Acute Mastoiditis in Children: Necessity and Timing of Imaging

Introduction: Acute mastoiditis (AM) can be clinically diagnosed, with an option for supplemental imaging: computerized tomography (CT) scan and magnetic resonance imaging (MRI). Debate widely exists whether clinical diagnosis alone is sufficient, in view of the risk of missing undetected complications. We sought to study the reasons leading to the performance of an imaging study during AM course.

Methods: Medical records of children

Results: 86 children were diagnosed with 88 AM episodes. Of the AM episodes, 55 (63%) were in boys and 46 (52%) were in th median day. Of those, 20 (100%) children underwent CT scans, and 3 (15%) also underwent additional MRI studies. Reasons for imaging studies included suspected subperiosteal abscess (9/20, 65%), lack of improvement despite adequate medical therapy (7, 35%) and focal neurological signs (4, 20%). Sixteen (16%) children underwent surgery for these pathologies: subperiosteal abscesses (n=12, 2 of them were aspirated), jugular vein thrombosis (n=2), perisinus empyema (n=2), epidural abscess (n=2) and Luc`s abscess (n=1).

Conclusion: Most children presenting with AM can be diagnosed clinically, without the need for imaging, and do well with intravenous antibiotics and myringotomy. CT and MRI imaging should be reserved for children with suspected AM complications.