Diagnostic and Surgical Treatment Outcome of Acute Mastoiditis in Pediatric Age Group.

ABSTRACT

Background: The incidence of Acute Mastoiditis in children has diminished, but it is not uncommon in clinical practice. Clinical presentation includes a history of otorrhea, pain in the ear, post aural swelling, a shift in pinna position and tenderness over the mastoid. The etiology includes acute and chronic suppurative otitis media, trauma and rarely hematogenous infection. Otoscopy is difficult in this age group due to edema of the EAM skin, pain and non-cooperation. Temporal bone CT scan is very useful in evaluating the pathology in the middle ear cleft such as cortical necrosis, Ossicular erosion and Cholesteatoma. Conservative medical management is useful in tiding over the crisis but surgical exploration of middle ear cleft, eradication of the disease and Tympanoplasty alone leads to cure prevents recurrence. The study aimed at analyzing retrospectively clinical and etio-pathological characteristics of pediatric acute mastoiditis and mastoid abscess in 62 children and to plan a strategy for the management in our Hospital. Methods: Retrospective evaluation of the medical records of 62 children aged below 14 years was scrutinized to record demographic data, history, investigations, etiological factors and treatment outcomes to establish a treatment protocol for future adaptation. Results: 62 patient records were taken up in the present study; patients mean age was 9± 2.4 years. In 18 children (29.03%) previous history of CSOM was reported. All children had clear evidence of post-auricular inflammation. Other clinical features like shift in pinna position, otorrhea, fever and otalgia were noted. Increase in WBC count in 69.35% of the cases, anemia with Hb less than 8 gms% was noted in 19 (30.64%) patients. Total cell count more than 11000 was observed in 69.35% of the patients. C T scan temporal bones in the present study showed 11 (17.74%) children showed signs of Cholesteatoma, clouding of mastoid air cells was noted in 17 (27.41%) and 7 (11.29%) children presented intracranial complications. Immediate medical treatment with 3rd generation parenteral Cephalosporins, NSAIDS was initiated. Abscess drainage was done in 18 (29.03%) children. Cortical Mastoidectomy and/or MRM with Tympanoplasty were performed in 39 (62.90%) of the children. Conclusion: Surgical exploration of the middle ear cleft after initial stabilization of the child with medical treatment gave statistical significant cure rate with low recurrence rate. CT scan was significant in accurately diagnosing the mastoid involvement correlated per operatively in 71.79% of CSOM and 100% of ASOM in children undergoing surgical exploration. Surgical approach is required in cases of complications or failure of medical treatment. Watchful clinical monitoring to rule out intracranial complications is always essential in all patients with Acute Mastoiditis.