Acute Mastoiditis in a Very Young Baby – Clinical Course and Surgical Approach

Introduction: Acute mastoiditis (AM) is the one of the most prevalent infectious complications in healthy pediatric population. Its mean rate of life threatening intracranial complications is around 15%. Early diagnosis and treatment is highly important for uneventful outcome. A clear management protocol to avoid delays and a CT guided planning of surgical approach in this age.

Methods: A case report of a 5-months-old baby with sub-periosteal abscess.

Results: A generally healthy 5 months old baby with no history of acute otitis media was admitted due to acute mastoiditis, a large sub periosteal abscess, high fever and high white blood cells count. Urgent HRCT showed extensive damage of the cortex of the yet underdeveloped mastoid process. Surgical approach was planned according to a 3D reconstruction of the CT images (will be described in the poster).

Conclusion: The combination of a prompt sample for bacterial culture, immediate initiation of antibiotics, early surgical intervention combined with appropriate CT guided anatomic planning simplify clinical course in very young babies suffering from complicated acute mastoiditis. Smooth and immediate cooperation of pediatricians, experienced anesthetists, imaging facilities, and dedicated otologic surgical setting with the ear surgeons is crucial for the success of management of very young babies with complicated acute mastoiditis. In these cases margins for delays are very narrow.