Management of acute mastoiditis in children. A retrospective study and literature review

Abstract Objectives We aimed to figure out clinical characteristics of pediatric acute mastoiditis and to plan a strategy for the management of these young patients. Methods In this retrospective study we evaluated the medical records of 32 patients aged less than 16 years old, who were treated in our department for acute mastoiditis between 2000 and 2011. Results The mean age of the population was 3.7 years. In 6 children (18%) previous pathologic conditions of the ear have been reported. All children had some evidence of post-auricular inflammation. Other symptoms such as auricular protrusion, otorrhea, fever and otalgia have been reported. White blood cell count showed elevated values of leucocytes in 72% of the cases. Anemia was noted in 24 patients with a mean hemoglobin rate of 9 g/dl. Computerized tomographic scan of the petrous temporal bones was required in 27 children. In our series, 19 patients had subperiosteal abscess and 3 children presented involvement of the central nervous system. Upon admission, all the patients were immediately put on intravenous antibiotics. Abscess drainage was indicated in 11 cases. A simple mastoidectomy was performed in 54% of the cases. Most of the children recovered well. Three children suffering from immunodeficiency had a recurrence of acute mastoiditis and required a second surgical treatment. Conclusion Initial management of acute mastoiditis starts with intravenous antibiotics and computerized tomographic scan of the petrous temporal bones. Surgical approach is required in case of complications or failure of medical treatment. Watchful clinical monitoring is essential in all cases.