Acute Coalescent MastoiditisA Clinical Analysis of 10 Cases

Kim, Dong Ju; Ahn, Seong Ki; Kim, Jin Pyeong; Jeon, Sea Yuong

Abstract

BACKGROUND AND OBJECTIVES
Acute coalescent mastoiditis (ACM) has been an uncommon complication of acute otitis media (AOM) in the post-antibiotic era. But its incidence may rise with the emergence of antibiotic-resistant pathogens, most notably, Streptococcus pneumoniae. This disease still remains as a potentially dangerous condition. Significant and life-threatening complication may occur including subperiosteal abscess, facial paralysis, and intracranial complications, etc. We have experienced 10 cases of ACM. The purpose of our study was to assess the clinical features, diagnosis, isolated bacteria and therapeutic results. MATERIALS AND METHOD: Nine patients with acute coalescent mastoiditis who had been treated from September 1999 through July 2002 were retrospectively analyzed with charts and X-ray reviews. We identified 10 cases of ACM in 9 patients. One patient suffered right ACM at 12 months of age and left ACM at the age of 14 months, respectively. The symptoms, diagnosis, methods of treatment, isolated bacteria and results of follow-up were analyzed. Seven patients were children, 2 patients were adult. RESULTS: The most common symptoms and signs were post-auricular swelling or tenderness, otalgia and bulging of tympanic membrane. All but one patient (90%) complained of post-auricular swelling or tenderness. Two patients (20%) complained of otorrhea. Seven patients (70%) complained of otalgia. Eight patients (80%) showed bulging of tympanic membrane. Temporal bone CT showed 3 cases (30%) of ACM only, 6 cases of ACM with subperiosteal abscess and 1 case (10%) of suppurative labyrinthitis and cerebellar abscess. We carried out medical treatment in 3 cases, and therapeutic surgery in 7 cases. In the isolated bacteria, the most common pathogen was Streptococcus pneumoniae, but there was no growth of bacteria in 3 cases (30%). CONCLUSION: ACM is a disease that affects mainly infants and young children. In the early diagnosis of ACM, otalgia and bulging of tympanic membrane that persist more than 2 weeks are the most important symptoms and signs, apart from post-auricular swelling and mastoid tenderness . With the increasing trend of resistant Streptococcal species, treatment should include anti-Streptococcal pneumoniae antibiotics to prevent complications. Conservative treatment with intravenous antibiotics only is the appropriate initial management in patients who don't exhibit any signs of subperiosteal abscess or intracranial complications.