Epidemiology and variability in management of acute mastoiditis in children

Edwards, Stephen H.; Kumar, Sandeep; Lee, So-Yoon; Pali, Beth L.; Marek, Rachel L.; Dutta, Ankhi

doi:10.1016/j.amjoto.2022.103520

Cited by 10 publications

(10 citation statements)

References 23 publications

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“…Since the advent of universal PCV access, and especially PCV13, the incidence of AM has decreased, although it remains the most common complication of AOM. 1 The 2008 systematic review by van den Aardweg et al 5 reported an average of 42% of children with a history of otologic disease, compared to 30% (n = 34) in our series. This lower percentage may be due to the retrospective study design used here, as some of the charts may have been incomplete.…”

Section: Discussioncontrasting

confidence: 43%

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Prognostic Role of Unusual Clinical Presentation in Acute Mastoiditis

Huélamo,

Alonso-Cadenas,

Moreno

et al. 2024

Preprint

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Purpose To determine if unusual manifestations of acute mastoiditis (AM) have a worse outcome than when the disease presents characteristically. As a secondary objective, we describe the patients with an atypical clinical presentation of AM included in the series. Methods Retrospective single-center observational study of patients younger than 18 years diagnosed with AM from June 1, 2018 to May 31, 2023. Unusual or atypical presentation is defined as any clinical manifestation in the absence of retroauricular erythema and/or ear protrusion observed on physical examination. Results A total of 110 children with AM were included in the registry. The clinical presentation was usual in 104 patients (94.5%) and unusual in 6 (5.5%). The signs and symptoms on physical examination of children with an unusual presentation were as follows: fever, otalgia, and altered level of consciousness (Patients 1 and 2), ataxia (Patients 3 and 4), fever, ataxia, and vomiting (Patient 5), and headache and vomiting (Patient 6). Poor outcomes were more frequent in children with an unusual presentation (P < 0.001), mainly due to intracranial complications. In this series, only one patient with a usual clinical presentation developed sequelae (P > 0.05). Conclusions While AM with an unusual presentation is an uncommon finding, it should be considered in the differential diagnosis of young children with neurologic symptoms. Our results do not suggest a delay in diagnosis, but do show a greater risk of poor outcome.

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Section: Discussioncontrasting

confidence: 43%

“…The estimated incidence is 1.8/100,000 children since the introduction of the pneumococcal conjugate vaccine (PCV), PCV13. 1 The diagnosis of AM is clinical. Patients usually present with fever, otalgia, retroarticular erythema, and/or ear protrusion.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Role of Unusual Clinical Presentation in Acute Mastoiditis

Huélamo,

Alonso-Cadenas,

Moreno

et al. 2024

Preprint

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“…These findings are consistent with previous studies. Groth et al [16] and Edward et al [29] reported otalgia as a common presenting symptom of acute mastoiditis in pediatric populations, irrespective of age or gender. The lack of significant associations between symptoms and demographic variables underscores the importance of considering individual clinical presentations rather than demographic factors alone when diagnosing and managing acute mastoiditis in pediatric patients [30].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Acute Mastoiditis in Saudi Arabia: Demographic Insights, Clinical Profiles, and Prognostic Factors

Alshehri,

Alahmari

2024

Children

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Acute mastoiditis, a complication of otitis media, poses significant challenges in diagnosis and treatment, particularly in pediatric populations. This study aims to comprehensively evaluate the demographic characteristics, clinical features, and prognostic factors associated with acute mastoiditis in pediatric patients in Saudi Arabia. Analysis of a multicenter dataset was conducted to assess demographic variables, symptomatology, disease course, and predictors of acute mastoiditis in pediatric patients. Significant associations were found between demographic variables (age group, gender, nationality) and acute mastoiditis risk. Symptomatology analysis revealed consistent frequencies of otalgia across age groups and genders. Disease course analysis highlighted a mean duration from symptom onset to diagnosis of 14.11 days, with frequent complications like mastoid abscess and meningitis. Predictor identification identified symptoms (otalgia, fever, otorrhea), duration of illness, and complications as significant predictors of disease severity. These findings contribute valuable insights into the epidemiology and clinical management of acute mastoiditis, informing targeted interventions to improve patient outcomes.

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“…Rather, it is an external ear colonizer which can cause misleading false-positive culture results when ear swabs are used as a specimen source. Therefore, the practice of obtaining mastoid cultures or middle ear cultures instead of external ear cultures should be the mainstay of pathogen identification in AM [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…If no improvement is observed within 24 to 48 hours following the initial treatment, or if any complications are suspected, mastoidectomy should be considered [ 9 ]. There is wide variation when it comes to the duration of treatment of AM, and no difference was evident in readmission rates between shorter (<10-14 days) versus longer (>10-14 days) duration of oral antibiotic therapy following discharge [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Child With Retroauricular Tenderness: Is It Really Mastoiditis?

Saeed¹,

Maharjan²

2023

Cureus

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The presence of retroauricular tenderness and erythema has always been closely linked to a diagnosis of acute mastoiditis (AM), a condition that has become less common over the years given the advent of antibiotics and pneumococcal vaccination. However, other etiologies such as retroauricular cellulitis can also present similarly. We present the case of a 10-year-old patient who presented with outward and downward protrusion of the left ear with retroauricular tenderness and erythema and was initially presumed to have a diagnosis of AM and admitted for intravenous antibiotic management. Imaging was negative for any evidence of AM, and in retrospect, the patient was diagnosed with retroauricular cellulitis secondary to acute otitis externa. Being familiar with this differential of retroauricular pain and tenderness can lead to more cost-effective patient care and a different approach with antibiotic management.

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Epidemiology and variability in management of acute mastoiditis in children

Cited by 10 publications

References 23 publications

Prognostic Role of Unusual Clinical Presentation in Acute Mastoiditis

Prognostic Role of Unusual Clinical Presentation in Acute Mastoiditis

Pediatric Acute Mastoiditis in Saudi Arabia: Demographic Insights, Clinical Profiles, and Prognostic Factors

A Child With Retroauricular Tenderness: Is It Really Mastoiditis?

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