ACUTE MASTOIDITIS: GOOD OUTCOME WITH LOW RATE OF TEMPORAL BONE CT SCAN AND MASTEIDECTOMIES

M. Arigliani, M. Robazza, R. Moretti, A. Pusiol, G. Crichiutti

Pediatric Unit, Maternal-Infant Department, University of Udine, Italy 

Background and aims: Acute mastoiditis is the most frequent complication of acute otitis media (AOM) and it can lead to severe intracranial complications. We retrospectively analysed all the cases of acute mastoiditis admitted at our institution in the last ten years.

Methods: The medical records of children with acute mastoiditis, managed at the University Hospital of Udine, Italy, between January 2001 and December 2011 were reviewed. Inclusion criteria were post-auricular swelling and erythema with evidence of co-existent or recent AOM at presentation. Criteria for cortical mastoidectomy were intracranial complication or lack of clinical improvements after 24-48 hours of antibiotic intravenous therapy with a third generation cephalosporin at full dosage, without miringotomy.

Results: 45 patients (6 months-10 years of age, sixteen younger than 2 years) fulfilled the entry criteria. Twenty-nine were males (64%), with a rate of 3.4 per 10.000 E.R. admissions. Twenty-four (54%) were already on oral antibiotics for AOM before hospital admission. Post-auricular fluctuation was detected in eight cases (24%). Only two patients underwent a contrast- enhanced CT scan of the temporal bone. Mastoidectomy was carried out in five children (11%), in one case for neurological symptoms at presentation, in the other four for the failure of the conservative approach. All the patients recovered without sequelae.

Conclusion: in our experience a conservative approach for acute uncomplicated mastoiditis, with a low rate of diagnostic CT-scan, was curative in almost 90% of cases even in the majority of patients with post- auricular fluctuation at presentation. 

Bacterial infections