Pediatric Emergency Unit, Azienda Ospedaliera - Universitaria di Bologna, Policlinico Sant'Orsola - Malpighi, via Massarenti 10, 40100, Bologna, Italy.
Ital J Pediatr. 2018 Jun 18;44(1):71. doi: 10.1186/s13052-018-0511-z.
Acute 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.
to evaluate demographics and clinical characteristics of children with acute mastoiditis and to identify possible risk factors for complications.
We 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.
One 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.
Despite 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.
急性乳突炎是急性中耳炎的主要化脓性并发症。其发病率为每年每 10 万儿童 1.2 至 4.2 例，近年来有所上升。关于乳突炎及其并发症的危险因素存在争议数据。
评估患有急性乳突炎的儿童的人口统计学和临床特征，并确定并发症的可能危险因素。
我们回顾性分析了 2002 年 1 月至 2016 年 12 月期间我院儿科急诊收治的所有 1 个月至 14 岁儿童的病历。
共纳入 147 例（97 例男性和 50 例女性）病例进行分析，平均年龄为 4.8±3.6 岁，28.2%的患者年龄小于 2 岁。我们发现研究的最后 3 年中每年的乳突炎病例数都在增加。小于 2 岁的儿童急性中耳炎接受抗生素治疗的比例较低（p<0.05）或治疗时间较短（p<0.05），而治疗乳突炎时使用的抗生素剂量较高（p<0.01）。年龄较大的儿童更常出现耳痛或耳后疼痛等症状（p<0.0001，p<0.001）。在我们的研究中，没有发现任何乳突炎并发症的危险因素。
尽管引入了肺炎球菌疫苗，但近年来我们人群中急性乳突炎的发病率并未降低。我们必须面对这种情况仍然存在的所有原因，例如抗生素耐药性、新病原体的参与以及急性中耳炎治疗指南的实施可能发挥的作用，这些指南限制了抗生素在这种疾病中的应用。应特别注意年龄较小的儿童，因为这些儿童的症状和体征可能不太明显，因此可能会对急性中耳炎或乳突炎产生误解，导致治疗延误。
