Acute mastoiditis in children: contemporary opportunities and challenges

Abstract

BackgroundMastoiditis is the most common intra-temporal complication of acute otitis media. Despite potentially lethal sequelae, optimal management remains poorly defined.MethodA retrospective case review was conducted of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017.ResultsFifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0–27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred.ConclusionA detailed contemporary description of paediatric mastoiditis presentation and management is presented. The findings broadly mirror those published by other UK centres, but suggest a higher rate of identified disease complications and surgical interventions.

Acute paediatric mastoiditis in the UK before and during the COVID‐19 pandemic: A national observational study

“…A median age of 3.2 years in period 1 was significantly younger than the 4.7 years in period 2. The pre‐COVID‐19 figure is comparable to a recent UK series, 17 though older than most large International cohorts (1.3–2.1 years) 11,12,19 . In line with our hypothesis, Camanni et al found children aged 5–9 years were most commonly affected by mastoiditis in the summer, and an association between older age and P. aeruginosa as a causative organism for mastoiditis is described 16,18 …”

“…Camanni et al reported cases of paediatric mastoiditis limited to summer months (June‐September), finding P. aeruginosa to be the most commonly isolated organism, accounting for 51.6% of positive samples 16 . Our study did not collect data from the preceding summer to compare with period 2 unfortunately, and it is noted that P. aeruginosa can be prominent in some multi‐year series 17,18 …”

“… 16 Our study did not collect data from the preceding summer to compare with period 2 unfortunately, and it is noted that P. aeruginosa can be prominent in some multi‐year series. 17 , 18 …”

“…Complications in our population were largely due to intracranial sequelae (14.0%), similar to published series. 2 , 17 , 20 , 21 , 22 …”

“…Complications in our population were largely due to intracranial sequelae (14.0%), similar to published series. 2,17,[20][21][22] Both blood inflammatory marker levels (white cell counts and CRP) and the rate of intracranial complications and adverse events were lower in period 2. This difference is likely due to the lack of a winter effect during the pandemic: P. aeruginosa has previously been found to be associated with lower inflammatory markers, 16,18 and in our series was not associated with any intracranial complications.…”