Adenoid hypertrophy is associated with poorer outcomes of acute mastoiditis in children.

INTRODUCTION

Acute mastoiditis is one of the most common complication of acute otitis media, and its clinical course may vary significantly among patients.

OBJECTIVE

To investigate the association between adenoid size and the severity of acute mastoiditis in children.

METHODS

This retrospective cohort study included children (<18 years) hospitalized with acute mastoiditis. The primary outcome was the association between disease severity-defined by the presence of intracranial complications or PICU admission - and the adenoid-to-nasopharyngeal ratio (ANR), measured on CT scans at three nasopharyngeal levels. Secondary outcomes included length of hospital stay, differences in bacterial profiles, and incidence of subsequent ear infections.

RESULTS

A total of 106 children (64 males [60.3%], mean age 3.03 years [IQR: 1-3.9]) were included in the analysis, of whom 32 (30.2%) were classified as having severe disease. Patients with severe mastoiditis were younger, had higher CRP levels, a longer duration of fever before presentation, underwent mastoidectomy more frequently, and had longer hospital stays (all p < 0.05). The ANR was significantly higher in patients with severe disease (0.6 vs. 0.4, p = 0.01). In multivariable logistic regression, both younger age (aOR, 2.26; 95% CI, 1.90-4.70; p = 0.05) and higher ANR (aOR, 1.30; 95% CI, 1.10-1.60; p = 0.03) were independently associated with severe mastoiditis. Bacterial profiles did not differ significantly, but severe cases had more subsequent ear infections (42.5% vs. 21.3%, p = 0.019).

CONCLUSIONS

Higher ANR was associated with increased severity of acute mastoiditis in children. Further studies should explore whether early detection and treatment of adenoid hypertrophy can improve outcomes.