title: Advanced pediatric mastoiditis with and without intracranial complications.
abstract: OBJECTIVE
  Recently, several groups have noticed an increase in cases of advanced pediatric mastoiditis and intracranial complications. The objective of this study was to review the bacteriology of advanced mastoiditis in pediatric patients, with the hypothesis that a difference in bacteriology might explain the development of an intracranial complication.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  All pediatric patients with coalescent mastoiditis requiring surgery treated at a tertiary care children's hospital between 2002 and 2007 were reviewed. Every patient included was treated either with mastoidectomy alone (for coalescent mastoiditis without an intracranial complication) or with transtemporal craniotomy (for coalescent mastoiditis with an intracranial complication). All patients had surgical specimens sent for pathology, Gram stain, and aerobic and anaerobic cultures.
  
  
  RESULTS
  One hundred eight pediatric patients with coalescent mastoiditis were identified: 58 (53%) presented with coalescent mastoiditis alone, 17 (16%) presented with coalescent mastoiditis and an intracranial complication, and 33 (31%) were excluded because they were treated with myringotomy and tubes alone, had incomplete data, or had an unclear diagnosis. Streptococcus pneumoniae was the most commonly cultured organism in patients with and without intracranial complications. Anaerobic isolates were present in 29.4% of patients with intracranial complications and 5.7% of patients without intracranial complications (P = .015).
  
  
  CONCLUSIONS
  Nearly a quarter of pediatric patients with coalescent mastoiditis presented with a simultaneous intracranial complication. There was an increased incidence of anaerobic organisms in patients with intracranial complications compared to those without, indicating the importance of culture and antibiotic coverage appropriate for anaerobes. This series demonstrates the role of aggressive surgical management and close collaboration with the infectious disease service for long-term intravenous antibiotic therapy in treating pediatric patients with advanced mastoiditis.
authors.affiliation: Bobby R. Alford Department of Otolaryngology, Texas Children's Hospital, Houston, USA.
authors.forename: Jose P
authors.initials: JP
authors.lastname: Zevallos
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Vrabec
authors.forename: Robert A
authors.initials: RA
authors.lastname: Williamson
authors.forename: Carla
authors.initials: C
authors.lastname: Giannoni
authors.forename: Deidre
authors.initials: D
authors.lastname: Larrier
authors.forename: Marcelle
authors.initials: M
authors.lastname: Sulek
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Friedman
authors.forename: John S
authors.initials: JS
authors.lastname: Oghalai
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003399:Craniotomy / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008416:Mastoid / Q000601:surgery; D008417:Mastoiditis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D008826:Microbial Sensitivity Tests; D038781:Otoscopy / Q000379:methods; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents