Bilateral Infant Mastoiditis: An Unusual Clinical Entity

Abstract

Objective: Describe the clinical presentation and management of bilateral mastoiditis in infants. Method: Retrospective chart review of patients under the age of one presenting with clinical evidence of bilateral mastoiditis. Results: Two infants fulfilling inclusion criteria were identified. Both had clinical and radiologic evidence of bilateral mastoiditis with unilateral coalescent mastoiditis and an ipsilateral subperiosteal abscess. The patients required surgical intervention, including incision and drainage of the subperiosteal abscess and bilateral myringotomies with or without pressure equalizing tubes. Streptococcus pneumoniae was cultured from both patients. One patient also grew MRSA. Significant comorbidities were identified including neutropenia, history of recent meningitis, and prematurity. Conclusion: Acute mastoiditis pursues an aggressive course in infants and can be bilateral. Streptococcus pneumoniae tends to be the most common offending organism. Bilateral disease should prompt investigation for significant co-morbidities, including immune deficiencies.