Acute mastoiditis in children: review of the current status.

BACKGROUND: acute mastoiditis is the most common intratemporal complication of otitis media. Its management is still a challenge due to potentially serious consequences. This study was designed to evaluate the recent experience with pediatric acute mastoiditis at our institution and to determine if the incidence of this entity is changing over time.
MATERIAL AND METHODS: retrospective review of records of children with acute mastoiditis treated at the hospital of the Medical School at the University of Porto, Portugal, between July 1993 and June 1998. Criteria for the diagnosis of acute mastoiditis were postauricular swelling and erythema, protrusion of the auricle, and evidence of co-existent or recent otitis media.
RESULTS: 43 patients fulfilled the entry criteria. Most were boys (69%). Ages ranged from 8 months to 14 years and 4 months; infants represented 40% of the total. Acute mastoiditis was the first recognized sign of otitis media in 48% of patients. More recent years of the study saw an increase in the number of children referred with acute mastoiditis. Upon admission, 56% were under antibiotic treatment, with an average intake of 5.8 days. All patients were hospitalized; 26 cases recovered after intravenous antibiotics plus myringotomy, and the rest required an additional surgical procedure. The most common organisms recovered from cultures were Streptococcus pneumoniae and Streptococcus pyogenes. In our series, associated complications occurred in 13.9%; facial paralysis in one, and involvement of the central nervous system in five.
CONCLUSIONS: pediatric acute mastoiditis continues to be a potentially dangerous infection in the antibiotic era. The incidence of this complication may be increasing recently in the community studied. Great care is required of clinicians to reach an early diagnosis in order to promote adequate management and prevent inherently severe complications.