Therapeutic approach to pediatric acute mastoiditis – an update

Abstract Introduction: Acute mastoiditis remains the most common complication of acute otitis media. It may rarely appear also in cochlear implant patients. However, the treatment recommendations for this disease are not precisely defined or employed, and in the current literature the differences regarding both the diagnosis and management are relatively substantial. Objective: The aim of this study was to determine a standard and safe procedure to be applied in case of pediatric acute mastoiditis. Methods: A retrospective chart review of 73 patients with 83 episodes of acute mastoiditis hospitalized at our tertiary-care center between 2001 and 2016 was conducted. Bacteriology, methods of treatment, hospital course, complications, and otologic history were analyzed. Based on our experience and literature data, a protocol was established in order to standardize management of pediatric acute mastoiditis. Results: All the patients treated for acute mastoiditis were submitted to an intravenous antibiotic regimen. In the analyzed group pharmacological treatment only was applied in 11% of children, in 12% myringotomy/tympanostomy was added, and in the vast majority of patients (77%) mastoidectomy was performed. In our study recurrent mastoiditis was noted in 8% of the patients. We also experienced acute mastoiditis in a cochlear implant child, and in this case, a minimal surgical procedure, in order to protect the device, was recommended. Conclusions: The main points of the management protocol are: initiate a broad-spectrum intravenous antibiotic treatment; mastoidectomy should be performed if the infection fails to be controlled after 48 h of administering intravenous antibiotic therapy. We believe that early mastoidectomy prevents serious complications, and our initial observation is that by performing broad mastoidectomy with posterior attic and facial recess exposure, recurrence of acute mastoiditis can be prevented.急性乳突炎仍是急性中耳炎最常见的并发症，亦可偶发于人工耳蜗植入（Cochlear Implant）患者群体中。但目前针对该疾病的治疗建议尚未得到明确界定与规范应用，现有文献中关于其诊断与管理方案的差异均较为显著。 本研究旨在确立适用于儿童急性乳突炎的标准化、安全诊疗流程。 本研究对2001年至2016年间于本三级医疗中心住院的73例患者共83次急性乳突炎发作病例开展回顾性病历分析，对患者的细菌学特征、治疗方式、住院病程、并发症及耳部病史进行了系统性梳理与分析。结合本中心临床经验与现有文献数据，我们制定了一套标准化诊疗方案，以实现儿童急性乳突炎管理的规范化。 所有急性乳突炎患者均接受了静脉抗生素治疗方案。在本分析队列中，仅采用单纯药物治疗的患儿占比11%，12%的患儿联合实施了鼓膜切开术/鼓室造口术，绝大多数患者（77%）接受了乳突切除术。本研究中，8%的患者出现了复发性乳突炎。我们还收治了1例并发急性乳突炎的人工耳蜗植入患儿，该病例中为保护植入装置，我们推荐实施小型外科手术。 本诊疗方案的核心要点包括：首先启动广谱静脉抗生素治疗；若静脉抗生素治疗48小时后感染仍未得到有效控制，则需实施乳突切除术。我们认为，早期乳突切除术可预防严重并发症，初步观察显示，采用伴乳突后隐窝与面隐窝暴露的广泛乳突切除术，可有效预防急性乳突炎的复发。