30 patients with 31 episodes of acute mastoiditis (AM) were identified by discharge diagnosis and studied retrospectively. There were 17 females and 13 males. The age range was 3 months to 14 years, with 43% less than 24 months. All had abnormal tympanic membranes. 27/31 had swelling above or posterior to the ear which deviated the pinna. Findings on mastoid films were clouding-16, osteomyelitis-2, and normal-7. In 14 patients organisms were recovered from normally sterile sites. The most frequent were Pneumococcus-5, group A streptococcus-3, Haemophilus-2, and anaerobes-3. 15/30 patients did well without surgery. In 23/31 episodes the patients were afebrile and much improved within 24 hours of hospitalization. Of these 23 episodes, 8 were treated surgically and 15 medically. In 8 episodes fever lasted longer than 24 hours. In 3/8 an intracranial complication had occurred; in 2/8 fever responded to a change in antimicrobials. Complications which occurred in 11/30 patients were subperiosteal abscess-7, meningitis-4, osteomyelitis-2, facial nerve palsy-1, and subdural and brain abscess-1. Of 6 patients with neurological complications, 4 had no external sign of AM on physical exam. In the absence of a complication, most patients will respond to antimicrobials within 24 hours. The absence of mastoid swelling does not rule out AM.
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Ogle, J., Lauer, B. 1144 ACUTE MASTOIDITIS: DIAGNOSIS AND COMPLICATIONS. Pediatr Res 19, 301 (1985). https://doi.org/10.1203/00006450-198504000-01174