Acute mastoiditis: increase in the incidence and complications

Abstract

Objective: Acute mastoiditis is a serious complication of acute otitis media, but it can be treated successfully in most of the cases with broad spectrum intravenous antibiotics and myringotomy. In the last 5 years we have perceived that there have been more complicated cases in the otic infectious pathology and the frequency was also higher.

Methods: We reviewed the cases of mastoiditis in the last 10 years (1996-2005) in The Niño Jesús University Children Hospital in Madrid to confirm the clinic impression, the bacteriology, treatments and evolution of the children and analyze the causes of this clinic situation.

Results: We have studied 215 cases of mastoiditis (0.6-17 years), 67.4% less than 3 years old and 69.3% males. The number of cases every year was the double since 1999 with the same percentage of admissions in the Pediatric service, and the triple in 2005. The percentage of surgical treatment grew from 4.3% to 33% in the last years and to 70% in 2005. Most cases (80%) have received prior antibacterial agent therapy, but individual pathogens and current complications of periostitis or subperiosteal abscess formation were equally distributed between the two groups. We have detected a 28.57% of Streptococcus pneumoniae and a significative high rate of Staphylococcus aureus (16.32%). A 53.68% of cases had negative cultures.

Conclusions: There is a progressive increase in the incidence of acute mastoiditis in our medium, and an increase of the surgical treatments. Ten years ago the process was controlled with antibiotic therapy only, but now the number of interventions has been eight times the previous years. Most cases of acute mastoiditis have responded well to medical management alone. But if higher levels of resistance predominate, more severe forms of pneumococcal or other pathogen like S. aureus disease are likely to be seen, these would be less likely to respond to oral or parenteral antibiotic therapy, so, tympanocentesis for middle ear culture may become more valuable and more frequently used in cases of antibiotic treatment failures, and surgical therapy may be necessary more often in the future. Our hospital seems to be in this tendency now.