Acute mastoiditis: Increase of incidence and controversies in antibiotic treatment

An important complication of acute otitis media is acute mastoiditis which responds to antibiotic therapy and myringotomy. Patients with acute mastoiditis were reviewed during 1996-2005 in the tertiary University Children’s Hospital in Madrid. The number of patients with acute mastoiditis increased by about 2-fold during this period. Of 205 children with mastoiditis, ranging from 0.6-17 years of age, surgical treatment was needed in about 4.3% in 1996 and in 70% in 2005. In spite of 80% of the children having received antibiotics at the pediatric visit, the number of complications increased (periostitis, subperiosteal abscess), and the number of surgical interventions increased by 8-fold. Etiological agents were Streptococcus pneumoniae (28.5%) and Staphylococcus aureus (16.3%). Negative cultures were obtained in 53.6% of cases. Lack of response to conventional therapy may require more tympanocentesis procedures for a middle ear culture, and surgical therapy may be necessary more often, as is the tendency in our hospital

La mastoiditis aguda es una complicación importante de la otitis media aguda que responde al tratamiento antibiótico y la miringotomía. Se realizó un estudio de revisión de los pacientes con mastoiditis aguda que acudieron al Hospital Infantil Universitario Niño Jesús de Madrid, de nivel terciario, durante 1996-2005. El número de pacientes con mastoiditis aguda aumentó aproximadamente dos veces durante este periodo. De los 205 niños registrados con mastoiditis, con una edad de 0,6 a 17 años, se requirió tratamiento quirúrgico en cerca del 4,3% en 1996 y en el 70% en 2005. A pesar de que el 80% de los niños recibieron antibióticos al visitar al pediatra, el número de complicaciones aumentó (periostitis, absceso subperióstico) y el número de intervenciones quirúrgicas fue hasta ocho veces superior. Los agentes etiológicos identificados fueron Streptococcus pneumoniae (28,5%) y Staphylococcus aureus (16,3%). Los cultivos fueron negativos en el 53,6% de los casos. Según la tendencia observada en nuestro hospital, la falta de respuesta a un tratamiento convencional puede requerir un mayor número de procedimientos de timpanocentesis para los cultivos de oído medio y la necesidad de realizar un tratamiento quirúrgico con mayor frecuencia

[Acute mastoiditis: increase of incidence and controversies in antibiotic treatment].

An important complication of acute otitis media is acute mastoiditis which responds to antibiotic therapy and myringotomy. Patients with acute mastoiditis were reviewed during 1996-2005 in the tertiary University Children's Hospital in Madrid. The number of patients with acute mastoiditis increased by about 2-fold during this period. Of 205 children with mastoiditis, ranging from 0.6-17 years of age, surgical treatment was needed in about 4.3% in 1996 and in 70% in 2005. In spite of 80% of the children having received antibiotics at the pediatric visit, the number of complications increased (periostitis, subperiosteal abscess), and the number of surgical interventions increased by 8-fold. Etiological agents were Streptococcus pneumoniae (28.5%) and Staphylococcus aureus (16.3%). Negative cultures were obtained in 53.6% of cases. Lack of response to conventional therapy may require more tympanocentesis procedures for a middle ear culture, and surgical therapy may be necessary more often, as is the tendency in our hospital.

[A radiological assessment of the nasopharynx in healthy children from the Madrid area]. / Evaluación radiológica de la nasofaringe en niños sanos de nuestro medio.

OBJECTIVE: The objective of this study was to assess the adenoid size of each pediatric age group in our media and to compare the subjective visual assessment with a confronted measurement, the Fujioka's adenoidal-nasopharyngeal (AN) ratio. These data would allow the composition of a map, a guide for pediatricians useful in predicting the degree of upper airway obstruction, the role of adenoids in the etiology of serious otitis media and/or in selecting patients for adenoidectomy. PATIENTS AND METHODS: We studied 1,033 radiographs of the nasopharynx taken in the emergency room of children between 5 months and 15 years of age that did not have any otorhinolaryngological (ENT) pathology. These individuals had no history of ear, nose or throat disease and the ENT evaluation was done in order to discard any ENT pathology. The subjective review and the AN ratios were calculated by experienced observers, tabulated and statistically analyzed. RESULTS: Only 692 infants and children passed the careful selection. The differences in mean values among the ages were statistically significant (p < 0.001). The mean AN ratio reached its highest value (0.575) at 5 years of age. The AN ratio as an indicator of adenoid size was comparable to the visually estimated classifications of adenoid size (p < 0.0001). In addition, 85% of the radiographs selected were in the group normal to slightly enlarged (AN = 0.48). CONCLUSIONS: The distribution of the mean AN ratios for age groups in healthy children shows a line which we could use as a standard, or guideline, to compare the AN ratio of any infant or child with any pathology related to the adenoids.