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Conservative Management of Acute Mastoiditis in Children
JAMA Otolaryngology—Head & Neck Surgery, 04/19/2011
Bakhos D et al. - Antibiotic drug use combined with retroauricular puncture and grommet insertion is an effective alternative to mastoidectomy in the treatment of acute mastoiditis with subperiosteal abscess (SA) in children.
Methods- The authors identified 50 patients younger than 14 years with acute mastoiditis (mean age, 32 months).
- Individuals with subacute mastoiditis and cholesteatoma were excluded from this study.
- All the children had received antibiotic drug treatment.
- Before 2002, a subperiosteal abscess (SA) was managed by mastoidectomy.
- Beginning in 2002, however, conservative management was initially attempted to avoid mastoidectomy.
- Acute mastoiditis occurred in 30 patients already treated with antibiotics before hospital admission.
- On examination, 1 child had facial palsy. All the patients except 1 (who had temporozygomatic swelling) had postauricular swelling.
- Myringotomy or retroauricular puncture isolated bacteria in 38 patients.
- Streptococcus pneumoniae was identified in 28 patients.
- Computed tomography (43 patients) diagnosed 31 SAs, including 3 cases of sigmoid sinus thrombosis and 1 subdural abscess.
- All the children were cured without complications regardless of the type of treatment.
- Comparing the periods before and after 2002, the number of SAs was similar (15 and 16, respectively), but the number of mastoidectomies was reduced (16 and 1, respectively).
- The hospital length of stay of patients who underwent aspiration was shorter than that of patients who underwent cortical mastoidectomy.
