Intracranial complications of acute mastoiditis

Objective Oral antibiotic use may have changed the incidence and microbiolo gy of otitic intracranial complications. We reviewed cases of acute mastoid itis to document: (1) incidence of intracranial complications; (2) risk fac tors; and (3) identify pathologic organisms. Methods: A retrospective study of children at a tertiary care children's hospital with acute mastoiditis from July, 1986 through June, 1998. Results: 118 children with acute mastoi ditis were identified. Eight patients (6.8%), ages 20 months to 14 years, h ad intracranial complications related to acute mastoiditis. Three children had a sigmoid sinus thrombosis, two children had an epidural abscess, and t wo children had both complications of sigmoid sinus thrombosis and epidural abscess, and a sigmoid sinus thrombosis and meningitis was present in one child. Pre-admission oral antibiotics were administered for an average of 1 0 days in seven of the eight patients. Persistent otorrhea and/or otalgia w ere present in all patients. Intraoperative cultures were negative in four cases (50%). Organisms isolated included. Streptococcus pneumoniae (2); Pro teus mirabilis (I); Pseudomonas aeruginosa (1); and coagulase negative Stap hylococcus (I). Multi-drug resistant organisms were documented in only one case. All patients underwent a contrast enhanced CT of the temporal bones a nd brain. Surgical management included complete mastoidectomy in all patien ts and a pressure equalization tube in seven of the eight cases. Conclusion s: Our review did not document an increase in the incidence of otitic intra cranial complications. Persistent otalgia or otorrhea while on oral antibio tics with associated neurologic symptoms are ominous signs suggestive of a complication. Multi-drug resistant organisms are uncommon whereas negative intraoperative cultures are common. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.