Acute mastoiditis in children: A retrospective study of 188 patients

Objective: The aim of this study is to define the clinical and bacteriological characteristics of acute mastoiditis (AM) in children in order to optimize diagnostic work-up and treatment. Methods: In this retrospective study, 188 children between 3 months and 15 years of age (15 +/- 24 months; median +/- SD) were referred to our pediatric ENT emergency center for AM during a 7-year period (December 2001-January 2008). Results: Fifty seven percent were male and 43% were female. Clinical follow-up duration was 3.9 +/- 0.7 months (mean +/- SEM). The incidence of AM remained stable during the whole study period. Microbiological samples (n = 236) were negative in 33% of cases. The most frequently isolated germs were Streptococcus pneumoniae (51%). Streptococcus pyogenes (11.5%), Anaerobes (6.5%), and coagulase-negative Staphylococcus (6.5%). Paracentesis, puncture of retro auricular abscess under local anesthesia, and peroperative samples all contributed to isolate the involved germ(s). All the patients were hospitalized and received intravenous antibiotics, and 36.2% (n = 68) underwent surgery. Several surgical procedures were necessary in 4 cases (2.1%). AM recurrences requiring a second hospitalization were observed in 8 patients (4.3%). The only observed complication was lateral sinus thrombosis (n = 6; 3.2%). Surgical failures, requiring more than one surgical procedure, were more frequent in case of: (i) presence of Anaerobes (p <= 0.001) or Gram-negative bacteria (p <= 0.05) in microbiological samples; (ii) surgical drainage without mastoidectomy (p <= 0.001). Recurrences were more frequent in AM due to Streptococcus pneumoniae. Conclusions: Based on our findings and on literature data, a protocol was established in order to standardize the management of pediatric AM in our center. The mains points are: no systematic surgery; if surgery is indicated, it must encompass a mastoidectomy; broad-spectrum intravenous antibiotic treatment covering the most commonly involved germs (3rd generation cephalosporin) and secondarily adapted to the results of microbiological samples. If the infection is not controlled after 48 h of intravenous antibiotherapy, a mastoidectomy had to be performed. (C) 2010 Elsevier Ireland Ltd. All rights reserved.