[Acute mastoiditis in children: can mastoidectomy be avoided?].
OBJECTIVE
Mastoidectomy is the standard management for exteriorized mastoiditis. The objective of this study was to assess the results of conservative management of acute mastoiditis and to study the types of bacteria isolated and their sensitivity to antibiotics.


METHODS
A retrospective study including children admitted with acute mastoiditis was conducted between 1994 and 2007. Intravenous antibiotics were systematic. Since 2002, mastoidectomy has been replaced by retroauricular puncture and grommet tube insertion.


RESULTS
Forty-four children had acute mastoiditis. All but one (temporozygomatic swelling) had postauricular swelling. The culture was positive in 78% of cases. Streptococcus pneumoniae was the most common bacteria identified. Twenty-six subperiosteal abscesses were found on the CT scan. Mastoidectomy was performed in 17 cases, 16 of which took place before 2002. The hospital stay has been decreased by six days with retroauricular puncture and grommet tube insertion management.


CONCLUSIONS
In the absence of intracranial complications and suspicion of Fusobacterium necrophorum, a retroauricular puncture and grommet tube insertion associated with antibiotic therapy is an effective alternative to mastoidectomy in the treatment of acute mastoiditis with subperiosteal abscess.
Trijolet
J-P
JP
Services d'ORL-chirurgie cervico-faciale et de bactériologie-virologie, CHRU de Tours, 37044 Tours, France.
Bakhos
D
D
Lanotte
P
P
Pondaven
S
S
Lescanne
E
E
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008417:Mastoiditis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D008876:Middle Ear Ventilation / Q000379:methods; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D019152:Paracentesis / Q000379:methods; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents