O Urwald1, J-C Merol, M Legros. 1. Service d'O.R.L. et de chirurgie de la face et du cou, Hôpital Robert Debré, C.H.U. de Reims, avenue du Général Koenig, 51092 Reims Cedex, France.
Abstract
OBJECTIVE: We reviewed retrospectively the clinical, radiological and therapeutic findings in 38 infants and children with acute mastoiditis. MATERIAL AND METHODS: From 1988 to 2001, 38 children (mean age 36 months) were treated for acute mastoiditis and periostitis or retroauricular abscess. RESULTS: Diagnosis was usually made on the basis of typical retroauricular signs (60% of the cases), but was sometimes delayed owing to inappropriate antibiotics in 16 cases (42%) or atypical presentation in 3 (8%). Twenty-four children (70%) had no otolaryngological history. Pneumococci were isolated in most of the cases (n=15, 57%) with 13% having penicillin-resistant pneumococci. Lateral sinus thrombophlebitis was the most frequent complication, observed in 3 children (8%). Mastoiditis revealed congenital or acquired cholesteatoma in 4 children, who were all four infected with Gram-negative bacteria. Intravenous antibiotic therapy was associated with antroatticotomy in 36 children. CONCLUSION: Despite emergence of new antibiotic resistance, the annual rate of mastoiditis has remained unchanged, remaining a serious complication of middle ear acute otitis. Cholesteatoma should be suspected in case of Gram-negative bacteria or in older children.
OBJECTIVE: We reviewed retrospectively the clinical, radiological and therapeutic findings in 38 infants and children with acute mastoiditis. MATERIAL AND METHODS: From 1988 to 2001, 38 children (mean age 36 months) were treated for acute mastoiditis and periostitis or retroauricular abscess. RESULTS: Diagnosis was usually made on the basis of typical retroauricular signs (60% of the cases), but was sometimes delayed owing to inappropriate antibiotics in 16 cases (42%) or atypical presentation in 3 (8%). Twenty-four children (70%) had no otolaryngological history. Pneumococci were isolated in most of the cases (n=15, 57%) with 13% having penicillin-resistant pneumococci. Lateral sinus thrombophlebitis was the most frequent complication, observed in 3 children (8%). Mastoiditis revealed congenital or acquired cholesteatoma in 4 children, who were all four infected with Gram-negative bacteria. Intravenous antibiotic therapy was associated with antroatticotomy in 36 children. CONCLUSION: Despite emergence of new antibiotic resistance, the annual rate of mastoiditis has remained unchanged, remaining a serious complication of middle ear acute otitis. Cholesteatoma should be suspected in case of Gram-negative bacteria or in older children.
Authors: S Palma; R Bovo; A Benatti; C Aimoni; M Rosignoli; M Libanore; A Martini Journal: Eur Arch Otorhinolaryngol Date: 2013-04-16 Impact factor: 2.503