Spremo Slobodan, Udovcić Biljana
Clinic for Otorhinolaryngology, Clinic Center in Banja Luka, Zdrave Korde 1, 78000 Banja Luka, Bosnia and Herzegovina.
Bosn J Basic Med Sci. 2007 May;7(2):127-31. doi: 10.17305/bjbms.2007.3066.
The objective was to review our experience with clinical course, diagnostic and therapeutic profile of children treated for acute mastoiditis, and to investigate for possible susceptibility factors. Study was designed as retrospective review of pediatric patients presenting with acute mastoiditis secondary to acute otitis media over the last 6 years, from 2000 to 2006. The study involved children aged from 1 to 16 years treated for acute mastoiditis and subsequent intratemporal and intracranial complications in Clinic for otorhinolaryngology, Clinic Center Banja Luka. Selected clinical parameters, mastoid coalescence and risk factors for necessity of surgical intervention were analyzed. Medical history review of a total of 13 patients with acute mastoiditis was analyzed. Acute coalescent mastoiditis occurred 11 patients (84%) while noncoalescent form of acute mastoiditis occurred in 2 cases (16%). Intracranial complication occurred in 3 patients (2 meningitis and 1 peridural intracranial abscess), while 2 patients had intratemporal complication (subperiostal abscess) associated to coalescent mastoiditis. We observed clinical profile of acute mastoiditis in regard to pathology found on the tympanic membrane, middle ear mucosa and destructions on the bony wall of the middle ear and mastoid. The main signs of progressive infection were tympanic membrane perforation, pulsatile suppurative secretion from the mucosa, and intratemporal abscess. All patients with coalescent mastoiditis required mastoidectomy, while noncoalescent mastoiditis was treated conservatively with broad-spectrum intravenous antibiotics and myringotomy. In conclusion acute mastoiditis is uncommon but serious complication of acute otitis media in children associated with significant morbidity. Coalescent mastoiditis concomitant with subperiostal abscess, intracranial complications and mastoiditis not responsive after 48 hours to intravenous antibiotics should urge clinician to timely mastoid surgery.
目的是回顾我们在治疗儿童急性乳突炎的临床病程、诊断和治疗方面的经验，并调查可能的易感因素。本研究设计为对2000年至2006年过去6年中因急性中耳炎继发急性乳突炎的儿科患者进行回顾性研究。该研究涉及在巴尼亚卢卡临床中心耳鼻喉科诊所接受急性乳突炎及随后颞骨内和颅内并发症治疗的1至16岁儿童。分析了选定的临床参数、乳突融合情况以及手术干预必要性的危险因素。对总共13例急性乳突炎患者的病史进行了分析。11例患者（84%）发生急性融合性乳突炎，2例患者（16%）发生非融合性急性乳突炎。3例患者发生颅内并发症（2例脑膜炎和1例硬膜外颅内脓肿），2例患者发生与融合性乳突炎相关的颞骨内并发症（骨膜下脓肿）。我们观察了急性乳突炎在鼓膜、中耳黏膜病理以及中耳和乳突骨壁破坏方面的临床特征。进行性感染的主要体征为鼓膜穿孔、黏膜搏动性脓性分泌物以及颞骨内脓肿。所有融合性乳突炎患者均需要进行乳突切除术，而非融合性乳突炎则采用广谱静脉抗生素和鼓膜切开术进行保守治疗。总之，急性乳突炎在儿童中虽不常见，但却是急性中耳炎的严重并发症，会导致显著的发病率。伴有骨膜下脓肿、颅内并发症的融合性乳突炎以及静脉使用抗生素48小时后无反应的乳突炎应促使临床医生及时进行乳突手术。
