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Acute mastoiditis--revisited
1Department of Otolaryngology, Sheba Medical Center, Tel Hashomer, Israel.
Abstract:
The clinical course and causative organisms were studied in 18 patients with acute mastoiditis, 13 of whom (72%) had no previous history of middle ear disease. Their age ranged from 5 months to 21 years, and duration of middle ear symptoms immediately prior to admission ranged from 1 to 45 days (average 9.7 days). None had undergone a myringotomy prior to admission, while 13 (72%) had been receiving antibiotic treatment for acute otitis media. Three were admitted with intracranial complications. Bacteria were isolated in 10 of the 16 patients in whom samples were available for bacterial culture, and included Streptococcus pneumonia (2), Streptococcus pyogenes (2), Staphylococcus aureus (2), Staphlococcus coagulase negative (2), Klebsiella pneumonia (1), and Pseudomonas aeruginosa (1). Of the 17 patients treated by us, 11 received surgery. Acute otitis media, secretory otitis media, acute mastoiditis, subacute mastoiditis and masked mastoiditis create a continuum. Antibiotic treatment for acute otitis media cannot be considered as an absolute safeguard against acute mastoiditis. When antibiotics are prescribed for acute mastoiditis before culture result is available, an anti-staphylococcal agent should be included. At least some patients with acute mastoiditis develop a primary infection of the bony framework of the middle ear cleft. The prevalence of the intracranial complications in acute mastoiditis is still high and may appear soon after or concomitant with the first sign of acute mastioditis.
Insights
Acute mastoiditis can occur without prior ear disease and may lead to serious intracranial complications. Early antibiotic treatment for acute otitis media does not always prevent mastoiditis, necessitating careful management.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Pediatric Medicine
Background:
- Acute mastoiditis is a serious complication of middle ear infections.
- Many patients present without a history of middle ear disease.
- Intracranial complications remain a significant concern.
Purpose of the Study:
- To investigate the clinical course and causative organisms of acute mastoiditis.
- To assess the relationship between acute otitis media treatment and mastoiditis development.
- To highlight the prevalence and timing of intracranial complications.
Main Methods:
- Retrospective analysis of 18 patients with acute mastoiditis.
- Clinical data collection including patient history, symptoms, and treatment.
- Bacterial culture and identification from patient samples.
Main Results:
- 72% of patients had no prior middle ear disease history.
- 13 patients (72%) received prior antibiotic treatment for acute otitis media.
- Commonly isolated bacteria included Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus.
- Three patients presented with intracranial complications.
Conclusions:
- Acute mastoiditis, acute otitis media, and secretory otitis media represent a continuum of disease.
- Antibiotic treatment for acute otitis media is not a guaranteed preventative measure against mastoiditis.
- Empirical antibiotic therapy for mastoiditis should include anti-staphylococcal coverage pending culture results.
- Intracranial complications are prevalent and can manifest early in the course of acute mastoiditis.