Acute mastoiditis in children – a retrospective analysis of incidence, etiology, and treatment approaches

Summary Introduction: Acute mastoiditis is a purulent inflammation of the mastoid mucosa with disintegration of the interstitial bone septa. It is the most common intratemporal inflammatory complication of otitis media in children. Early diagnosis and treatment are crucial to prevent the spread of inflammation from the temporal bone extra- and intracranially. Aim of the study: The aim of this retrospective study is to analyze the cases of acute mastoiditis in children in our department. The study aims to evaluate the incidence of acute mastoiditis in the pediatric population, identify the main etiological agents responsible for this infection, and analyze current therapeutic approaches, prevention, and its effectiveness. Materials and methods: The data of patients treated and hospitalized in the children‘s ward and ENT department of KZ, a. s. – Hospital Děčín, o.z., from 1 January 2015 – 1 September 2022 with the diagnosis – acute mastoiditis – H-700 according to ICD-10, were searched using the hospital information system, and were processed in the form of a retrospective study. Results: 23 patients were included in the evaluated cohort. The study population was mainly aged 12–18 years. The smallest number of children were in the age group under 6 years. Streptococcus pneumoniae with subtypes 3 and 8 was the most frequent causative agent in the study, for which the Synflorix vaccine was shown to be ineffective. Empiric antibiotic therapy was administered to all patients studied. In the group of cases aged 12 to 18 years, antibiotic therapy was started in monotherapy. In younger patients, antibiotic therapy always consisted of a double combination of antibiotics, in particular Clindamycin and Gentamycin. Surgical therapy was indicated in 13 of 23 cases. In most cases, the length of hospital stay did not vary with age, etiologic agent, or place of residence. No dependence was found between the type of treatment for acute mastoiditis or the causative agent of the disease or the effect on hearing. Conclusion: In our retrospective study, we found that the incidence of acute mastoiditis correlates with the generally known incidence in the Czech Republic and global data.The study shows that Streptococcus pneumoniae is identified as the most common pathogen of acute mastoiditis in children. The analysis showed that the Prevenar 13 vaccine showed better efficacy in preventing acute mastoiditis compared to the Synflorix vaccine. These results suggest that reassessment of the vaccination strategy used could contribute to further reduction in the incidence of acute mastoiditis. It can be concluded that the length of recovery and possible impact on hearing after treatment of acute mastoiditis may not depend on the type of microbial agent. We recommend continued monitoring and evaluation of vaccine efficacy and clinical approaches to improve prevention and treatment of this serious complication of otitis media. Key words acute mastoiditis – incidence – etiological agent – pneumococcal vaccination – therapy of acute mastoiditis