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[Acute Mastoiditis in Children: a series of 38 Cases].

OBJECTIVE
We reviewed retrospectively the clinical, radiological and therapeutic findings in 38 infants and children with acute mastoiditis.


MATERIAL AND METHODS
From 1988 to 2001, 38 children (mean age 36 months) were treated for acute mastoiditis and periostitis or retroauricular abscess.


RESULTS
Diagnosis was usually made on the basis of typical retroauricular signs (60% of the cases), but was sometimes delayed owing to inappropriate antibiotics in 16 cases (42%) or atypical presentation in 3 (8%). Twenty-four children (70%) had no otolaryngological history. Pneumococci were isolated in most of the cases (n=15, 57%) with 13% having penicillin-resistant pneumococci. Lateral sinus thrombophlebitis was the most frequent complication, observed in 3 children (8%). Mastoiditis revealed congenital or acquired cholesteatoma in 4 children, who were all four infected with Gram-negative bacteria. Intravenous antibiotic therapy was associated with antroatticotomy in 36 children.


CONCLUSION
Despite emergence of new antibiotic resistance, the annual rate of mastoiditis has remained unchanged, remaining a serious complication of middle ear acute otitis. Cholesteatoma should be suspected in case of Gram-negative bacteria or in older children.