Surgical intervention for acute mastoiditis: 10 years experience in a tertiary children hospital

Shavit, Sagit Stern; Raveh, Eyal; Levi, Lirit; Sokolov, Meirav; Ulanovski, David

doi:10.1007/s00405-019-05606-2

Cited by 20 publications

(16 citation statements)

References 31 publications

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“…Patients presenting intracranial complications are most likely to undergo a mastoidectomy (8) . In a series of 570 children published recently from Israel, reported a significant increase in AM cases that had an indication for surgical intervention during the years 2008-2017 (11% vs. 19% between the first and the last five years of the study respectively, P = 0.008) and described higher fever, leukocytes counts and CRP values in CAM compared to simple AM (9) . A study from the UK (10) , described 30 patients (aged 2 months to 15 years) with intracranial complications of AM.…”

Section: Discussionmentioning

confidence: 99%

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The clinical course of children undergoing mastoidectomy due to complicated mastoiditis

Ziv

Sapir

Leibowitz

et al. 2021

Preprint

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Objectives: To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) undergoing simple mastoidectomy. Study Design: A retrospective chart review of children diagnosed with CAM who underwent a mastoidectomy during 2012-2019. Setting: Tertiary care university hospital. Participants: 33 patients were divided into two groups: 17 patients with subperiosteal abscess (SPA) alone- single complication group (SCG) and 16 patients with SPA and additional complications (sigmoid sinus vein thrombosis, perisinus fluid/abscess, epidural abscess)-multiple complications group (MCG). Main Outcome Measures: post-operative data were collected. Demographics, microbiology data, inflammatory parameters, hospitalization length, and POF pattern were recorded, compared, and analyzed. Results: Of 162 acute mastoiditis patients, 33(20.4%) underwent surgery due to CAM; 17(51%) and 16(49%) belonged to the SCG and MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P=0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P=0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings; A total of 18 positive cultures were reported. Fusobacterium necrophorum counted for 8/18(44.5%) of all positive cultures, 7/9(77.8%) in the MCG vs. 1/9(11.1 %) in the SCG, P=0.004. Streptococcus pneumoniae was reported only in SCG (5/9, 55.5%, vs. 0/9, P=0.008). Conclusion: Post-mastoidectomy fever due to CAM is not unusual and seems to be a benign condition for the first 5-6 days following surgery. MCG patients are more prone to develop POF. F. necrophorum is more likely to be associated with MCG, and S. pneumoniae is common in SCG patients. Keywords: Mastoiditis, post-operative fever, complications, microbiology

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Section: Discussionmentioning

confidence: 99%

“…The high rates of F. necrophorum in our study are similar to those reported by Stern-Shavit et al . (9) and describing a significant increase in the role of F. necrophorum in the pathophysiology of CAM. In this retrospective study conducted between the years 2008-2017, 570 cases of AM were investigated.…”

Section: Microbiologymentioning

confidence: 99%

The clinical course of children undergoing mastoidectomy due to complicated mastoiditis

Ziv

Sapir

Leibowitz

et al. 2021

Preprint

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“…The surgical management may differ between various medical centers and includes myringotomy, placement of VT, and incision plus drainage of SPA, with or without cortical mastoidectomy (6) . In a series of 570 children published recently from Israel, reported a significant increase in AM cases that had an indication for surgical intervention during the years 2008-2017 (11% vs. 19% between the first and the last five years of the study respectively, P = 0.008) and described higher fever, leukocytes counts and CRP values in CAM compared to simple AM (7) . A study from the UK (8) , described 30 patients (aged 2 months to 15 years) with intracranial complications of AM.…”

Section: Discussionmentioning

confidence: 99%

Post-operative fever in children undergoing mastoidectomy due to complicated acute mastoiditis

O¹,

Sapir²,

Leibowitz³

et al. 2021

Preprint

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Objectives: To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment. Study Design: A retrospective chart review of children diagnosed with CAM who underwent mastoid surgery during 2012-2019. Setting: Tertiary care university hospital. Participants: the study includes 33 patients, divided into two groups: 17 patients with subperiosteal abscess (SPA) alone - single complication group (SCG) and 16 patients with SPA and additional intracranial or intratemporal complications -multiple complications group (MCG). Main Outcome Measures: post-operative fever course and pattern (POF). Results :33 patients belong to the SCG 17(51%) and 16(49%) belonged to the MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P=0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P=0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings. Conclusion: Following a cortical mastoidectomy for CAM, POF is not unusual in the first 6 days and seem to be benign condition. POF is more common, higher, and persistent for a longer duration in MCG compared with SCG. At POD 6, fever is expected to normalize in both groups, so if fever persists further evaluation should be considered.

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“…Several studies indicate an increase in incidence and an increase in surgical intervention and attribute this to the rising number of antibiotic resistances ( 12 , 13 ). On the other hand, numerous studies report a constant or even decreasing incidence ( 2 , 9 , 11 , 14 ). It should be noted, however, that an increase in the complication rate and the need for surgical intervention was observed here as well ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Otitis media with subsequent mastoiditis and cerebral herniation in a patient with Arnold chiari malformation

2023

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We present the case of a 13-year-old boy who unexpectedly needed to be resuscitated at home after an assumed uncomplicated otitis media. Imaging at our clinic showed mastoiditis and a cystoid mass in the left cerebellopontine angle compressing the brainstem, as well as an Arnold-Chiari-Malformation. Both the laboratory examination of cerebrospinal fluid (CSF) and surgical biopsy with pathological evaluation of the mastoid supported the inflammatory etiology of the mass. Microbiologically, Streptococcus intermedius was detected in the blood culture and CSF. Due to brain death, which most likely already existed preclinically, the organs were released for donation during the course. Our case demonstrates a very rare lethal complication of acute otitis media on the basis of a cerebral malformation and emphasizes the need to stay alert when patients complain of symptoms after assumed resolution.

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Surgical intervention for acute mastoiditis: 10 years experience in a tertiary children hospital

Cited by 20 publications

References 31 publications

The clinical course of children undergoing mastoidectomy due to complicated mastoiditis

The clinical course of children undergoing mastoidectomy due to complicated mastoiditis

Post-operative fever in children undergoing mastoidectomy due to complicated acute mastoiditis

Case report: Otitis media with subsequent mastoiditis and cerebral herniation in a patient with Arnold chiari malformation

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