Harley E H, Sdralis T, Berkowitz R G
Department of Otolaryngology, Royal Children's Hospital, Melbourne, Australia.
Otolaryngol Head Neck Surg. 1997 Jan;116(1):26-30. doi: 10.1016/S0194-59989770347-4.
We undertook a retrospective study to examine our experience with acute mastoiditis over a 12-year period. Fifty-eight cases were identified in children aged 3 months to 15 years. Acute mastoiditis was the first evidence of otitis media in 54% of our patients. Pain and fever lasting for more than a median period of 4 days were most likely to be the harbingers of incipient acute mastoiditis. Streptococcus pneumoniae was the most common organism recovered from the cultures. All children were treated with intravenous antibiotics; 41 children were managed with an adjunctive drainage procedure. No statistically significant differences were observed between the cure rates and failure rates for children treated surgically with myringotomies with or without tubes and children managed more aggressively with mastoidectomies. One infant had bacterial meningitis. Cholesteatoma was diagnosed in two children. We conclude from our study that acute mastoiditis occurs mainly in young children and may be the first evidence of ear disease. Pain and fever that persist despite appropriate treatment for acute otitis media are the two most important symptoms. Intravenous antibiotics combined with myringotomy with or without tube insertion are as appropriate as intravenous antibiotics with mastoidectomy for initial management of acute mastoiditis in the absence of a subperiosteal abscess or central nervous system extension.
我们进行了一项回顾性研究，以考察我们在12年期间治疗急性乳突炎的经验。共确定了58例年龄在3个月至15岁的儿童患者。在我们的患者中，54%的急性乳突炎是中耳炎的首发表现。疼痛和发热持续时间超过中位数4天，最有可能是早期急性乳突炎的先兆。肺炎链球菌是培养物中最常见的病原体。所有儿童均接受静脉注射抗生素治疗；41名儿童接受了辅助引流手术。在接受鼓膜切开术加或不加置管手术治疗的儿童与接受更积极的乳突切除术治疗的儿童之间，治愈率和失败率没有统计学上的显著差异。1名婴儿发生了细菌性脑膜炎。2名儿童被诊断出患有胆脂瘤。我们从研究中得出结论，急性乳突炎主要发生在幼儿中，可能是耳部疾病的首发表现。尽管对急性中耳炎进行了适当治疗，但疼痛和发热持续存在是两个最重要的症状。在没有骨膜下脓肿或中枢神经系统扩展的情况下，静脉注射抗生素联合鼓膜切开术加或不加置管与静脉注射抗生素加乳突切除术一样适用于急性乳突炎的初始治疗。
