Mastoiditis in children

Background Despite new antibiotics mastoiditis in children still is a serious infection confronting the pediatrician and otolaryngologist with diagnostic and therapeutic problems. Patients and Methods In a retrospective study we reviewed the charts of 48 children who had a mastoidectomy from 1990 to 1995 in the Department of Oto-Rhino-Laryngology at the University of Essen. Results 60% of the patients presented with a retroauricular swelling, and a pathologic tympanic membrane was found in 89%. The erythrocyte sedimentation rate as the most valuable laboratory parameter was increased in 95% of cases. Larger osteodestructive lesions as a complication of mastoiditis could be predicted in three of ten cases by plain x-ray of the temporal bone. The most common bacteria to be isolated were Staphylococcus aureus, Streptococcus pneumoniae and Pseudomonas aeruginosa. Conclusion Because of potential endocranial complications (10% in our patients) as well as difficult radiologic diagnosis of osteodestructive lesions by plain x-ray, we advocate mastoidectomy instead of a mere pharmacological therapy in the treatment of mastoiditis.