Mastoiditis aguda: revisión casuística / Acute mastoiditis: review of a single center experience

RESUMEN

Fundamento. La incidencia de mastoiditis aguda y la necesidad de tratamiento quirúrgico disminuyeron con la introducción del tratamiento antibiótico. Posteriormente se ha mantenido estable o podría haber aumentado por cambios de la sensibilidad microbiana. Objetivo. Conocer la presentación clínica y evolución de las mastoiditis agudas tratadas en nuestro centro. Método. Revisión retrospectiva de 19 mastoiditis agudas ingresadas entre enero de 1998 y enero de 2002. Resultados. La edad media fue de 35 meses. Todos iban a guarderia o colegio. 7 (36.8%) tenían otitis medias agudas recurrentes. 13 (68.4%) recibieron antibióticos el mes anterior. 17 (89.5%) presentaban otitis aguda. 13 (68.4%) manifestaban fiebre, 18 (94.7%) otalgia o irritabilidad, 9 (47.4%) supuración, todos tímpano alterado y eritema postauricular, 15 (78.9%) tumefacción postauricular y 17 (89.5%) pabellón desplazado. El recuento fue superior a 15000 leucocitos/mm3 en 4, la proteína C reactiva superior a 60 mg/L en 7 y el hemocultivo negativo en 15 de 17. La tomografía computerizada confirmó el diagnóstico, 2 con osteitis y 2 con absceso retroauricular. El antibiótico más utilizado fue la cefotaxima. 2 requirieron punción timpánica (10.5%), 8 drenaje transtimpánico (42.1%), 2 mastoidectomía (10.5%) y 9 (47.4%) ningun abordaje. Conclusiones. La mastoiditis aguda se da sobre todo en menores de 6 años, no siempre con otitis media aguda recurrente, que han recibido antibióticos el mes previo. Habitualmente es complicación de una otitis media aguda. El diagnóstico es clínico. La tomografía computerizada determina la extensión. El tratamiento es antibiótico endovenoso y drenaje de la colección purulenta (AU)

ABSTRACT

Background. The incidence of acute mastoiditis and the need for surgical treatment declined significantly after the introduction of antibiotics and stabilized subsequently. However, given the changes in bacterial sensitivities, the incidence of acute mastoiditis may be rising. Objective. To describe the clinical characteristics, treatment, and outcome of patients diagnosed with acute mastoiditis in our institution. Method. Retrospective review of 19 patients with acute mastoiditis seen in our institution between January 1998 and January 2002. Results. Mean age at diagnosis was 35 months. All patients were attending either daycare or school. Seven patients (36.8%) had recurrent acute otitis media. Thirteen patients (68.4%) had received an antibiotic during the previous month. Seventeen patients (89.5%) had concomitant acute otitis media, 13 (68.4%) had fever, 18 (94.7%) had otalgia or irritability, 9 (47.4%) had otorrhea, 15 (78.9%) had retroauricular swelling, 17 (89.5%) had auricular displacement, and ll patients had abnormal tympanic membrane and retroauricular erythema. White blood cell count was greater than 15,000/cumm in 4 patients, C-Reactive protein was greater than 60 mg/L in 7 patients, and blood culture was negative in 15 of 17 patients in whom blood culture was obtained. Computorized tomography confirmed the diagnosis of mastoiditis in all patients. In two patients, there was evidence of osteitis, and in 2 patients a retroauricular abscess was noted. The most frequent antibiotic prescribed was cefotaxime. Two patients (10.5%) required myringotomy, 8 patients (42.1%) required the placement of tympanic drainage tubes, 2 patients (10.5%) required mastoidectomy, and 9 patients (47.4%) did not require any surgical intervention. Conclusions. Acute mastoiditis is diagnosed typically in young children (< 6 years) that have a recent history of antibiotic administration, as a complication of acute otitis media. However, it is not always associated with recurrent acute otitis media.The diagnosis is usually clinical, and computorized tomography may help in the definition of the extension of the infection. The treatment is with intravenous antibiotics and surgical drainage of any abscesses (AU)