Trends in the incidence and treatment of mastoiditis and associated complications

Abstract

Objectives: Evaluate hospital utilization for mastoiditis and its complications. Methods: National Inpatient Sample (NIS) for 1998–2000 was searched for diagnosis of mastoiditis, and examined for demographics, complications, and procedures. Data were analyzed to identify factors affecting length of stay (LOS) and charges. Results: There were 2289 admissions (1272 age <18, 1017 age >18 years) for mastoiditis, representing 0.01% of NIS sample. Approximately 20% of pediatric and adult admissions had complications of mastoiditis, including meningitis, brain abscess, and facial paralysis. Admissions with complications had increased LOS ( P < 0.01) but similar charges to those without. Pediatric admissions with procedures had a mean of 2.4 procedures; 57% had none. Myringotomy was performed in over 90% of pediatric admissions with procedures. Pediatric admissions for acute/subacute mastoiditis had fewer secondary diagnoses and procedures ( P < 0.001) and lower LOS and charges ( P < 0.02) than admissions for chronic mastoiditis. Adult admissions with procedures had a mean of 2.3 procedures; 58% had none. Mastoidectomy was performed in 80% of adult admissions with procedures. Adult admissions for chronic mastoiditis had shorter LOS ( P < 0.05) and more procedures ( P < 0.001) than admissions for acute/subacute mastoiditis. Conclusion: The incidence of mastoiditis among hospitalized patients is low, although a significant percentage experience complications. Surgical management was primarily myringotomy for pediatric patients, and mastoidectomy for adults. Increased age and number of secondary diagnoses was associated with presence of complications in pediatric patients, while increased number of secondary diagnoses was associated with presence of complications in adults. Multiple factors including disease chronicity, age, race, and secondary diagnoses affected LOS and total charges.