JOURNAL READING

INDICATION FOR
MASTOIDECTOMY IN ACUTE
MASTOIDITIS IN CHILDREN

Pembimbing :
Dr. Tris Sudyartono,
Sp.THT-KL
Dr. Agus Sudarwi, Sp.
THT-KL
Dr. Santo Pranowo,

Dwi Nurani Diningsih 11 2012 122

Jimmy Nyomin 11 2012 132
Dedik Cahyono 11 2012 154
Wong Jia Yen 11 2012 247
Kepaniteraan Klinik Ilmu Penyakit THT
RSMR Mardi Rahayu

ABSTRACT

INTRODUCTION
Acute mastoiditis can be develop in
children less than 14 years of age and
the incidence is estimated between 1.2
and 4.2 per 100.000/years.
This incidence increased every year, and
suggested because abuse oral
antibiotics and this can increase of
penicillin-resistance Streptococcus
Pneumoniae.

INTRODUCTION

METHODS
A retrospective chart review was
carried at Royal Childrens Hospital,
Melbourne, Australia, of all children
less than 16 years who has been
diagnosed of acute mastoiditis.
The criteria for diagnosis were the
presence of a middle air effusion,
postauricular swelling/erythema, and
systemic symptoms.

RESULT

RESULT

An 11-year old boy presented

with mastoiditis. Cortical
mastoidectomy revealed
extensive cholesteatoma.
Modified radical
mastoidectomy was
performed 1 month later.

A 13-year-old girl
presented with
mastoidits. Cortical
mastoidectomy was
performed, with findings
of acute mastoiditis only.

RESULT
Initial treatment
resulted in
resolution of acute
mastoiditis in 38
patients (95%)

RESULT

DISCUSSION
In this study, 4 of 40 children (10%)
who presented with acute mastoiditis
underwent mastoidectomy as initial
management. Three of these 4 children
had an underlying cholesteatoma.
Of the remaining 36 children, 1 represented 2 weeks later with acute
mastoiditis related to the presence of a
cholesteatoma.

DISCUSSION
This outcome indicates that children with
acute mastoiditis in the absence of a clinical
suspicion of cholesteatoma, and without
evidence of a significant suppurative
complication, can be managed initially without
mastoidectomy.

 Mastoidectomy was the mainstay

of treatment for acute mastoiditis
in the preantibiotic era.
The availability of antibiotics
radically changed the management
of the disease.
Intravenous antibiotics combined
with the insertion of ventilation
tubes have been shown to be
effective in the management of
uncomplicated cases of acute
mastoiditis.

 Cholesteatoma is an uncommon
underlying condition in children
who present with acute mastoiditis.
Our current study, 4 children (10%)
found to have cholesteatoma (4 11 years old).

 In conclusion, mastoidectomy does not appear to

be routinely required in the initial management of
uncomplicated acte mastoiditis. Children who
present with acute mastoiditis should undergo
mastoidectomy in the presence of significant
suppurative complications, including sigmoid
sinus thrombosis ad intracranial infection, or if
cholesteatoma is clinically suspected.
The main predictive factor for the presence of
cholesteatoma is older patient age.

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