Abstract
The objective was to review our experience with clinical course, diagnostic and therapeutic profile of children treated for acute mastoiditis, and to investigate for possible susceptibility factors. Study was designed as retrospective review of pediatric patients presenting with acute mastoiditis secondary to acute otitis media over the last 6 years, from 2000 to 2006. The study involved children aged from 1 to 16 years treated for acute mastoiditis and subsequent intratemporal and intracranial complications in Clinic for otorhinolaryngology, Clinic Center Banja Luka. Selected clinical parameters, mastoid coalescence and risk factors for necessity of surgical intervention were analyzed. Medical history review of a total of 13 patients with acute mastoiditis was analyzed. Acute coalescent mastoiditis occurred 11 patients (84%) while noncoalescent form of acute mastoiditis occurred in 2 cases (16%). Intracranial complication occurred in 3 patients (2 meningitis and 1 peridural intracranial abscess), while 2 patients had intratemporal complication (subperiostal abscess) associated to coalescent mastoiditis. We observed clinical profile of acute mastoiditis in regard to pathology found on the tympanic membrane, middle ear mucosa and destructions on the bony wall of the middle ear and mastoid. The main signs of progressive infection were tympanic membrane perforation, pulsatile suppurative secretion from the mucosa, and intratemporal abscess. All patients with coalescent mastoiditis required mastoidectomy, while noncoalescent mastoiditis was treated conservatively with broad-spectrum intravenous antibiotics and myringotomy. In conclusion acute mastoiditis is uncommon but serious complication of acute otitis media in children associated with significant morbidity. Coalescent mastoiditis concomitant with subperiostal abscess, intracranial complications and mastoiditis not responsive after 48 hours to intravenous antibiotics should urge clinician to timely mastoid surgery.
Highlights
Patients and MethodsAcute mastoidits and complications Meningitis Peridural abscess Subperiostal mastoid abscess Mastoid bony wall destruction Mastoid mucoperiosteal inflammation Total coalescent 2 1 2 6 0 mastoiditisMastoidits Coalescent and noncoalescent * Endocranial complications † Intratemporal complications ‡ Total X2 statistic pLatency to the onset of acute mastoiditis - 5 daysTotal 8 3 2 in regard to clinical profiles of acute mastoiditis, demographical profiles, therapy protocol and the treatment outcome we used nonparametric test Chi square test for independent samples
We evaluated significance of physical signs, and therapy protocols used to treat acute mastoiditis in relation to coalescent and noncoalescent form of acute mastoiditis
Noncoalescent mastoiditis was treated with intravenous antibiotics and in one case myringotomy and insertion of ventilating tube
Summary
Patients and MethodsAcute mastoidits and complications Meningitis Peridural abscess Subperiostal mastoid abscess Mastoid bony wall destruction Mastoid mucoperiosteal inflammation Total coalescent 2 1 2 6 0 mastoiditisMastoidits Coalescent and noncoalescent * Endocranial complications † Intratemporal complications ‡ Total X2 statistic pLatency to the onset of acute mastoiditis - 5 daysTotal 8 3 2 in regard to clinical profiles of acute mastoiditis, demographical profiles, therapy protocol and the treatment outcome we used nonparametric test Chi square test for independent samples. Acute mastoidits and complications Meningitis Peridural abscess Subperiostal mastoid abscess Mastoid bony wall destruction Mastoid mucoperiosteal inflammation Total coalescent 2 1 2 6 0 11 mastoiditis. Mastoidits Coalescent and noncoalescent * Endocranial complications † Intratemporal complications ‡ Total X2 statistic p. Latency to the onset of acute mastoiditis - 5 days. Total 8 3 2 12 in regard to clinical profiles of acute mastoiditis, demographical profiles, therapy protocol and the treatment outcome we used nonparametric test Chi square test for independent samples. We evaluated significance of physical signs, and therapy protocols used to treat acute mastoiditis in relation to coalescent and noncoalescent form of acute mastoiditis. The statistical tests were calculated by Statistica software on a personal computer
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