Diagnosis and management of acute mastoiditis in a cohort of Italian children

Abstract

Objective: The Italian Society for Pediatric Infectious Diseases created a registry to determine the management of pediatric acute mastoiditis (AM) in Italy. Methods: A cross-sectional survey of paediatricians was conducted to evaluate hospitalization due to AM in Italian pediatric wards between 1 January 2002, and 31 December 2013. Results: A total of 913 children (561 males, 61.4%) were included in this study. The annual number of AM cases significantly increased during the study period (30 in 2002 and 98 in 2013) but only among older children (≥4 years old; p = 0.02). AM complications occurred in 69 (7.6%) of the children and sequelae were observed in 13 (1.4%) patients. Conclusion: The annual number of pediatric AM cases admitted to Italian pediatric wards increased in the past few years; this increase was strictly age-related. The risk of severe AM complications appeared relatively low, and most AM cases could be treated conservatively.

Keywords::

• acute mastoiditis
• acute otitis media
• antibiotic treatment
• ear
• pediatric otolaryngology
• pneumococcal vaccination

Financial & competing interests disclosure

This study was supported in part by grants from the Italian Ministry of Health (Ricerca Corrente 2014 850/01 and 850/02, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• A slight but significant increase in acute mastoiditis (AM) incidence has been reported in several countries in the past few years.

• In Italy, the annual number of pediatric AM cases progressively increased between 2002 and 2013 in an age-dependent manner.

• The number of AM cases increased despite the implementation of regional programs to improve the administration of pneumococcal conjugate vaccines to infants and children.

• AM symptoms were observed more often among children <2 years old than among older children.

• AM diagnoses were made or confirmed by radiographic examinations in half of the cases.

• The risk of severe AM complications appeared relatively low, and most AM cases could be treated conservatively.

• International guidelines for managing AM are needed to standardize approaches to AM and to identify risk factors for AM complications.