Clinical presentation of acute mastoiditis in children.

Nineteen children with 21 episodes of acute mastoiditis were treated in our hospital from 1989 to 1998. The diagnosis was based on physical, radiologic, and surgical findings. The affected children were aged from 1 year old to 17 years old, with the peak incidence at 4 years old (23.8%). Postauricular pain (90.5%) and fever (81%) were the most common harbingers of incipient acute mastoiditis. Streptococcus pneumoniae (38.1%) was the most common organism isolated followed by Pseudomonas aeruginosa (23.8%). Underlying diseases such as leukemia and myeloid metaplasia were found in 38.6% of patients. All of the patients were initially treated with intravenous antibiotics during hospitalization. Six patients were managed with an adjunctive drainage procedure such as myringotomy or mastoidectomy. The most common complication of acute mastoiditis was hearing loss (31.6%); the second was meningitis (21.1%). Subperiosteal abscess was found in two patients and brain abscess in one. Although acute mastoiditis is an uncommon condition, early diagnosis and management are necessary to prevent more serious complications.