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Indications for surgery in acute mastoiditis and their complications in children.
- Source :
-
International journal of pediatric otorhinolaryngology [Int J Pediatr Otorhinolaryngol] 2006 Jul; Vol. 70 (7), pp. 1175-82. Date of Electronic Publication: 2006 Jan 18. - Publication Year :
- 2006
-
Abstract
- Objective: To review the clinical charts of 45 paediatric patients treated for acute otomastoiditis at the ORL Department of the University of Brescia (Italy) between January 1994 and March 2005 and to discuss the diagnostic workup and the outcome of treatment.<br />Methods: Twenty-six males and 19 females were admitted with acute mastoiditis and subperiosteal abscess. Thirteen of them (28.9%) presented an intracranial complication. Only three of them were not operated upon; one received a ventilation tube (VT); all the others underwent a mastoidectomy within 48-72 h. Twenty out of 32 uncomplicated mastoiditis were treated conservatively and the remaining 12 underwent myringotomy+/-VT, associated with a mastoidectomy in 9 cases.<br />Results: Antibiotics alone or with VTs achieved a full recovery in 28 out of 32 uncomplicated cases. Mastoidectomy resolved the disease in 13 patients (9 with complications). In severe complications, a canal wall down (CWD) (n=2) or an intact canal wall (ICW) mastoidectomy (n=7) were preferred, based on the extent of the lesions and the degree of hearing loss. All children recovered completely at 1 year follow-up. In the uncomplicated cases that were operated upon, the mean hospital stay was 7.8 days (versus 4.3 days for the conservative group). In children with intracranial complications the mean hospital stay was 12.8 days, significantly less than the four non-surgical patients, who remained hospitalized for an average of 18 days.<br />Conclusion: Acute mastoiditis can fully recover with conservative treatment or myringotomy+VTs. Immediate surgical treatment is indicated for intracranial complications, if the neurological conditions are not critical. A simple mastoidectomy+/-tympanoplasty is warranted in: (1) exteriorization, if the child is older than 30 months or >15 kg of weight, (2) intracranial complications (combined with a neurosurgical procedure as needed) and (3) cholesteatoma or granulation tissue.
- Subjects :
- Abscess complications
Abscess diagnostic imaging
Abscess drug therapy
Abscess surgery
Acute Disease
Adolescent
Anti-Bacterial Agents therapeutic use
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Intracranial Thrombosis diagnostic imaging
Jugular Veins diagnostic imaging
Male
Mastoid diagnostic imaging
Mastoid surgery
Mastoiditis diagnostic imaging
Mastoiditis drug therapy
Periosteum diagnostic imaging
Temporal Bone diagnostic imaging
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography
Intracranial Thrombosis etiology
Mastoiditis complications
Mastoiditis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 0165-5876
- Volume :
- 70
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- International journal of pediatric otorhinolaryngology
- Publication Type :
- Academic Journal
- Accession number :
- 16413617
- Full Text :
- https://doi.org/10.1016/j.ijporl.2005.12.002