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85th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

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

28.05. - 01.06.2014, Dortmund

Evolution of acute mastoiditis in childhood

Meeting Abstract

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  • corresponding author Marie-Paule Thill - CHU St Pierre, ENT Dept., Brüssel, Belgium
  • M. Horoi - CHU St Pierre, ENT Dept., Brüssel, Belgium
  • K. Ostermann - CHU St Pierre, ENT Dept., Brüssel, Belgium

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 85th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Dortmund, 28.05.-01.06.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14hno11

doi: 10.3205/14hno11, urn:nbn:de:0183-14hno111

Published: July 24, 2014

© 2014 Thill et al.
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Outline

Text

Acute mastoiditis is an inflammation of the mastoid cells with an extension to the periostum. It is a rare complication of acute otitis media. Since the availability of antibiotics, acute mastoiditis did nearly disappear but there is a recrudescence since the 90s and especially since 2005. A possible reason for the recrudescence is bad use of antibiotics. Predisposing factors are hyperpneumatisation of the mastoid, the absence of anterior middle ear infections, genetic factors and an allergic diathesis.

Vaccination against streptococcus pneumoniae, the most frequent pathogen isotated, plays an important role. In the literature there is documentation of an increase of the virulence of mastoiditis since 2005 due particularly to pneumococcus serotype 19A which was not included in the initial heptavalent conjugate pneumococcal vaccine (included is only serotype 19F). The 19A serotype is more prone to complications and has a 30% resistance pattern to third generation cephalosporins and to penicillin. Since 2011 there is a new conjugate vaccine comprising 13 serotypes including 19A. There are not enough data yet as to the evolution of mastoiditis.

Good management should begin with the bacteriological documentation by local puncture, followed by large spectrum antibiotics that should be adapted according to the antibiogram. We recommend also to put a tympanostomy tube. CT scan of the ear or even the brain is indicated if there are neurological signs on admission or if the evolution is not favorable after 48 h of antibiotics. There should be a search for signs of local bone destruction or complications like lateral sinus thrombosis, brain abscess, complications of cholesteatoma etc. Mastoidectomy is a treatment of last resort and should take into account the local evolution. It can often be limited to puncture or local drainage.