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Acute Mastoiditis in Children: A 10-year Retrospective and Validated Multicenter Study

Anthonsen, Kristian MD; Høstmark, Karianne MD; Hansen, Søren MD; Andreasen, Kristian MD; Juhlin, Jon MD; Homøe, Preben MD, PhD, DMSc; Caye-Thomasen, Per MD, DMSc

The Pediatric Infectious Disease Journal: May 2013 - Volume 32 - Issue 5 - p 436–440
doi: 10.1097/INF.0b013e31828abd13
Original Studies

Background: Conservative treatment of acute otitis media may lead to more complications. This study evaluates changes in incidence, the clinical and microbiological findings, the complications and the outcome of acute mastoiditis in children in a country employing conservative guidelines in treating acute otitis media.

Methods: All admitted children (0–15 years) diagnosed with acute mastoiditis during the period from 1998 to 2007 in eastern Denmark (population 2.2 million) were identified. Patient files were retrieved and reviewed; the data were entered into a database.

Results: The average incidence of admitted children with acute mastoiditis was 4.8/100,000 children per year (95% CI were ± 0.03 -0.04), and there was no change in the incidence during the 10-year period. Of the 214 children included (mean age 2.1 years, range 0.3–13.1, median 1.3 years), 100% presented with protrusion of the pinna and 95% with retroauricular swelling and redness, whereas 32% had a retroauricular abscess. Mastoidectomy had been performed in children with a retroauricular abscess. Thirty-one percent had a ventilation tube inserted. The remaining group was treated with antibiotics and analgesics, and 86% also had a myringotomy performed. Streptococcus pneumoniae and group A streptococci were the bacteria most commonly cultured, 94% being susceptible to penicillin. The complication rate was low at 1.9%. All children included were initially admitted; no patients were outpatients.

Conclusions: The incidence of acute mastoiditis is stable in eastern Denmark where conservative management guidelines for treating acute otitis media are used. Bacterial resistance toward penicillin is low (6%), complications are rare and the treatment outcome is good. Furthermore, no severe complications after treatment were observed.

From the Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Kristian Anthonsen, MD, Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.