Mastoiditis (Updated – May 2014.)

Bunik M. Mastoiditis. Pediatr Rev. 2014 Feb;35(2):94-5; discussion 94-5.

“Treatment usually includes both systemic antibiotics and surgical drainage. In terms of antibiotics, first choice for those without a history of chronic otitis should be intravenous ceftriaxone plus clindamycin, pending culture. More than 50% of children have been taking antibiotics, usually for otitis, at the time of admission. If the child has had a history of recurrent otitis media then ceftazidime, cefepime, or piperacillin-tazobactam should replace ceftriaxone for added Pseudomonas coverage. Cultures obtained perioperatively from the middle ear or mastoid should continue to guide antibiotic therapy during the hospitalization. Surgical treatment is usually required and ranges from myringotomy to more extensive surgery. Recently, more conservative management, consisting of retroauricular puncture and aspiration, has been studied as an alternative to traditional mastoidectomy. Preliminary results demonstrate that the retroauricular puncture has the advantage of a shorter hospital stay than with mastoidectomy.”

Full-text for Children’s users.

Chien JH, Chen YS, Hung IF, Hsieh KS, Wu KS, Cheng MF. Mastoiditis diagnosed
by clinical symptoms and imaging studies in children: disease spectrum and
evolving diagnostic challenges. J Microbiol Immunol Infect. 2012 Oct;45(5):377-81.

“With the application of imaging studies, many cases of mastoiditis were identified. The classical postauricular signs were present in only 10% of patients. The presenting symptoms, inflammatory markers, pathogens, management and outcome were greatly influenced by the duration of the illness prior to admission.”

Full-text for Children’s users.

Psarommatis IM, Voudouris C, Douros K, Giannakopoulos P, Bairamis T, Carabinos
C. Algorithmic management of pediatric acute mastoiditis. Int J Pediatr
Otorhinolaryngol. 2012 Jun;76(6):791-6.

“Although simple mastoidectomy represents the most reliable and effective surgical method to treat acute mastoiditis, a more conservative approach consisting of adequate parenteral antibiotic coverage and myringotomy can be safely adopted for all children suffering from uncomplicated acute mastoiditis. Non-responsive cases should undergo simple mastoidectomy within 3-5 days in order to avoid further in-hospital acquired complications. Simple mastoidectomy should also be performed in every case of unsuccessful subperiosteal abscess drainage or presence of intracranial complications.”

Lin HW, Shargorodsky J, Gopen Q. Clinical strategies for the management of acute mastoiditis in the pediatric population. Clin Pediatr (Phila). 2010 Feb;49(2):110-5.

“Although the incidence of acute mastoiditis has been substantially reduced since the introduction of antibiotic therapy, mastoiditis complications are still commonly seen in the pediatric population. Many of these cases require lengthy hospitalizations and extensive medical and surgical interventions. Accordingly, a safe, effective, and resourceful diagnostic and therapeutic plan must be executed for the workup and treatment of each patient suspected of having acute mastoiditis. With thorough clinical evaluations, early diagnosis, and close follow-up, a large proportion of children with severe acute otitis media or early stage mastoiditis can be managed in the primary care setting without immediate surgical specialty involvement. This review presents an overview of the anatomical and pathophysiological considerations in acute mastoiditis and offers pediatricians a practical, evidence-based algorithm for the diagnostic and therapeutic approach to this disease.”

Full-text access for Children’s and Emory users.

Bilavsky E, Yarden-Bilavsky H, Samra Z, Amir J, Nussinovitch M. Clinical, laboratory, and microbiological differences between children with simple or complicated mastoiditis. Int J Pediatr Otorhinolaryngol. 2009 Sep;73(9):1270-3.

“High-grade fever, high absolute neutrophil count, and high C-reactive protein level may serve as clinical and laboratory markers of complicated mastoiditis. Children with these findings warrant close follow-up and perhaps, earlier surgical intervention.”

Full-text access for Emory users.

More PubMed results on mastoiditis.

Created 1/15/13, revised 5/19/14.

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