title: Algorithmic management of pediatric acute mastoiditis.
abstract: OBJECTIVE
  Today, no uniformly accepted diagnostic and therapeutic criteria have been established for the management of pediatric acute mastoiditis. The aim of this study is determine the efficacy and safety of an algorithmic approach for treating pediatric acute mastoiditis.
  
  
  METHODS
  The medical records of all children (n=167) with a diagnosis of AM admitted in our center during the period 2002-2010 were retrospectively studied. Data concerning medical history, symptomatology, laboratory and imaging findings, presence of complications, treatment methods and final outcomes were reviewed and analyzed. Parenteral antibiotics and myringotomy were applied to all children on the day of admission. Initial surgical approach also included drainage or simple mastoidectomy for subperiosteal abscesses and simple mastoidectomy for children suffering from intracranial complications. Finally, simple mastoidectomy was performed as a second line treatment in children showing poor response to the initial conservative approach.
  
  
  RESULTS
  All children were cured after a mean hospitalization of 9.8 days. The rate of intracranial complications at admission was 6.5% and the overall rate of the use of mastoidectomy 42%. Following the presented treatment scheme in all cases, no child developed additional complications while in-hospital and under treatment or after discharge.
  
  
  CONCLUSIONS
  Although simple mastoidectomy represents the most reliable and effective surgical method to treat acute mastoiditis, a more conservative approach consisting of adequate parenteral antibiotic coverage and myringotomy can be safely adopted for all children suffering from uncomplicated acute mastoiditis. Non-responsive cases should undergo simple mastoidectomy within 3-5 days in order to avoid further in-hospital acquired complications. Simple mastoidectomy should also be performed in every case of unsuccessful subperiosteal abscess drainage or presence of intracranial complications.
authors.affiliation: ENT Department, P. & A. Kyriakou Children's Hospital of Athens, Thivon & Levadias St., Goudi, Athens, Greece. ipsarommatis@gmail.com
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Psarommatis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Voudouris
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Douros
authors.forename: Polyvios
authors.initials: P
authors.lastname: Giannakopoulos
authors.forename: Theodoros
authors.initials: T
authors.lastname: Bairamis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Carabinos
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000628:therapy; D000208:Acute Disease; D000367:Age Factors; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008417:Mastoiditis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents