Therapeutic approach to pediatric acute mastoiditis – an update

Mierzwiński, Józef; Tyra, Justyna; Haber, Karolina; Drela, Maria; Pa̧czkowski, Dariusz; Puricelli, Michael D.; Sinkiewicz, Anna

doi:10.1016/j.bjorl.2018.06.002

Cited by 14 publications

(5 citation statements)

References 30 publications

(54 reference statements)

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“…S. pneumoniae was rare (3.4%). Other studies have reported a very high prevalence of S. pneumoniae infection in AM (21–77%) (14–16) and have declared it to be the predominant pathogen. An explanation for the difference to other studies might be the pneumococcal vaccination, which was introduced and recommended by the Standing Committee on Vaccination in Germany in 2006.…”

Section: Discussionmentioning

confidence: 99%

A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases

Häußler,

Peichl,

Bauknecht

et al. 2023

Otol Neurotol

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Background Acute mastoiditis (AM) is a potentially life-threatening condition primarily affecting children. To date, there are no consistent criteria or valid guidelines for the diagnosis and treatment of pediatric AM. Therefore, this study evaluates the clinical course of AM in terms of clinical signs and treatment. In addition, a novel classification scheme for the disease and a treatment algorithm is being proposed. Methods Patient records over a 12-year period from a single center were reviewed to identify confirmed cases of AM in children. Data collected included clinical signs, body temperature, and infection parameters during the disease, as well as radiological imaging, antibiotics, and surgical as well as conservative treatment. In addition, a classification of the AM stages was established in accordance with the findings described and practical experience, consisting of four stages (1, mastoidal irritation; 2, mild AM; 3, advanced AM; 4, advanced AM and additional complications) with corresponding treatment recommendations. In the retrospective cohort, those AM cases that were treated alongside the classification were compared with the rest concerning clinical course and outcome. Results A total of 109 patients (mean age, 3.8 ± 3.8 years) were included. The main symptoms at hospital admission were auricular protrusion (n = 73; 67.0%), fever (n = 56; 51.4%) with a mean temperature of 38.3 ± 1.1°C, and otalgia (n = 28; 25.7%). The mean laboratory-tested levels of leukocytes and C-reactive protein at the time of hospital admission were 15.96 ± 8.7/nl and 59.6 ± 54.0 mg/L, respectively. During winter, there was a higher prevalence of AM, with peak hospital admissions in April (n = 22). The most common pathogen was Streptococcus pyogenes (32 cases). Treatment was purely conservative in four cases, whereas the remaining cases underwent surgery (41× grommet insertion, 64× plus mastoidectomy). The outcome was generally good, but in eight patients a second surgical procedure had to be performed as they showed signs of clinical deterioration. A total of 101 patients were treated according to the proposed algorithm, and all of which had a good outcome without the need for further interventions. Conclusion Based on clinical experience in a large cohort of pediatric AM patients, a novel diagnostic and treatment algorithm has been developed and successfully tested in a retrospective cohort for AM in children to prevent further complications and to ease its management by pediatricians and otorhinolaryngologists in the emergency setting.

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Section: Discussionmentioning

confidence: 99%

A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases

Häußler,

Peichl,

Bauknecht

et al. 2023

Otol Neurotol

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“…17 Based on a recent systematic review of pediatric acute mastoiditis management, nearly 75% of the patients with uncomplicated cases were cured without surgical therapy; however, myringotomy with or without tube placement achieved a 94% cure rate. 18 For complicated cases, treatment may involve intravenous antibiotic therapy with or without myringotomy, 6 mastoidectomy (if the infection is not controlled after 48 hours of intravenous antibiotics), 19 and craniotomy (in severe cases with intracranial complications). 20 According to the systematic review by Anne et al, 18 mastoidectomy achieved a 100% cure rate, whether performed alone or after less invasive procedures.…”

Section: Discussionmentioning

confidence: 99%

Complications in Pediatric Acute Mastoiditis: HCUP KID Analysis

Favre¹,

Patel

Carr³

2021

Otolaryngol.--head neck surg.

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Objective A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and mortality. The aim of this study was to evaluate the incidence and management of complications related to pediatric acute mastoiditis using a national database. Study Design Retrospective review of 2016 Kids’ Inpatient Database, part of the Healthcare Cost and Utilization Project. Setting Academic, community, general, and pediatric specialty hospitals in the United States. Methods International Classification of Diseases, Tenth Revision, Clinical Modification code H70.XXX was used to retrieve records for children admitted with a diagnosis of mastoiditis. Data included patient demographics, intracranial infections, procedures (middle ear drainage, mastoidectomy, and intracranial drainage), length of stay (LOS), and total charges. Results In total, 2061 children aged ≤21 years were identified with a diagnosis of acute mastoiditis. Complications included subperiosteal abscess (6.90%), intracranial thrombophlebitis/thrombosis (5.30%), intracranial abscess (3.90%), otitic hydrocephalus (1.20%), encephalitis (0.90%), subperiosteal abscess with intracranial complication (0.60%), petrositis (0.60%), and meningitis (0.30%). Children with intracranial abscesses were more likely ( P < .001) to undergo myringotomy ± ventilation tube insertion (63.7%), mastoidectomy (53.8%), mastoidectomy with ventilation tube or myringotomy (42.5%), intracranial drainage procedure (36.3%), or all 3 key procedures (15.0%). Children with any type of intracranial complication had a significantly longer LOS ( P < .001) and higher total charges ( P < .001). Both a diagnosis of bacterial meningitis and undergoing an intracranial drainage procedure ( P < .001) contributed significantly to LOS and total charges. Conclusion Patients with intracranial complications are more likely to undergo surgical procedures; however, there is still wide variability in practice patterns, illustrating that controversies in the management of otitis media complications persist.

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“…Em quadros persistentes é adotado a ingestão de fármacos com incisão e drenagem de abscesso sub-periosteal. Em último caso, é realizado o tratamento farmacológico com mastoidectomia/revisão de mastoidectomia (MIERZWIŃSKI et al, 2019).…”

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Casos clínicos em audiologia e suas inter-relações com a linguagem

2023

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Os autores desta obra: 1. Atestam não possuir qualquer interesse comercial que constitua um conflito de interesses em relação ao artigo científico publicado; 2.Declaram que participaram ativamente da construção dos respectivos manuscritos, preferencialmente na: a) Concepção do estudo, e/ou aquisição de dados, e/ou análise e interpretação de dados; b) Elaboração do artigo ou revisão com vistas a tornar o material intelectualmente relevante; c) Aprovação final do manuscrito para submissão.; 3. Certificam que os artigos científicos publicados estão completamente isentos de dados e/ou resultados fraudulentos; 4. Confirmam a citação e a referência correta de todos os dados e de interpretações de dados de outras pesquisas; 5.Reconhecem terem informado todas as fontes de financiamento recebidas para a consecução da pesquisa; 6. Autorizam a edição da obra, que incluem os registros de ficha catalográfica, ISBN, DOI e demais indexadores, projeto visual e criação de capa, diagramação de miolo, assim como lançamento e divulgação da mesma conforme critérios da Atena Editora. DECLARAÇÃO DA EDITORA A Atena Editora declara, para os devidos fins de direito, que: 1. A presente publicação constitui apenas transferência temporária dos direitos autorais, direito sobre a publicação, inclusive não constitui responsabilidade solidária na criação dos manuscritos publicados, nos termos previstos na Lei sobre direitos autorais (Lei 9610/98), no art. 184 do Código Penal e no art. 927 do Código Civil; 2. Autoriza e incentiva os autores a assinarem contratos com repositórios institucionais, com fins exclusivos de divulgação da obra, desde que com o devido reconhecimento de autoria e edição e sem qualquer finalidade comercial; 3. Todos os e-book são open access, desta forma não os comercializa em seu site, sites parceiros, plataformas de ecommerce, ou qualquer outro meio virtual ou físico, portanto, está isenta de repasses de direitos autorais aos autores; 4. Todos os membros do conselho editorial são doutores e vinculados a instituições de ensino superior públicas, conforme recomendação da CAPES para obtenção do Qualis livro; 5. Não cede, comercializa ou autoriza a utilização dos nomes e e-mails dos autores, bem como nenhum outro dado dos mesmos, para qualquer finalidade que não o escopo da divulgação desta obra.

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Therapeutic approach to pediatric acute mastoiditis – an update

Cited by 14 publications

References 30 publications

A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases

A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases

Complications in Pediatric Acute Mastoiditis: HCUP KID Analysis

Casos clínicos em audiologia e suas inter-relações com a linguagem

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