Abstract
BackgroundAcute mastoiditis is the main suppurative complication of acute otitis media. Its incidence ranges from 1.2 to 4.2/100.000 children/year and a rise has been reported in the last years. There are controversial data regarding risk factors for mastoiditis and its complications.Aim of the study: to evaluate demographics and clinical characteristics of children with acute mastoiditis and to identify possible risk factors for complications.MethodsWe retrospectively reviewed medical charts of all the children aged 1 month-14 years admitted to our Paediatric Emergency Department from January 2002 to December 2016.ResultsOne hundred forty-seven cases (97 males and 50 females) were included in the analysis, mean age was 4.8 ± 3.6 years and 28.2% of the patients were younger than 2 years. We found an increasing number of mastoiditis per year during the last 3 years of the study. Children younger than 2 years were less treated with antibiotics for acute otitis media or treated for a shorter period (p < 0.05), while they were treated at higher antibiotic’s dosage for mastoiditis (p < 0.01). Older children presented more frequently with symptoms such as earache or retroauricular pain (p < 0.0001, p < 0.001). We didn’t identify any risk factor for mastoiditis complications in our study.ConclusionsDespite the introduction of pneumococcal vaccines, the incidence of acute mastoiditis in our population has not been reduced during the last years. We have to face all the reasons why this condition is still relevant, such as antibiotic resistance, new pathogens involved and a possible role played by the implementations of therapeutic acute otitis media guidelines restricting the use of antibiotics in this disease. A particular attention should be given to younger children where signs and symptoms may be less pronounced, therefore acute otitis media or mastoiditis may be misunderstood and appropriate treatment delayed.
Highlights
Acute mastoiditis is the main suppurative complication of acute otitis media
Acute mastoiditis (AM) is the most common severe complication of acute otitis media (AOM) and it is due to the extension of the infection to the mastoid process of the temporal bone [1]
A total of 149 episodes of AM occurred in 143 patients during 2002–2016 in our Pediatric ED
Summary
Acute mastoiditis is the main suppurative complication of acute otitis media. Its incidence ranges from 1.2 to 4.2/100.000 children/year and a rise has been reported in the last years. Aim of the study: to evaluate demographics and clinical characteristics of children with acute mastoiditis and to identify possible risk factors for complications. Balsamo et al Italian Journal of Pediatrics (2018) 44:71 their guidelines about diagnosis and treatment for AOM, every author strongly recommended pain management and suggested an observational management in low risk patients consisting in deferring antibacterial treatment for 48–72 h, the so call “watchful waiting strategy” [9, 11]. Italian guidelines were published in 2010 in order to define better AOM criteria and recommendations for watchful waiting and antibiotics’ prescription [12]. Regional guidelines suggest immediate antibiotic treatment in every severe AOM, instead of national recommendations where watchful waiting strategy is considered when AOM is unilateral and occurred in children older than 2 years
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