Mastoïditis aguda: revisió casuística

espanolFundamento. La incidencia de mastoiditis aguda y la necesidad de tratamiento quirurgico disminuyeron con la introduccion del tratamiento antibiotico. Posteriormente se ha mantenido estable o podria haber aumentado por cambios de la sensibilidad microbiana. Objetivo. Conocer la presentacion clinica y evolucion de las mastoiditis agudas tratadas en nuestro centro. Metodo. Revision retrospectiva de 19 mastoiditis agudas ingresadas entre enero de 1998 y enero de 2002. Resultados. La edad media fue de 35 meses. Todos iban a guarderia o colegio. 7 (36.8%) tenian otitis medias agudas recurrentes. 13 (68.4%) recibieron antibioticos el mes anterior. 17 (89.5%) presentaban otitis aguda. 13 (68.4%) manifestaban fiebre, 18 (94.7%) otalgia o irritabilidad, 9 (47.4%) supuracion, todos timpano alterado y eritema postauricular, 15 (78.9%) tumefaccion postauricular y 17 (89.5%) pabellon desplazado. El recuento fue superior a 15000 leucocitos/mm3 en 4, la proteina C reactiva superior a 60 mg/L en 7 y el hemocultivo negativo en 15 de 17. La tomografia computerizada confirmo el diagnostico, 2 con osteitis y 2 con absceso retroauricular. El antibiotico mas utilizado fue la cefotaxima. 2 requirieron puncion timpanica (10.5%), 8 drenaje transtimpanico (42.1%), 2 mastoidectomia (10.5%) y 9 (47.4%) ningun abordaje. Conclusiones. La mastoiditis aguda se da sobre todo en menores de 6 anos, no siempre con otitis media aguda recurrente, que han recibido antibioticos el mes previo. Habitualmente es complicacion de una otitis media aguda. El diagnostico es clinico. La tomografia computerizada determina la extension. El tratamiento es antibiotico endovenoso y drenaje de la coleccion purulenta. EnglishBackground. The incidence of acute mastoiditis and the need for surgical treatment declined significantly after the introduction of antibiotics and stabilized subsequently. However, given the changes in bacterial sensitivities, the incidence of acute mastoiditis may be rising. Objective. To describe the clinical characteristics, treatment, and outcome of patients diagnosed with acute mastoiditis in our institution. Method. Retrospective review of 19 patients with acute mastoiditis seen in our institution between January 1998 and January 2002. Results. Mean age at diagnosis was 35 months. All patients were attending either daycare or school. Seven patients (36.8%) had recurrent acute otitis media. Thirteen patients (68.4%) had received an antibiotic during the previous month. Seventeen patients (89.5%) had concomitant acute otitis media, 13 (68.4%) had fever, 18 (94.7%) had otalgia or irritability, 9 (47.4%) had otorrhea, 15 (78.9%) had retroauricular swelling, 17 (89.5%) had auricular displacement, and ll patients had abnormal tympanic membrane and retroauricular erythema. White blood cell count was greater than 15,000/cumm in 4 patients, C-Reactive protein was greater than 60 mg/L in 7 patients, and blood culture was negative in 15 of 17 patients in whom blood culture was obtained. Computorized tomography confirmed the diagnosis of mastoiditis in all patients. In two patients, there was evidence of osteitis, and in 2 patients a retroauricular abscess was noted. The most frequent antibiotic prescribed was cefotaxime. Two patients (10.5%) required myringotomy, 8 patients (42.1%) required the placement of tympanic drainage tubes, 2 patients (10.5%) required mastoidectomy, and 9 patients (47.4%) did not require any surgical intervention. Conclusions. Acute mastoiditis is diagnosed typically in young children ( catalaFonament. La incidencia de mastoiditis aguda i la necessitat de tractament quirurgic van disminuir amb la introduccio del tractament antibiotic. Posteriorment, s’ha mantingut estable o podria haver augmentat per canvis de la sensibilitat microbiana. Objectiu. Coneixer la presentacio clinica i evolucio de les mastoiditis agudes tractades al nostre centre. Metode. Revisio retrospectiva de 19 mastoiditis agudes ingressades entre gener de 1998 i gener de 2002. Resultats. L’edat mitjana va ser de 35 mesos. Tots anaven a guarderia o col·legi. 7 (36.8%) tenien otitis mitjanes agudes recurrents. 13 (68.4%) reberen antibiotics el mes anterior. 17 (89.5%) presentaven otitis aguda. 13 (68.4%) manifestaven febre, 18 (94.7%) otalgia o irritabilitat, 9 (47.4%) supuracio, tots timpa anormal i eritema postauricular, 15 (78.9%) tumefaccio postauricular i 17 (89.5%) pavello desplacat. El recompte fou superior a 15000 leucocits/mm3 en 4, la proteina C reactiva superior a 60 mg/L en 7 i l’hemocultiu negatiu en 15 de 17. La tomografia computada confirma el diagnostic, 2 amb osteitis i 2 amb absces retroauricular. L’antibiotic mes utilitzat fou la cefotaxima. 2 van requerir puncio timpanica (10.5%), 8 drenatge transtimpanic (42.1%), 2 mastoidectomia (10.5%) i 9 (47.4%) cap abordatge. Conclusions. La mastoiditis aguda es dona sobretot en menors de 6 anys, no sempre amb otitis mitjana aguda recurrent, que han rebut antibiotics el mes previ. Habitualment es complicacio d’una otitis mitjana aguda. El diagnostic es clinic. La tomografia computada determina l’extensio. El tractament es antibiotic endovenos i drenatge de la col·leccio purulenta.