Conclusion:
In this national pediatric cohort, non-operative management was most common, with fewer than 40% of patients undergoing surgery. Complications of AM most strongly predicted surgical need. These findings are consistent with a growing trend toward conservative management of pediatric acute mastoiditis.
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