External acute mastoiditis of the infant and child: therapeutic management

Abstract

Introduction: Recently there has been an evolution in the therapeutic care of external acute mastoiditis (EAM) of the child and the infant. The use of mastoidectomy is controversial. The aim of our study was to detail the evolution in the therapeutic management of EAM and to represent our results. Methods: Our study includes 14 patients treated in our ENT department in collaboration with the pediatric department over a period of 5 years. Results: They were 8 boys and 6 girls of average age of 22 months. Computed tomography of the rocks showed a filling of the mastoid cells with cortical erosions confirming the acute mastoiditis in all cases. It was associated with a subcutaneous collection of average size of 15 mm. A sub-dural empyema associated with lateral sinus thrombosis was encountered in one case. A surgical treatment was performed in 3 cases consisting of a mastoidectomy in 2 cases and a retro-auricular incision with evacuation of the subperiosteal abscess for one child. The most commonly used combination of antibiotics was cefotaxime and fosfomycine (9 patients). Conclusion: treatment of EAM is nowadays based on antibiotherapy associated with paracentesis or transtympanic ventilation tube. The surgical treatment is limited to evacuating or draining a subperiosteal abscess, the indications of the mastoidectomy is reserved for complicated forms or after failure of the medical treatment.