Objective: The incidence of complications resulting from acute otitis media has significantly decreased since the introduction of antibiotics. The use of antibiotics has lead to decrease in the complications of acute mastoiditis as well as the mortality of the disease. The purpose of the study was to review our experience in the diagnosis and treatment of complications of acute mastoiditis in children. Study design. Retrospective clinical study.
Material and methods: We present a retrospective study of 70 children with extracranial and intracranial complications of acute mastoiditis who were treated in the period from 1968 to 2006 at Department of Otolaryngology, Medical University of Gdansk. Their treatment has been documented with long period of otologic follow-up.
Results: Extracranial complications occurred in 41 (30.4%) of treated acute mastoiditis cases, and subperiostal abscess was the commonest one in 37 (90.2%) patients. Intracranial complications occurred in 29 (21.4%) of acute mastoiditis cases and facial paralysis was the commonest one in 14 (40.0%) cases, followed by sigmoid sinus thrombosis and perisinus abscess. Ear cultures grew in patients with otogenic complications, the most often Staphylococcus aureus, Streptococcus sp. and Pseudomonas aeruginosa were found. Mastoidectomy with myringotomy resolved the disease in 46 (65.7%) children, only myringotomy in 6 (8.6%) and canal wall down mastoidectomy in 18 (25.7%) children. Complete resolution was achieved in all cases.
Conclusion: The persistent othorrea, otalgia and headache, prolonged high fever, neurological signs were the most common symptoms associated with the development of intracranial complications of acute mastoiditis in children. Computed tomography and MRI are necessary tools for diagnosis and surgery planning in every case of latent mastoiditis. Antibiotic treatment of acute mastoiditis does not prevent otogenic complications. Extracranial or intracranial complications of acute mastoiditis need surgical treatment and prolonged antibiotic therapy. The present study found evidence for decreased incidence of mastoiditis and their suppurative complications during last years.