© 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
Summary
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.
INTRODUCTION
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.
RESULTS
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
- Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
- Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
- Aby kupić kod proszę skorzystać z jednej z poniższych opcji.
Opcja #1
19 zł
Wybieram
- dostęp do tego artykułu
- dostęp na 7 dni
uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony
Opcja #2
49 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 30 dni
- najpopularniejsza opcja
Opcja #3
119 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 90 dni
- oszczędzasz 28 zł
Piśmiennictwo
1. Janczewski G: Otorynolaryngologia praktyczna. 2005, wydanie I: 122-123. 2. Pang LH, Barakate MS, Havas TE: Mastoiditis in a paediatric population: a review of 11years experience in management. Int J Pediatr Otorhinolaryngol, 2009 Nov; Vol. 73 (11): 1520-1524. 3. Luntz M, Keren G, Nusem S, Kronenberg J: Acute mastoiditis – revisited. Ear, Nose & Throat Journal, 1994 Sep; Vol. 73 (9), 648-654. 4. Lammers TH, Krieser DM: Unusual presentation of acute otomastoiditis with petrositis. J Paediatr Child Health, 2013 Apr 1. 5. Pang LH, Barakate MS, Havas TE: Mastoiditis in a paediatric population: a review of 11 years experience in management. Int J Pediatr Otorhinolaryngol, 2009 Nov; Vol. 73 (11): 1520-1524. 6. Kontorinis G, Psarommatis I, Karabinos C et al.: Incidence of non-infectious ’acute mastoiditis’ in children. J Lar Otol, 2012 Mar; Vol. 126 (3): 244-248. 7. Anthonsen K, Høstmark K, Hansen S et al.: Acute Mastoiditis in Children: A 10-year Retrospective and Validated Multicenter Study.Pediatr Infect Dis J, 2013 May; Vol. 32 (5): 436-440. 8. Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC: Intratemporal complications from acute otitis media in children: 17 cases in two years. Acta Otorrinolaringológica, 2012 Jan-Feb; Vol. 63 (1): 21-25. 9. Gorphe P, de Barros A, Choussy O et al.: Acute mastoiditis in children: 10 years experience in a French tertiary university referral center. Eur Arch Otorhinolaryngol, 2012 Feb; Vol. 269 (2): 455-460. 10. Morinière S, Lanotte P, Celebi Z et al.: Acute mastoiditis in children: clinical and bacteriological study of 17 cases. Presse Med, 2003 Sep 27; 32(31): 1445-1449. 11. Homøe P, Jensen RG, Brofeldt S: Acute mastoiditis in Greenland between 1994-2007. Rural And Remote Health, 2010 Apr-Jun; Vol. 10 (2): 1335. 12. Groth A, Enoksson F, Hultcrantz M et al.: Acute mastoiditis in children aged 0-16 years-a national study of 678 cases in Sweden comparing different age groups. Int J Pediatr Otorhinolaryngol, 2012 Oct; Vol. 76 (10), pp. 1494-500. 13. Pritchett CV, Thorne MC: Incidence of pediatric acute mastoiditis: 1997-2006. Arch Otolaryngol Head Neck Surg, 2012 May; Vol. 138 (5): 451-455. 14. Anthonsen K, Høstmark K, Hansen S et al.: Acute Mastoiditis in Children: A 10-year Retrospective and Validated Multicenter Study. Pediatr Infect Dis J, 2013 May; Vol. 32 (5): 436-440. 15. Chien JH, Chen YS, Hung IF et al.: Mastoiditis diagnosed by clinical symptoms and imaging studies in children: disease spectrum and evolving diagnostic challenges. J MicrobiolImmunolInfect, 1995-9133, 2012 Oct; Vol. 45 (5): 377-381. 16. Minks DP, Porte M, Jenkins N: Acute mastoiditis – the role of radiology.Clin Radiol, 2013 Apr; Vol. 68 (4): 397-405. 17. Tamir S, Schwartz Y, Peleg U et al.: Acute mastoiditis in children: is computed tomography always necessary? Ann Otol Rhinol Laryngol, 2009 Aug; Vol. 118 (8): 565-569. 18. Migirov L: Computed tomographic versus surgical findings in complicated acute otomastoiditis. Ann Otol Rhinol Laryngol, 2003 Aug; Vol. 112 (8): 675-677. 19. Psarommatis IM, Voudouris C, Douros K et al.: Algorithmic management of pediatric acute mastoiditis. Int J Pediatr Otorhinolaryngol, 2012 Jun; Vol. 76 (6): 791-796. 20. Trijolet J, Bakhos D, Lanotte Pet al.: Acute mastoiditis in children: can mastoidectomy be avoided? Ann Otolaryngol Chir Cervicofac, 2009 Sep; Vol. 126 (4): 169-174. 21. Goldstein NA, Casselbrant ML, Bluestone CD, Kurs-Lasky M: Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg, 1998 Nov; Vol. 119 (5): 444-454.
