title: Conservative management of acute mastoiditis in children.
abstract: OBJECTIVE
  To determine whether treatment of acute mastoiditis in children using antibiotics combined with retroauricular puncture and grommet insertion is effective compared with "standard management" with mastoidectomy.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary pediatric center.
  
  
  METHODS
  We identified 50 patients younger than 14 years with acute mastoiditis (mean age, 32 months). Individuals with subacute mastoiditis and cholesteatoma were excluded from this study. All the children had received antibiotic drug treatment. Before 2002, a subperiosteal abscess (SA) was managed by mastoidectomy. Beginning in 2002, however, conservative management was initially attempted to avoid mastoidectomy.
  
  
  METHODS
  The proportion of cured children after conservative management of SA in acute mastoiditis.
  
  
  RESULTS
  Acute mastoiditis occurred in 30 patients already treated with antibiotics before hospital admission. On examination, 1 child had facial palsy. All the patients except 1 (who had temporozygomatic swelling) had postauricular swelling. Myringotomy or retroauricular puncture isolated bacteria in 38 patients. Streptococcus pneumoniae was identified in 28 patients. Computed tomography (43 patients) diagnosed 31 SAs, including 3 cases of sigmoid sinus thrombosis and 1 subdural abscess. All the children were cured without complications regardless of the type of treatment. Comparing the periods before and after 2002, the number of SAs was similar (15 and 16, respectively), but the number of mastoidectomies was reduced (16 and 1, respectively). The hospital length of stay of patients who underwent aspiration was shorter than that of patients who underwent cortical mastoidectomy.
  
  
  CONCLUSIONS
  Antibiotic drug use combined with retroauricular puncture and grommet insertion is an effective alternative to mastoidectomy in the treatment of acute mastoiditis with SA in children.
authors.affiliation: Centre Hospitalier Régional Universitaire de Tours, Université François Rabelais de Tours, Unité pédiatrique d'ORL et CCF, 2 boulevard Tonnele, 37044 Tours, France. bakhos_d@med.univ-tours.fr
authors.forename: David
authors.initials: D
authors.lastname: Bakhos
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Trijolet
authors.forename: Sylvain
authors.initials: S
authors.lastname: Morinière
authors.forename: Soizick
authors.initials: S
authors.lastname: Pondaven
authors.forename: Musaed
authors.initials: M
authors.lastname: Al Zahrani
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lescanne
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008417:Mastoiditis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D008876:Middle Ear Ventilation; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents