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[Acute mastoiditis: increase of incidence and controversies in antibiotic treatment].

An important complication of acute otitis media is acute mastoiditis which responds to antibiotic therapy and myringotomy. Patients with acute mastoiditis were reviewed during 1996-2005 in the tertiary University Children's Hospital in Madrid. The number of patients with acute mastoiditis increased by about 2-fold during this period. Of 205 children with mastoiditis, ranging from 0.6-17 years of age, surgical treatment was needed in about 4.3% in 1996 and in 70% in 2005. In spite of 80% of the children having received antibiotics at the pediatric visit, the number of complications increased (periostitis, subperiosteal abscess), and the number of surgical interventions increased by 8-fold. Etiological agents were Streptococcus pneumoniae (28.5%) and Staphylococcus aureus (16.3%). Negative cultures were obtained in 53.6% of cases. Lack of response to conventional therapy may require more tympanocentesis procedures for a middle ear culture, and surgical therapy may be necessary more often, as is the tendency in our hospital.