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Acute mastoiditis in children: a 12-year retrospective study
E H Harley1, T Sdralis, R G Berkowitz
1Department of Otolaryngology, Royal Children's Hospital, Melbourne, Australia.
Insights
Acute mastoiditis in children often presents as the first sign of otitis media. Persistent pain and fever indicate this serious ear infection, treatable with antibiotics and drainage.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
Background:
- Acute mastoiditis is a complication of otitis media, primarily affecting children.
- Early identification and management are crucial to prevent further complications.
Purpose of the Study:
- To review the clinical experience with acute mastoiditis over a 12-year period.
- To identify key indicators and evaluate treatment outcomes for pediatric acute mastoiditis.
Main Methods:
- Retrospective study of 58 pediatric cases (3 months to 15 years).
- Analysis of clinical presentation, causative organisms, and treatment modalities.
- Comparison of surgical interventions including myringotomy and mastoidectomy.
Main Results:
- Acute mastoiditis was the initial manifestation of otitis media in 54% of cases.
- Prolonged pain and fever (median 4 days) were significant indicators.
- Streptococcus pneumoniae was the most common pathogen.
- No significant difference in cure rates between myringotomy and mastoidectomy.
Conclusions:
- Acute mastoiditis predominantly affects young children and can be the first sign of ear disease.
- Persistent pain and fever despite otitis media treatment are critical symptoms.
- Intravenous antibiotics with myringotomy (with or without tubes) are effective initial management, comparable to mastoidectomy, unless complications are present.
Abstract:
We undertook a retrospective study to examine our experience with acute mastoiditis over a 12-year period. Fifty-eight cases were identified in children aged 3 months to 15 years. Acute mastoiditis was the first evidence of otitis media in 54% of our patients. Pain and fever lasting for more than a median period of 4 days were most likely to be the harbingers of incipient acute mastoiditis. Streptococcus pneumoniae was the most common organism recovered from the cultures. All children were treated with intravenous antibiotics; 41 children were managed with an adjunctive drainage procedure. No statistically significant differences were observed between the cure rates and failure rates for children treated surgically with myringotomies with or without tubes and children managed more aggressively with mastoidectomies. One infant had bacterial meningitis. Cholesteatoma was diagnosed in two children. We conclude from our study that acute mastoiditis occurs mainly in young children and may be the first evidence of ear disease. Pain and fever that persist despite appropriate treatment for acute otitis media are the two most important symptoms. Intravenous antibiotics combined with myringotomy with or without tube insertion are as appropriate as intravenous antibiotics with mastoidectomy for initial management of acute mastoiditis in the absence of a subperiosteal abscess or central nervous system extension.