Advanced Journal of Microbiology Research

Review

Epidemiology, Diagnosis, and Treatment of Mastoiditis in Children: A Review of the Current State of Knowledge

Halit Özkaya, Abdullah Bariş Akcan* and Gökhan Aydemir

Department of Pediatrics, Gata Haydarpasa Teaching Hospital, Uskudar, Istanbul, Turkey.

Accepted 24 November, 2023

Abstract

Mastoiditis is an infection of mastoid process, the portion of the temporal bone of the skull which is behind the ear and contains open air-containing spaces. With possible extra cranial and intracranial complications, acute mastoiditis is the leading complication of acute otitis media (AOM). The goal of this review was to assess the clinical features, pathogens, complications and management of acute and chronic mastoiditis. Retrospective systematic review of studies and articles on acute and chronic mastoiditis between 1983 and 2010 in pubmed, include clinical, epidemiological, microbiological, treatment and outcome data. In 10 studies, the average age was 16, ranging from 6 months to 70 years, with 55% from 0 to 5 years. Most common symptom was otalgia (84 %), 58% of patients had history of past AOM and 61% were under antibiotic therapy during admission. 74% presented with retroauricular swelling and erythema, 58% had a displaced pinna. In general, the prevalence of organisms causing mastoiditis varies greatly between studies, among countries and according to the age of the patient. Reported pathogens were as follows: Streptococcus pneumoniae, most frequently isolated pathogen in acute mastoiditis, prevalence of approximately 25% Group A beta-hemolytic streptococci, Staphylococcus aureus, Moraxella catarrhalis, Haemophilus influenzae, Pseudomonas aeruginosa, Mycobacterium species, Aspergillus fumigatus and other fungi, Nocardia asteroides. Extension of the infectious process beyond the mastoid system can lead to a variety of intracranial and extracranial complications, including meningitis, cerebral abscess, epidural, subdural and intraparenchymal abscesses, vascular thrombosis, osteomyelitis, and abscesses deep within the neck. Permanent damage of the ear leads to hearing loss, vertigo and sometimes facial weakness. The Cochrane review found that antibiotic treatment of otitis media may play an important role in reducing the risk of mastoiditis in populations where it is more common. Despite the use of antibiotics, acute mastoiditis still remains a threat to patients with AOM, especially children under 5 years of age. On the basis of the clinical features and imaging findings, the disease is managed conservatively with intravenously administered antibiotics or treated with mastoidectomy and drainage plus antibiotic therapy. Great care is required by clinicians to make an early diagnosis in order to promote adequate management and prevent complications.