Acute mastoiditis: A one year study in the pediatric hospital of Cairo university
Mosaad Abdel-Aziz, Hassan El-Hoshy
Abstract
Background: Acute mastoiditis is a serious complication of acute otitis media especially in the pediatric age group. This study reports the authors experience in the treatment of children admitted with acute mastoiditis to the Pediatric Hospital of Cairo University throughout the year 2007, also we aimed to evaluate our current management of this serious disease.
Methods: Nineteen children were included in this study, 11 females and 8 males, their ages ranged from 9 months to 11 years. All children were treated with intravenous antibiotic on initial admission, myringotomy was considered for cases that did not respond to medical treatment for 48 hours, while cortical mastoidectomy (with myringotomy) was reserved for cases that presented initially with subperiosteal abscess with or without postauricular fistula, cases with intracranial complications and for cases that showed no response to myringotomy (after 48 hours). Follow up of the patients was carried out for at least 1 year.
Background: Acute mastoiditis is a serious complication of acute otitis media especially in the pediatric age group. This study reports the authors experience in the treatment of children admitted with acute mastoiditis to the Pediatric Hospital of Cairo University throughout the year 2007, also we aimed to evaluate our current management of this serious disease.
Methods: Nineteen children were included in this study, 11 females and 8 males, their ages ranged from 9 months to 11 years. All children were treated with intravenous antibiotic on initial admission, myringotomy was considered for cases that did not respond to medical treatment for 48 hours, while cortical mastoidectomy (with myringotomy) was reserved for cases that presented initially with subperiosteal abscess with or without postauricular fistula, cases with intracranial complications and for cases that showed no response to myringotomy (after 48 hours). Follow up of the patients was carried out for at least 1 year.
Results: Medical management alone was enough in 5 cases (26%); all of them had erythematous tender mastoid on first presentation. Seven cases (37%) needed myringotomy; 2 of them showed no response and they needed cortical mastoidectomy and the other 5 cases responded well except for 1 case that developed post-auricular subperiosteal abscess 2 months later necessitating cortical mastoidectomy with no evidence of recurrence till the end of the follow-up period. Seven cases (37%) presented with subperiosteal abscess and they needed cortical mastoidectomy with myringotomy; they showed no recurrence till the end of the study.
Conclusion: Conservative management is an effective method in the treatment of non-complicated acute mastoiditis, but myringotomy should be considered if there is no response within 48 hours. Cortical mastoidectomy should be used in conjunction with the medical management in the treatment of complicated cases.
Background
Acute mastoiditis is a serious complication of acute otitis media (AOM). It is more common in the pediatric age group as most patients are younger than 4 years, this higher incidence in younger age group reflects the peak age for AOM, however its incidence has been decreased since the revolution of antibiotic therapy. Some recent literature indicated an increase of the disease incidence in last years especially in countries with less antibiotic prescription, while others reported that no increased incidence despite the national restriction guidelines of antibiotics prescription. The disease my cause significant and even life-threatening complications beyond the tympanomastoid system; including subperiosteal abscess, Bezolds abscess, facial paralysis, suppurative labyrinthitis, meningitis, epidural and subdural abscess, brain abscess, lateral sinus thrombophlebitis, and otitic hydrocephalus.
The treatment of acute mastoiditis is variable, ranging from conservative management in the form of parenteral antibiotic therapy to myringotomy (with or without ventilation tube placement) to a more aggressive intervention in the form of mastoidectomy. This study reports the authors experience in the treatment of children admitted with acute mastoiditis to the Pediatric Hospital of Cairo University throughout the year 2007, also we aimed to evaluate our current management of this serious disease in the pediatric population.
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Conclusion: Conservative management is an effective method in the treatment of non-complicated acute mastoiditis, but myringotomy should be considered if there is no response within 48 hours. Cortical mastoidectomy should be used in conjunction with the medical management in the treatment of complicated cases.
Background
Acute mastoiditis is a serious complication of acute otitis media (AOM). It is more common in the pediatric age group as most patients are younger than 4 years, this higher incidence in younger age group reflects the peak age for AOM, however its incidence has been decreased since the revolution of antibiotic therapy. Some recent literature indicated an increase of the disease incidence in last years especially in countries with less antibiotic prescription, while others reported that no increased incidence despite the national restriction guidelines of antibiotics prescription. The disease my cause significant and even life-threatening complications beyond the tympanomastoid system; including subperiosteal abscess, Bezolds abscess, facial paralysis, suppurative labyrinthitis, meningitis, epidural and subdural abscess, brain abscess, lateral sinus thrombophlebitis, and otitic hydrocephalus.
The treatment of acute mastoiditis is variable, ranging from conservative management in the form of parenteral antibiotic therapy to myringotomy (with or without ventilation tube placement) to a more aggressive intervention in the form of mastoidectomy. This study reports the authors experience in the treatment of children admitted with acute mastoiditis to the Pediatric Hospital of Cairo University throughout the year 2007, also we aimed to evaluate our current management of this serious disease in the pediatric population.
DOWNLOAD COMPLETE PDF HERE
Acute mastoiditis is rarely seen today. Prior to the discovery of antibiotics, acute mastoiditis was the most common complication of acute otitis media and often resulted in death. The incidence has dropped significantly with the advent of antibiotics. Likewise, the frequency of mastoidectomy for this condition has decreased ten fold, down from 20% in 1938 to 2.8% in 1948 with a 90% decrease in mortality rate. Acute mastoiditis is a natural extension of acute otitis media. At the onset of infection, acute inflammation of the middle ear also involves inflammation of the mastoid air cells, which is not associated with bony resorption and must be differentiated from clinically significant mastoiditis