Sunday, May 8, 2011

Conservative Care Effective in Acute Mastoiditis

From Reuters Health Information

NEW YORK (Reuters Health) Apr 27 - Conservative management can replace mastoidectomy as primary treatment for acute mastoiditis with subperiosteal abscess, a new study shows.

Subperiosteal abscess is the most common complication of acute mastoiditis, the researchers note in a report in the April issue of Archives of Otolaryngology-Head and Neck Surgery.

Before 2002, say Dr. David Bakhos of the Universite Francois-Rabelais de Tours in France and his colleagues in their paper, patients at their center routinely had mastoidectomy for subperiosteal abscess.

Beginning in 2002, the investigators changed their approach, first treating patients conservatively, with postauricular puncture or a tympanostomy tube, with the goal of avoiding mastoidectomy.

For this month's report they reviewed their data on 50 consecutive patients with acute mastoiditis, all younger than 14 and all hospitalized between 1994 and 2008. Thirty-one children had subperiosteal abscess identified by computed tomography, including three patients with sigmoid sinus thrombosis and one patient with a subdural abscess.

Fifteen were treated before 2002 and 16 afterward. All patients received broad-spectrum intravenous antibiotics, and all were cured without complications.

Just one of the post-2002 patients had a mastoidectomy. This patient, a 16-month-old with sigmoid sinus thrombosis, did not get better after 2 days of conservative treatment. An ear culture was negative, but his blood culture was positive for Fusobacterium necrophorum.

Children treated primarily with mastoidectomy stayed in the hospital for an average of 15 days and took antibiotics for an average of 24 days. In the conservatively managed group, the mean hospital stay was 9 days and the mean course of antibiotics was 18 days.

"Antibiotic drug use combined with retroauricular puncture and grommet insertion is an effective alternative to mastoidectomy in the treatment of acute mastoiditis with subperiosteal abscess in children," the researchers conclude.

But, they add, "when mastoiditis is caused by F. necrophorum, physicians must be aware that this infection may be more aggressive and more complicated to treat. If conservative management fails, mastoidectomy must be considered."


Arch Otolaryngol Head Neck Surg 2011;137:346-350.

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