Contemporary management of acute mastoiditis in children: Insights from a U.S. national database.

OBJECTIVE

Acute mastoiditis (AM) is a serious complication of acute otitis media. While historically managed with mastoidectomy, recent trends support conservative treatment, including intravenous (IV) antibiotics and pressure equalization tube (PET) placement. International studies demonstrate high success with these approaches, but U.S. pediatric data remains limited.

METHODS

Pediatric patients diagnosed with AM identified via Current Procedural Terminology (CPT®) coding and International Classification of Diseases (ICD-10) between January 2010 and October 2021 were reviewed using PearlDiver, a private analytics database. Patient demographics, treatments, intervention timing, complication rates, and predictors of surgery were assessed using multivariate logistic regression.

RESULTS

The mean patient age was 6.46 years, with 57.5% male. Surgical intervention occurred in 36.8%, including 1784 PETs, 347 subperiosteal abscess drainages, and 530 mastoidectomies. Median time to surgery was 1 day. Intracranial complications (e.g., abscess, meningitis, defined by ICD codes) occurred in 13.7%. Older age was linked to lower odds of surgery (p < 0.001), while under-immunization and complications of AM increased surgical likelihood (both p < 0.001). Intracranial complications were the strongest predictor of mastoidectomy (p < 0.0001). Higher family income correlated with fewer complications and lower mastoidectomy rates.

CONCLUSION

In this national pediatric cohort, non-operative management was most common, with fewer than 40% of patients undergoing surgery. Complications of AM most strongly predicted surgical need. These findings are consistent with a growing trend toward conservative management of pediatric acute mastoiditis.