Treatment of acute mastoiditis: report of 31 cases over a ten year period.

OBJECTIVE

With possible extracranial and intracranial complications, acute mastoiditis is the leading complication of acute otitis media (AOM). The goal of this study is to assess the clinical features, pathogens, complications and especially management of acute mastoiditis in the ENT service, University Hospital of Strasbourg, France.

METHODS

Systematic review of all medical records of patients who were admitted with acute mastoiditis from January 1993 to April 2003.

RESULTS

31 patients, 18 male (58%) and 13 female (42%) fulfilled inclusion criteria. The average age was 16, going from 6 months to 70 years, with 55% between 0 to 5 years. Most common symptom was otalgia (84%), 58% of patients had history of past AOM and 61% were under antibiotic therapy during admission. Twenty-three patients (74%) presented retroauricular swelling and erythema. 18 (58%) had a displaced pinna. Cultures taken from pus isolated Streptococcus pneumoniae in 12 cases (38.7%), Pseudomonas aeruginosa in 2 cases (6.4%), Streptococcus beta-haemolyticuis 1 case, Staphylococcus coagulase-positive 1 case and Mycobacterium tuberculosis hominis 1 case (3%). Complications of acute mastoiditis occurred in 3 cases (10%): Meningitis 2 cases and facial nerve paralysis 1 case. Surgery therapy was periformed in 84% of cases (mastoidectomy only or in combination with myringotomy with tube insertion) and medical therapy only in 16% of cases.

CONCLUSION

Despite use of antibiotics, acute mastoiditis remains still a threat for patients with AOM, especially for children under 5 years of age. Great care is required from clinicians to make an early diagnosis in order to promote adequate management and prevent complications.