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Acute mastoiditis in infants younger than 6 months: is an alternative treatment protocol needed?

  • Otology
  • Published:
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Abstract

Objectives

Several studies have reported that younger children suffer from increased incidence and more severe episodes of acute mastoiditis (AM) than older children, whereas other researchers have found the opposite. The aim of our study was to describe the occurrence, clinical, and microbiological aspects of AM in children 6 months or younger, and compare them with the results in an older reference age band.

Methods

The medical files of children hospitalized with a diagnosis of AM during 2001–2016 were retrospectively reviewed. Diagnosis of AM was based on the presence of clinical signs of acute otitis media (AOM) accompanied by two or more of the following: auricle protrusion, retro-auricular erythema, swelling, and local tenderness. Children were divided into two age bands, 6 months or younger, and older than 6 months.

Results

Fifty patients in the young age band and 335 in the older reference age band were included. Bilateral AOM was identified in 14 (28%) children under 6 months, and 50 (14.9%) in the reference age band (p < 0.001). Fever, mean WBC, and CRP values were similar in both age bands; 4 (8%) children under 6 months had pre-auricular/zygomatic area swelling, as compared to 1(0.02%) in the reference age band (p < 0.001). Complication rates (subperiosteal abscess, sinus vein thrombosis, and epidural abscess) were similar in both age bands. All children were treated with myringotomy and IV antibiotics. Cortical mastoidectomy with the insertion of ventilation tube was performed in 10 (20%) children in the younger age band and 58(17.3%) in the reference age band. Streptococcus pneumoniae was the most common (38%) isolated bacteria in the younger age band, and Group A streptococcous (GAS) (20.6%) in the reference age band.

Conclusions

AM in children 6 months or younger has similar presentation and characteristics as in older children. Pre-auricular swelling and bilateral AOM are more typical in the younger age band; Streptococcus pneumoniae is the most common pathogen in the younger children. We suggest that the treatment approach should be the same for both groups.

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Authors and Affiliations

  1. Department of Otorhinolaryngology and Head and Neck Surgery, Schneider Children’s Medical Center of Israel and Rabin Medical Center, Beilinson Campus, 49202, Petah Tikva, Israel

    Meirav Sokolov, Sharon Tzelnick, Sagit Stern, Ohad Hilly, Eyal Raveh & David Ulanovski

  2. Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

    Oded Scheuerman

  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Meirav Sokolov, Sharon Tzelnick, Sagit Stern, Ohad Hilly, Oded Scheuerman, Eyal Raveh & David Ulanovski

Authors
  1. Meirav Sokolov
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  2. Sharon Tzelnick
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  3. Sagit Stern
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  4. Ohad Hilly
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  5. Oded Scheuerman
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  6. Eyal Raveh
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  7. David Ulanovski
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Correspondence to Meirav Sokolov.

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This article does not contain any studies with human participants or animals performed by any of the authors. The study protocol was approved by the institutional review board (IRB-0242-17-RMC).

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Sokolov, M., Tzelnick, S., Stern, S. et al. Acute mastoiditis in infants younger than 6 months: is an alternative treatment protocol needed?. Eur Arch Otorhinolaryngol 278, 339–344 (2021). https://doi.org/10.1007/s00405-020-06088-3

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  • DOI: https://doi.org/10.1007/s00405-020-06088-3

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