Reale Marella, Montagnani Carlotta, Orlando Pietro, Mazzetti Luca, Trinci Marco, Leone Luca, Guidi Mariapaola, Indolfi Giuseppe, Trapani Sandra, Trabalzini Franco, Galli Luisa
Otorhinolaryngology Unit, Head and Neck Department, Meyer Children's Hospital IRCCS, Florence, Italy.
Infectious Diseases Unit, Department of Pediatrics, Meyer Children's Hospital IRCCS, Florence, Italy.
Ital J Pediatr. 2025 Sep 24;51(1):272. doi: 10.1186/s13052-025-02075-8.
Acute mastoiditis (AM) is the most common complication of acute otitis media (AOM) and could lead to serious complications if not diagnosed early and treated appropriately. Nowadays, there is no definitive consensus about the diagnostic algorithm and the optimal therapeutic management for patients with AM. The purpose of this study is to analyze the management of children admitted for AM and complicated AM (CAM) in a referral children's hospital, evaluating differences in clinical presentation and management to outline a diagnostic and therapeutic pathway. Moreover, the incidence over time was assessed.
Retrospective study of children admitted for AM at Meyer University Hospital- IRCCS, Florence from January 2016 to December 2023.
Eighty-five patients were included in the study (60% male, median age 4 years), the microbiological examinations were carried out in 68% of them. The most frequent isolated pathogens were Pseudomonas aeruginosa in AM and Streptococcus pyogenes in CAM. Seventeen patients developed a CAM. An elevated CRP value is associated with an increased risk of CAM (p = 0.043). Management of patients with AM was mainly medical with intravenous antibiotics. Surgical intervention was required only in one case (1 out of 68). In contrast, surgical intervention was required in 76% of CAM cases (13 out of 17). The most common procedure was mastoidectomy combined to abscess drainage, according to the predominance of this complication in our study group. Only one patient had a recurrence leading to a second surgery. No significant statistical correlation was found between the occurrence of complications and younger age, personal history of otitis or leukocyte count. A significant increase in AM case was found during the study period.
AM and CAM are infrequent but potentially life-threatening complications of AOM. A marked rise in AM cases was observed in 2023, likely due to the lifting of pandemic restrictions. A heterogeneous management of mastoiditis was observed, even within a single center. Elevated CRP levels are the only identified parameter associated with the complicated form. Pediatricians should be aware of the importance of a prompt diagnosis and guidelines should be developed to support effective management.
急性乳突炎（AM）是急性中耳炎（AOM）最常见的并发症，如果不及早诊断和适当治疗，可能会导致严重并发症。如今，对于AM患者的诊断算法和最佳治疗管理尚无明确共识。本研究的目的是分析一家转诊儿童医院收治的AM和复杂性急性乳突炎（CAM）患儿的治疗情况，评估临床表现和治疗的差异，以勾勒出诊断和治疗路径。此外，还评估了随时间推移的发病率。
对2016年1月至2023年12月在佛罗伦萨迈耶大学医院-IRCCS因AM入院的患儿进行回顾性研究。
85例患者纳入研究（60%为男性，中位年龄4岁），其中68%进行了微生物学检查。AM中最常见的分离病原体是铜绿假单胞菌，CAM中是化脓性链球菌。17例患者发展为CAM。CRP值升高与CAM风险增加相关（p = 0.043）。AM患者的治疗主要是使用静脉抗生素。仅1例（68例中的1例）需要手术干预。相比之下，76%的CAM病例（17例中的13例）需要手术干预。根据我们研究组中这种并发症的主导情况，最常见的手术是乳突根治术联合脓肿引流。只有1例患者复发并需要二次手术。并发症的发生与年龄较小、中耳炎个人史或白细胞计数之间未发现显著的统计学相关性。在研究期间发现AM病例显著增加。
AM和CAM是AOM罕见但可能危及生命的并发症。2023年观察到AM病例显著增加，可能是由于大流行限制的解除。即使在单一中心内，也观察到乳突炎的治疗方法存在异质性。CRP水平升高是唯一确定的与复杂形式相关的参数。儿科医生应意识到及时诊断的重要性，应制定指南以支持有效的治疗管理。
