Contemporary management of paediatric acute mastoiditis in Aotearoa New Zealand.

BACKGROUND

There has been a recent increase in the incidence of paediatric acute mastoiditis (AM) with a global trend towards more conservative management strategies. Our aim was to evaluate the contemporary management of paediatric AM in Aotearoa New Zealand.

METHODOLOGY: A retrospective observational study including AM patients aged <18 years treated in five tertiary hospitals across Aotearoa New Zealand between 2014 and 2022.

RESULTS

There were 212 cases of AM with 104 cases (49%) of uncomplicated AM and 108 cases (51%) of complicated AM. Complications included 75 cases (35%) of sub-periosteal abscess (SPA), 18 cases (8%) of meningitis or intra-cranial abscess, 21 cases (10%) of venous sinus thrombosis and 6 cases (3%) of petrous apicitis. 54 (52%) of uncomplicated AM cases were managed with medical therapy, 42 (40%) with conservative surgery and 8 (8%) with mastoidectomy. Additional surgery was required in 13 (13%) cases. Median length of stay was 3 days (range 1-23 days). 30 day unplanned readmissions occurred in 7 (7%) cases. There were no cases of recurrent AM. There were no significant differences in outcomes between treatment strategies. 40 (53%) of SPA cases were managed with incision and drainage/aspiration and 24 (33%) were managed with mastoidectomy. There was no significant difference in the proportion of cases requiring additional surgery.

CONCLUSIONS

Conservative treatment strategies, including medical management or conservative surgery for uncomplicated AM and incision and drainage for SPA cases, may be considered in cases of paediatric AM.