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81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

12.05. - 16.05.2010, Wiesbaden

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Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, CT

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Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. Wiesbaden, 12.-16.05.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10hnod373

doi: 10.3205/10hnod373, urn:nbn:de:0183-10hnod3735

Published: April 22, 2010

© 2010 Marev.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Objective: The aim of this study was to obtain comprehensive data on clinical presentation, microbiology, computed tomography, surgical findings and histology in acute, sub-acute and chronic mastoiditis.

Material and method: We performed a prospective,observational study in children under 16 years of age presenting to our institution during the 2-year period beginning in April 2004.The children were examined and their condition treated in accordance with a standardized protocol elaborated by the paediatric, otolaryngology (ORL) and radiology departments.Thirty-eight patients were hospitalized (22 with acute mastoiditis, seven with sub-acute mastoiditis,nine with chronic mastoiditis).

Results: There were 30 complications present in 21 patients (55%).Streptococcus pyogenes was the most common pathogen (7/24 cases), followed by Streptococcus pneumoniae (4/24 cases). Mastoid surgery was performed in 29 patients.Histology of mastoid tissue revealed predominantly acute inflammation in two cases.Radiologic data were evaluated retrospectively.Spiral, volume-based high-resolution CT of the temporal bone had a sensitivity of 100%, specificity of 38%, positive predictive value of 50% and negative predictive value of 100% in detecting coalescence of mastoid trabeculae.

Conclusion: histological evidence suggests that sub-acute/chronic infection underlies not only sub-acute and chronic mastoiditis, but most cases of acute mastoiditis as well. HR-CT of the temporal bone is effective in ruling out coalescence.Cranial CT is valuable in identifying intra-cranial extension.Cranial and HR-CT are recommended in the examination of children with mastoiditis.