Mastoiditis in toddlers

AB - There is an increased recovery of Fusobacterium necrophorum from cases of otitis media and mastoiditis in the pediatric population. These infections may be highly severe, causing local osteomyelitis, bacteremia, and Lemierre’s syndrome. The severity and difficulties in providing optimal treatment for these infections may be especially difficult in this age group due to immunological immaturity and delayed presentation. In this review of literature, we present and analyze the clinical presentation, management, and outcome of otic infections caused by F. necrophorum in infants and young toddlers less than 2 years old. Search in Pubmed was conducted for reported cases in the English literature for the time period of the last 50 years. Twelve well-described cases were retrieved with F. necrophorum otitis and mastoiditis and complications reported in all cases. Treatment included both intravenously with antimicrobial agents (beta lactams plus metronidazole) and mastoidectomy. Lemierre’s syndrome and Lemierre’s syndrome variants developed in 60 % of the patients. Dissemination of the infection as distal osteomyelitis and septic shock were also reported. The outcome was favorable in all the cases. Otitis and mastoiditis infections in children less then 2 years old are invasive infections, and severe complications can occur.

In addition to a complete medical history and physical examination, the physician inspects using an otoscope the outer ears and eardrums of the child. Diagnosis is established by clinical tests showing bacterial growth in cultures of ear drainage. Pus taken from the ear or sucked out of the abscess with a needle is sent to a laboratory so that the infecting bacteria can be identified. Imaging studies are used to confirm diagnosis. X rays are considered unreliable but can show clouding of the mastoid air cells. A head CT scan or CT of the ear may show a fluid-filled middle ear and an abnormality in the mastoid bone. Audiograms can also be performed to assess hearing loss.

Mastoiditis in toddlers

mastoiditis in toddlers

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