Infants under the age of six months with acute mastoiditis. A descriptive study of 15 years in Sweden.
OBJECTIVE
To investigate the occurrence, clinical signs and outcome of acute mastoiditis in infants under the age of 6 months in Sweden between the years 1993-2007.


METHODS
All ENT departments in Sweden reported children 0-5 months treated for acute mastoiditis 1993-2007 and all records were reviewed. The clinical course and various characteristics were recorded.


RESULTS
Seventeen young infants with acute mastoiditis were identified. Three patients had suffered acute otitis media earlier, otherwise the children were previously healthy. Preceding the episode of acute mastoiditis, the children had an upper respiratory tract infection or fever for seven days in mean (median three days) and the mean number of days with ear-symptoms was three days (median two days). Three patients were treated with antibiotics prior to admittance. Almost all children presented with clear retroauricular signs with protruding ear and redness behind the ear. The children were hospitalised for six days (mean and median). Eight patients (47%) suffered from a subperiosteal abscess. All but one patient underwent surgery: myringotomy (13); incision or punction of the mastoid (5); mastoidectomy (3). Streptococcus pneumoniae was the most frequent bacterium identified in cultures. No intracranial complications or other severe complications were found.


CONCLUSIONS
Acute mastoiditis is extremely rare in infants under the age of 6 months. The patients in this study did not have any predisposing diseases. An upper respiratory tract infection had preceded the episode of acute mastoiditis for some time in the majority of cases, but the time from first ear symptoms to hospitalization was very short. Acute mastoiditis is a potentially life-threatening disease, but the timely administration of intravenous antibiotics and surgical intervention prevented the occurrence of severe complications in these young infants.
Department of Otorhinolaryngology, Skåne University Hospital, Lund, Sweden. Electronic address: karin.stenfeldt@telia.com.
K
K
Stenfeldt
Department of Otorhinolaryngology, Helsingborg Hospital, Helsingborg, Sweden.
F
F
Enoksson
Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden.
J
J
Stalfors
Department of Otorhinolaryngology, Karolinska University Hospital,Stockholm, Sweden.
M
M
Hultcrantz
Department of Otorhinolaryngology, Skåne University Hospital, Lund, Sweden.
A
A
Hermansson
Strama Skåne, Grynmalaregatan 1, Lund, Sweden.
A
A
Groth
D000038:Abscess / Q000453:epidemiology; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D007958:Leukocyte Count; D008297:Male; D008416:Mastoid / Q000382:microbiology / Q000601:surgery; D008417:Mastoiditis / Q000453:epidemiology* / Q000601:surgery*; D009305:Nasopharynx / Q000382:microbiology; D010033:Otitis Media / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D014432:Tympanic Membrane / Q000601:surgery
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
Acute mastoiditis; Acute otitis media; Infants; Mastoidectomy; Subperiosteal abscess