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Acute mastoiditis in infants and children
Insights
Acute mastoiditis in children remains a significant concern, with a high rate of serious complications like meningitis. This 25-year study highlights that these risks have not decreased over time.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Acute mastoiditis is an infection of the mastoid bone, often a complication of middle ear infections.
- It primarily affects infants and young children, presenting with specific clinical signs.
Purpose of the Study:
- To analyze the clinical characteristics, diagnostic methods, and complications of acute mastoiditis in a pediatric population over a 25-year period.
- To assess trends in the frequency of serious complications associated with acute mastoiditis.
Main Methods:
- Retrospective review of 57 pediatric cases of acute mastoiditis diagnosed over 25 years.
- Clinical examination, tympanic membrane assessment, and mastoid roentgenograms were utilized.
- Bacterial cultures were performed to identify causative agents.
Main Results:
- Common symptoms included tympanic membrane abnormalities, fever, and localized swelling.
- Infants (<1 year) showed swelling above the ear, while older children had mastoid process swelling.
- Osteomyelitis was identified in 9 patients via roentgenograms.
- Common pathogens were Streptococcus pneumoniae, Staphylococcus aureus, and Streptococcus pyogenes.
- Serious complications occurred in 53% of patients, including one death from meningitis.
Conclusions:
- Acute mastoiditis in children presents with varied signs depending on age.
- Prompt diagnosis using imaging and cultures is crucial for identifying bacterial etiology and complications.
- The incidence of severe complications from acute mastoiditis has not diminished over the last three decades, underscoring the need for continued vigilance.
Abstract:
During a 25-year period, 57 cases of acute mastoiditis occurred in infants and young children who ranged in age from 2 months to 12 years of age. All patients had abnormalities of the tympanic membrane and most had fever and localized edema and redness of the overlying skin. Fifty per cent of the infants who were less than one year of age had swelling primarily above the involved ear pushing the pinna out and down. By contrast, older children had swelling of the skin overlying the mastoid process which produced the classical finding of an elevated earlobe. Mastoid roentgenograms were a useful adjunct to diagnosis, revealing concurrent osteomyelitis in 9 patients. A diagnosis of specific bacterial etiology was made in 80 per cent of the patients in whom cultures were performed. Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes were the bacteria most frequently isolated. Unusual manifestations or serious complications occurred in 53 per cent of the patients, including one death (due to meningitis). These data indicate that the frequency of serious complications from acute mastoiditis has not declined over the past 3 decades.