Acute mastoiditis — the antibiotic era: a multicenter study☆
Introduction
Acute mastoiditis is an acute inflammatory disease of the mastoid process [1], [2]. Its incidence has declined since the introduction of antibiotics [3], [4]. In 1959 Palva et al. reported that 0.4% of acute episodes of otitis media (AOM) developed into acute mastoiditis [5], whereas the reported incidence during the 1980s was 0.004% [6]. In recent years, however, the number of children admitted to some hospitals with acute mastoiditis has risen [7], [8], [9].
The purpose of this study was to re-evaluate the clinical course and identify the causative organisms of acute mastoiditis in a community where most of the patients with AOM are treated with antibiotics.
Section snippets
Patients and methods
The clinical records of all patients treated for acute mastoiditis at nine secondary or tertiary referral centers in Israel between 1984 and 1998 were reviewed. The diagnosis of acute mastoiditis was made using the following clinical criteria: signs of AOM on otoscopy and local inflammatory findings over the mastoid process (i.e. pain, redness, local sensitivity and/or protrusion of the auricle), or local inflammatory findings over the mastoid process and roentgenographic or surgical findings
Results
Patients’ ages ranged from 3 months to 79 years (mean 5.3 years). Sixty three patients (28.3%) were aged 1 year or younger, and 196 patients (87.9%) were younger than 8 years (Table 1). One hundred and seventeen patients (52.5%) were male and 106 (47.5%) were female.
A history of AOM was recorded in 75 patients (33.6%), of whom 67 (30% of the whole group) had a history of recurrent AOM. Eleven patients (4.9%) had experienced a previous episode of acute mastoiditis (all 11 had experienced
Comments
In line with previous reports [7], [8] most of the patients in the present series were children younger than 8 years of age. One-third of them had a history of recurrent AOM. A second episode of acute mastoiditis was documented in 11 children, all of whom had been characterized as otitis-prone prior to the first episode of acute mastoiditis. A history of recurrent AOM therefore increases the risk of recurrence of acute mastoiditis.
Despite the generally accepted notion that acute mastoiditis is
Conclusions
A history of recurrent AOM increases the risk of recurrent acute mastoiditis.
Antibiotic treatment for AOM is not a safeguard against acute mastoiditis, and may be associated with a latent (masked) course of acute mastoiditis with a normal-looking tympanic membrane.
Early myringotomy for acute otitis media seems to be associated with a less complicated course of acute mastoiditis.
The distribution of organisms in acute mastoiditis differs from that in AOM, with significantly higher rates of S.
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Presented at The Seventh International Symposium on Recent Advances in Otitis Media, Fort Lauderdale, Florida, June, 1999.