Mastoiditis Diagnosed by Clinical Symptoms and Imaging Studies in Children: Disease Spectrum and Evolving Diagnostic Challenges

Abstract

BACKGROUND/PURPOSE: Acute mastoiditis has been increasingly reported. We reviewed our experience of mastoiditis in children in the era of expanding application of imaging tools and endless emerging antimicrobial resistance. METHODS: We reviewed all medical records of children (< 18 years of age) hospitalized with mastoiditis between January 2001and December 2010. Diagnosis of mastoiditis was based on clinical features and confirmed by imaging studies. Patients were classified as having acute or nonacute mastoiditis according to the duration of the disease. Acute mastoiditis was defined as illness of less than 3 weeks prior to hospitalization. Cases of longer than 3 weeks' duration were defined as nonacute mastoiditis. We compared the clinical, laboratory and microbiological features of acute and nonacute mastoiditis. RESULTS: A total of 104 children were enrolled in this study, comprising 56 acute cases and 48 nonacute cases. Fever and coryza were significantly more common in acute cases. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were both initially higher in acute mastoiditis. CRP, rather than ESR, declined faster in acute than in nonacute mastoiditis. Computerized tomography (CT) scans, but not plain films, were highly sensitive. Streptococcus pneumoniae and Haemophilus influenzae accounted for 52% of all isolates. Staphylococci, Pseudomonas spp. and polymicrobials were predominantly seen in non-acute mastoiditis. CONCLUSION: With the application of imaging studies, many cases of mastoiditis were identified. The classical postauricular signs were present in only 10% of patients. The presenting symptoms, inflammatory markers, pathogens, management and outcome were greatly influenced by the duration of the illness prior to admission.