Acute mastoiditis in an Italian pediatric tertiary medical center: a 15 – year retrospective study

Abstract

BackgroundAcute mastoiditis is the main suppurative complication of acute otitis media. Its incidence ranges from 1.2 to 4.2/100.000 children/year and a rise has been reported in the last years. There are controversial data regarding risk factors for mastoiditis and its complications.Aim of the study: to evaluate demographics and clinical characteristics of children with acute mastoiditis and to identify possible risk factors for complications.MethodsWe retrospectively reviewed medical charts of all the children aged 1 month-14 years admitted to our Paediatric Emergency Department from January 2002 to December 2016.ResultsOne hundred forty-seven cases (97 males and 50 females) were included in the analysis, mean age was 4.8 ± 3.6 years and 28.2% of the patients were younger than 2 years. We found an increasing number of mastoiditis per year during the last 3 years of the study. Children younger than 2 years were less treated with antibiotics for acute otitis media or treated for a shorter period (p < 0.05), while they were treated at higher antibiotic’s dosage for mastoiditis (p < 0.01). Older children presented more frequently with symptoms such as earache or retroauricular pain (p < 0.0001, p < 0.001). We didn’t identify any risk factor for mastoiditis complications in our study.ConclusionsDespite the introduction of pneumococcal vaccines, the incidence of acute mastoiditis in our population has not been reduced during the last years. We have to face all the reasons why this condition is still relevant, such as antibiotic resistance, new pathogens involved and a possible role played by the implementations of therapeutic acute otitis media guidelines restricting the use of antibiotics in this disease. A particular attention should be given to younger children where signs and symptoms may be less pronounced, therefore acute otitis media or mastoiditis may be misunderstood and appropriate treatment delayed.

Continuous Effectiveness of Pneumococcal 13-Valent Conjugate Vaccine on Pediatric Pneumococcal Otomastoiditis: Results of 15 Years of Active/Prospective Surveillance in a Mexican Hospital on the Mexico-US Border

“…The Italian 15 years retrospective study done by Balsamo, et al [ 15 ] did not show a statistical difference of OM before and after any PCV used, however, from all 143 patients enrolled in this publication, isolation was not reported, maybe because many patients did not undergo mastoidectomy and cultures not taken. On the other hand, in the study by Marom et al [ 16 ], the authors retrospectively analyzed all causes by both uncomplicated and complicated AOM in the USA between 2001 and 2011.…”

“…Nevertheless, publications particularly searching for the effect of either PCV7 and/or PCV13 on OM are scarce [15][16][17][18].…”

“…However, its effectiveness in decreasing otomastoiditis (OM), a local/suppurative complication of AOM, has barely been reviewed [15][16][17][18]. We have performed several studies related to IPD, particularly by looking at the effectiveness of PCV13 on overall IPD and meningitis and pleural empyema [19][20][21].…”

Severe acute otitis media and mastoiditis caused by group A beta‐hemolytic streptococcus

“…17 Acute mastoiditis (AM), the most common potentially serious complication of AOM, remains quite rare. Its microbial etiology is usually S. pneumoniae or GAS, 18,19 where GAS is the causative agent in 14% to 53% of hospitalized AOM/AM cases. 18,20,21 The incidence of invasive GAS infections, including severe AOM and AM, has been shown to fluctuate with a cycle of approximately 7 to 8 years.…”

“… 17 Acute mastoiditis (AM), the most common potentially serious complication of AOM, remains quite rare. Its microbial etiology is usually S. pneumoniae or GAS, 18 , 19 where GAS is the causative agent in 14% to 53% of hospitalized AOM/AM cases. 18 , 20 , 21 …”