Prognostic Role of Unusual Clinical Presentation in Acute Mastoiditis

Abstract

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.