JOURNAL READING

INDICATION FOR

MASTOIDECTOMY IN ACUTE

MASTOIDITIS IN CHILDRENDwi Nurani Diningsih – 11 2012 122

Jimmy Nyomin – 11 2012 132Dedik Cahyono – 11 2012 154Wong Jia Yen – 11 2012 247

Kepaniteraan Klinik Ilmu Penyakit THTRSMR Mardi RahayuPembimbing :

Dr. Tris Sudyartono, Sp.THT-KL

Dr. Agus Sudarwi, Sp. THT-KLDr. Santo Pranowo, Sp. THT-

KL

Pembimbing :Dr. Tris Sudyartono, Sp.THT-

KLDr. Agus Sudarwi, Sp. THT-KLDr. Santo Pranowo, Sp. THT-

KL

ABSTRACT

INTRODUCTION

• Acute mastoiditis can be develop in children less than 14 years of age and the incidence is estimated between 1.2 and 4.2 per 100.000/years.

• This incidence increased every year, and suggested because abuse oral antibiotics and this can increase of penicillin-resistance Streptococcus Pneumoniae.

INTRODUCTION

METHODSMETHODS

• A retrospective chart review was carried at Royal Children’s Hospital, Melbourne, Australia, of all children less than 16 years who has been diagnosed of acute mastoiditis.

• The criteria for diagnosis were the presence of a middle air effusion, postauricular swelling/erythema, and systemic symptoms.

RESULT

RESULT

An 11-year old boy presented with mastoiditis. Cortical mastoidectomy revealed extensive cholesteatoma.

Modified radical mastoidectomy was performed 1 month later.

An 11-year old boy presented with mastoiditis. Cortical mastoidectomy revealed extensive cholesteatoma.

Modified radical mastoidectomy was performed 1 month later.

A 13-year-old girl presented with mastoidits. Cortical

mastoidectomy was performed, with findings of acute

mastoiditis only.

RESULTInitial treatment resulted in resolution of acute mastoiditis in 38 patients (95%)

RESULT

DISCUSSION • In this study, 4 of 40 children (10%) who

presented with acute mastoiditis underwent

mastoidectomy as initial management. Three of

these 4 children had an underlying

cholesteatoma.

• Of the remaining 36 children, 1 re-presented 2

weeks later with acute mastoiditis related to the

presence of a cholesteatoma.

DISCUSSION

• This outcome indicates that children with acute

mastoiditis in the absence of a clinical suspicion

of cholesteatoma, and without evidence of a

significant suppurative complication, can be

managed initially without mastoidectomy.

• Mastoidectomy was the mainstay of treatment for acute mastoiditis in the preantibiotic era.

• The availability of antibiotics radically changed the management of the disease.

• Intravenous antibiotics combined with the insertion of ventilation tubes have been shown to be effective in the management of uncomplicated cases of acute mastoiditis.

• Cholesteatoma is an uncommon underlying condition in children who present with acute mastoiditis.

• Our current study, 4 children (10%) found to have cholesteatoma (4 - 11 years old).

• In conclusion, mastoidectomy does not appear to be

routinely required in the initial management of

uncomplicated acte mastoiditis. Children who present with

acute mastoiditis should undergo mastoidectomy in the

presence of significant suppurative complications, including

sigmoid sinus thrombosis ad intracranial infection, or if

cholesteatoma is clinically suspected.

• The main predictive factor for the presence of

cholesteatoma is older patient age.

tERIM

A

kASIH