Long-term Outcomes of Surgical Treatment for Paediatric Acute Mastoiditis: the Role of Mastoidectomy

Overview

Journal Eur Arch Otorhinolaryngol

Specialty Otorhinolaryngology

Date 2024 Dec 1

PMID 39616553

Authors

Matija Svagan

Janez Rebol

Affiliations

Soon will be listed here.

Abstract

Purpose: Despite the declining incidence of acute mastoiditis (AM) due to antibiotics, complications persist, necessitating surgical intervention in severe cases. Recent studies suggest conservative treatments, avoiding mastoidectomy, show high recovery rates. However, this trend raises concerns about severe complications, prolonged treatment, increased antibiotic use, and declining surgical skills. While much research focuses on AM pathogenesis and treatment, the long-term consequences, especially post-mastoidectomy ear function, are less understood. To address this, we studied the permanent effects of surgically treated AM and mastoidectomy on ear function.

Methods: A cohort of patients that received surgical treatment for AM in the form of mastoidectomy was invited to be tested after at least 5 years since the operation. Test battery included COMQ-12 questionnaire, physical exam and otomicroscopy, extended high pure tone audiogram, DPAOE and middle ear impedance testing. Results were compared with a control group and a group which received surgical treatment in the form of tympanostomy for acute otitis media with impeding mastoiditis.

Results: The COMQ-12 questionnaire yielded higher scores in questions about hearing in quiet environments, hearing in noise, tinnitus, and ear discomfort. Minor structural changes were observed in the test groups during otomicroscopy, but not in the control group. Pure tone audiometry revealed a median elevation of around 10 dB in high and extended high frequencies, with similar results observed in DPAOE testing. In middle ear impedance testing, only an elevation of the stapedial reflex threshold was noted; other tests did not show any statistically significant differences.

Conclusions: In the long term, the majority of patients post-AM have minor functional in structural consequences. In the context of treatment of AM, the effects of mastoidectomy are negligible when compared to less invasive surgical procedures.

References

Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L . Acute mastoiditis--the antibiotic era: a multicenter study. Int J Pediatr Otorhinolaryngol. 2001; 57(1):1-9. DOI: 10.1016/s0165-5876(00)00425-0. View

Zanetti D, Nassif N . Indications for surgery in acute mastoiditis and their complications in children. Int J Pediatr Otorhinolaryngol. 2006; 70(7):1175-82. DOI: 10.1016/j.ijporl.2005.12.002. View

Kvaerner K, Bentdal Y, Karevold G . Acute mastoiditis in Norway: no evidence for an increase. Int J Pediatr Otorhinolaryngol. 2007; 71(10):1579-83. DOI: 10.1016/j.ijporl.2007.06.022. View

Psarommatis I, Voudouris C, Douros K, Giannakopoulos P, Bairamis T, Carabinos C . Algorithmic management of pediatric acute mastoiditis. Int J Pediatr Otorhinolaryngol. 2012; 76(6):791-6. DOI: 10.1016/j.ijporl.2012.02.042. View

Pang L, Barakate M, Havas T . Mastoiditis in a paediatric population: a review of 11 years experience in management. Int J Pediatr Otorhinolaryngol. 2009; 73(11):1520-4. DOI: 10.1016/j.ijporl.2009.07.003. View

Lin H, Shargorodsky J, Gopen Q . Clinical strategies for the management of acute mastoiditis in the pediatric population. Clin Pediatr (Phila). 2009; 49(2):110-5. DOI: 10.1177/0009922809344349. View

Hullegie S, Venekamp R, van Dongen T, Hay A, Moore M, Little P . Prevalence and Antimicrobial Resistance of Bacteria in Children With Acute Otitis Media and Ear Discharge: A Systematic Review. Pediatr Infect Dis J. 2021; 40(8):756-762. PMC: 8274581. DOI: 10.1097/INF.0000000000003134. View

Geva A, Oestreicher-Kedem Y, Fishman G, Landsberg R, DeRowe A . Conservative management of acute mastoiditis in children. Int J Pediatr Otorhinolaryngol. 2008; 72(5):629-34. DOI: 10.1016/j.ijporl.2008.01.013. View

Chesney J, Black A, Choo D . What is the best practice for acute mastoiditis in children?. Laryngoscope. 2013; 124(5):1057-8. DOI: 10.1002/lary.24306. View

10.

Bakhos D, Trijolet J, Moriniere S, Pondaven S, Al Zahrani M, Lescanne E . Conservative management of acute mastoiditis in children. Arch Otolaryngol Head Neck Surg. 2011; 137(4):346-50. DOI: 10.1001/archoto.2011.29. View

11.

Psarommatis I, Giannakopoulos P, Theodorou E, Voudouris C, Carabinos C, Tsakanikos M . Mastoid subperiosteal abscess in children: drainage or mastoidectomy?. J Laryngol Otol. 2012; 126(12):1204-8. DOI: 10.1017/S0022215112002332. View

12.

Andersen S, Mikkelsen P, Konge L, Caye-Thomasen P, Sorensen M . Cognitive load in distributed and massed practice in virtual reality mastoidectomy simulation. Laryngoscope. 2015; 126(2):E74-9. DOI: 10.1002/lary.25449. View

13.

Wilson E, Discombe S, Paul S . A little-known danger. Br J Nurs. 2017; 26(17):960. DOI: 10.12968/bjon.2017.26.17.960. View

14.

Attlmayr B, Zaman S, Scott J, Derbyshire S, Clarke R, De S . Paediatric acute mastoiditis, then and now: is it more of a problem now?. J Laryngol Otol. 2015; 129(10):955-9. DOI: 10.1017/S0022215115002078. View

15.

Glynn F, Osman L, Colreavy M, Rowley H, Dwyer T, Blayney A . Acute mastoiditis in children: presentation and long term consequences. J Laryngol Otol. 2007; 122(3):233-7. DOI: 10.1017/S0022215107009929. View

16.

Guillen-Lozada E, Bartolome-Benito M, Moreno-Juara A . Surgical management of mastoiditis with intratemporal and intracranial complications in children. Outcome, complications, and predictive factors. Int J Pediatr Otorhinolaryngol. 2023; 171:111611. DOI: 10.1016/j.ijporl.2023.111611. View

17.

Harley E, Sdralis T, Berkowitz R . Acute mastoiditis in children: a 12-year retrospective study. Otolaryngol Head Neck Surg. 1997; 116(1):26-30. DOI: 10.1016/S0194-59989770347-4. View

18.

Tos M, Poulsen G . Attic retractions following secretory otitis. Acta Otolaryngol. 1980; 89(5-6):479-86. DOI: 10.3109/00016488009127165. View

19.

Sade J, Berco E . Atelectasis and secretory otitis media. Ann Otol Rhinol Laryngol. 1976; 85(2 Suppl 25 Pt 2):66-72. DOI: 10.1177/00034894760850S214. View

20.

Kang H, Ahn S, Jeon S, Hur D, Kim J, Park J . Sensation recovery of auricle following chronic ear surgery by retroauricular incision. Eur Arch Otorhinolaryngol. 2011; 269(1):101-6. DOI: 10.1007/s00405-011-1638-3. View