Indications for Mastoidectomy in Acute Mastoiditis in Children

Abstract

The objective of this study was to identify clinical features of acute mastoiditis in children that are indicative of the need for mastoidectomy. We performed a retrospective chart review of 40 children (20 male, 20 female) between 2 months and 12 years 9 months of age with a diagnosis of acute mastoiditis who were managed in our institution between July 1998 and June 2002. All patients received intravenous antibiotics; this was the only treatment in 14 patients (35%). Tympanostomy tubes were inserted in 22 patients, together with postauricular needle aspiration in 12 (30%), and incision and drainage of subperiosteal abscess in 10 (25%). Mastoidectomy was performed in 4 cases (10%), and cholesteatoma was found in 3. One other child was subsequently found to have cholesteatoma. We conclude that children who present with acute mastoiditis should undergo mastoidectomy if cholesteatoma is clinically suspected, or if extratemporal suppurative complications have occurred.

Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology

“…[2,6,7,12,14,16,18,25]. Although our rate of surgery (76%) was high, it was within the range of that reported in other studies (9-88%) [14,18,25].…”

Zygomatic abscess with temporal myositis — a rare extracranial complication of acute otitis media

“…Recurrence of disease with discharge from the ear and amoxicilline treatment also proved unproductive and eventually lead to the development of AOM complication --acute mastoiditis. The problem of increased bacterial resistance in acute mastoiditis was also observed by other authors [8,11,18,20]. Bacteria cultured from the middle ear and mastoid effusions are more resistant to regularly applied antibiotics than the bacteria found in uncomplicated AOM [11,15].…”

“…Each case of mastoiditis with purulent intratemporal or extracranial complication should be treated surgically, by myringotomy or myringostomy, mastoidectomy with pus drainage and granulation tissue removal. Treatment results of mastoiditis complications are usually good [2,17,18]. …”

Current concepts in the pathogenesis and treatment of chronic suppurative otitis media

“…Surgery in the form of tympanomastoidectomy is also indicated in cases of CSOM in which there are complications, some of which could potentially be life threatening, such as significant hearing loss, facial nerve palsy, subperiosteal abscess, petrositis, dural venous sinus thrombosis, meningitis, cerebral abscess and labyrinthine fistula, among others (Kangsanarak et & Berkowitz, 2004;Matanda et al, 2005;Zanetti & Nassif, 2006;Dubey & Larawin, 2007;Akinpelu et al, 2008;Mostafa et al, 2009). Chronic cholesteatomatous OM requires surgery, usually in the form of tympanomastoidectomy in order to eradicate cholesteatoma, a usual underlying cause of chronic infection (Shirazi et al, 2006).…”