© Borgis - New Medicine 4/2013, s. 107-110
Teresa Ryczer, *Lidia Zawadzka-Głos, Małgorzata Dębska, Monika Jabłońska-Jesionowska
Acute mastoiditis in pediatric population
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Lidia Zawadzka-Głos, MD, PhD
Introduction. Among intratemporal complications of acute otitis media, acute mastoiditis (AM) is the most common one. The diagnosis is based mainly on the clinical features, though radiological imaging can be helpful in more serious cases. The management consist of conservative and surgical treatment.
Material and methods. The retrospective analysis of patients with acute mastoiditis hospitalized in the Department of Pediatric Otolaryngology of Medical University of Warsaw from January 2011 to January 2013 was done. Data assessed included demographic characteristics, the type of complications, applied antibiotic therapy and surgical treatment.
Results. 24 patients with acute mastoidits were admitted to the hospital. The median age was 3.86 years (age range: 8 months to 13 years). Myringotomy was done in 20 patients (83%). Simple mastoidectomy was performed in 9 cases (37.5%). 6 patients had mastoid subperiosteal abscess. The standard antibiotic treatment was in most cases cefuroxime and clindamycin. In 3 patients the cause of mastoiditis was chronic inflammation process.
Conclusions. Acute mastoiditis occurs in most cases due to acute inflammatory process. The initial management always involves broad-spectrum antibiotic therapy. If there is no tympanic membrane perforation with otorrhea, myringotomy should be performed. In case of mastoid subperiosteal abscess, simple mastoidectomy (antromastoidectomy) can be indispensable, although abscess drainage plus myringotomy has been discussed in literature as equally good treatment.
The complications of acute otitis media may be intratemporal and extratemporal. Acutemastoiditisis the most common intratemporal complication ofacuteotitis media. Other intratemporal complications include acute labyrinthitis and perilymphatic fistula, facial palsy, and petrositis (with Gradenigo’s syndrome). The development of acute labyrinthitis may lead to sensorineural hearing loss. Extratemporal complications are subdivided into intracranial (meningitis, epidural abscess, subdural abscess, abscess of the central nervous system, sigmoid sinus thrombosis and otic hydrocephalus) and extracranial such as retroauricular, zygomatic and Bezold abscess (1, 2). Even though antibiotics are in widespread use, intratemporal complications of acute otitis media still occur in pediatric population. It is often that patients with AMhave no previous history of middle ear diseases. In the study of Luntz et al. 72% patients had negative history for middle ear pathology (3). The classical clinical features of acute mastoiditis are fever, erythema and tenderness in postauricular area, with displacement of the auricle (fig. 1). There are insufficient data to provide an evidence-based diagnostic scheme for acutemastoiditis. Management of AM consist of antibiotic therapy, radiological imaging including ultrasound and/or computed tomography if needed and surgical procedures (4).
Fig. 1. Acute mastoiditis in pediatric patient.
MATERIAL AND METHODS
The retrospective analysis was performed in the group of patients with acute mastoiditis that were hospitalized in the Department of Pediatric Otolaryngology of Medical University of Warsaw from January 2011 to January 2013. The analysis included data such as demographic characteristics, the type of complications, applied antibiotic therapy and the type of surgical procedures.
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