Management of Acute Mastoiditis and Accompanying Complications in Pediatric Patients: Single Center Experience

Objective: Acute mastoiditis (AM) is the most common complication associated with acute otitis media and plays a key role in the development of further complications. We identify the clinical characteristics, management, and outcome of patients with AM and to investigate the relationship between the development of recurrence and the treatment protocol of the first episode. Methods: Children hospitalized in our clinic due to a diagnosis of AM were retrospectively reviewed. Demographic data, disease-related symptoms, types of complications accompanied by AM, medical/surgical treatment modalities, culture results, laboratory findings, and presence of recurrence were screened. Laboratory findings were compared between those with and without accompanying complications, and between those with and without accompanying intracranial complications. Results: Of the 58 patients with AM, 24 (41.3%) had isolated AM. Complications associated with AM include subperiosteal abscess (61.7%), sigmoid sinus thrombosis (11.7%), facial paralysis (8.8%), petrositis with subperiosteal abscess (5.8%), meningitis (5.8%), facial paralysis with subperiosteal abscess (2.9%) and, epidural abscess with sigmoid sinus thrombosis (2.9%). Seven patients developed intracranial complications (12%), of whom one had more than one complication. Hemoglobin and hematocrit levels were found to be significantly lower in the presence of accompanying complications (p values, respectively p=0.000, p=0.000). C-reactive protein (CRP) levels were found to be significantly higher in the presence of intracranial complications (p=0.028). Recurrent AM developed in 9 patients (15.5%) during follow-up. There was no statistically significant relationship between the treatment protocol of the first episode and the development of recurrence (p=0.332). Conclusion: A conservative approach may be preferred for surgical treatment in patients without accompanying intratemporal or intracranial complications. Low hemoglobin and hematocrit levels, with the symptoms and imaging of the patients, may be a warning of the development of accompanying complications, and high CRP values may be a warning of accompanying intracranial complications.