ACUTE MASTOIDITIS IN CHILDREN – RISK FACTORS FOR COMPLICATIONS

Abstract

Introduction: Acute mastoiditis is the most frequent complication of acute otitis media. Antimicrobial therapy and healthcare improvement have dramatically decreased its incidence, although in the last decade a resurgence of the disease has been noticed.
Objectives: To evaluate sociodemographic, clinical, laboratory and therapeutic features of acute mastoiditis and to identify risk factors for complications in the paediatric population at a level II hospital; development of a proposed guideline.
Materials and methods: Systematic review of patients’ charts admitted with the diagnosis of AM in the 2000 -2010 period.
Results: Sixty patients (55 children) were admitted, predominantly male (53,3%). More than 1/3 (36,7%) of cases occurred in 2000 and 2006. The median age was Þ ve years. Nineteen patients (31,7%) had a previous history of recurrent middle ear infections, and 25 (41,7%) had other ENT disorders. 48,3% had a recent diagnosis of acute otitis media, all submitted to antimicrobial therapy. The symptoms were fever (75%), otalgia (93,3%), local inß ammatory signs (100%) and otorrhea (36,7%). Middle ear effusion, gathered by swabs, was cultured in nine cases, with Pseudomonas aeruginosa isolated in one case. Complications were found in eight patients (13,3%). Younger age (less than two years old), male sex, prior antimicrobial therapy, absence of otalgia were more common in complicated cases (p ≤ 0,05). All patients were submitted to IV antibiotics: 53,3% with second/third generation cephalosporins, for an average of 13 days. Three patients required surgery.
Conclusion: Against some databases, there wasn’t an increased number of admissions for MA, over the years of the study. Age less than two years, male gender, previous antimicrobial therapy and absence of ear pain seem to be predictive factors for complications. The criterious use of antimicrobial therapy and myringotomy should be emphasized.