A contemporary analysis of acute mastoiditis.

BACKGROUND

Acute mastoiditis persists as a serious infection despite a dramatic decline in incidence coincident with the introduction of antibiotic therapy.

OBJECTIVE

To assist the contemporary practitioner in the recognition and management of acute mastoiditis through the assessment of a large series of patients.

DESIGN

Retrospective case series comprising 124 patients with acute mastoiditis.

SETTING

Pediatric and adult otology referral center.

MAIN OUTCOME MEASURES

Selected clinical parameters. Risk factors for necessity of surgical intervention and for increased length of hospitalization were analyzed by a stepwise logistic regression model.

RESULTS

A history of antecedent acute otitis media was absent in 45% of patients. Pain (98%) was the most common presenting symptom. Physical signs included an abnormal-appearing tympanic membrane (88%), fever (83%), a narrowed external auditory canal (80%), and postauricular edema (76%). Streptococcus pneumoniae was the most commonly isolated organism. Mastoid surgery was required in 62% of the patients. An elevated white blood cell count (relative risk [RR], 7.4; P < .01), proptosis of the auricle (RR, 4.5; P = .03), and fever on admission (RR, 7.3; P = .05) were risk factors for surgical intervention. All 33 patients with complications (27%) proceeded to surgical intervention. The average length of hospital stay was 7.9 days. The strongest predictor for an increased length of hospital stay was whether the patient required surgery (RR, 3.7; P = .002).

CONCLUSIONS

Acute mastoiditis remains a potentially serious otologic infection. Not all patients present with a classic history or physical examination. Therapeutic mastoidectomy is often required.