Main Theme: Otology.
introduction:
The initial treatment of Acute Mastoiditis (AM) in children is source control, achieved either by myringotomy or ventilation tube (VT) insertion, alongside antibiotics. Patients presenting with tympanic membrane (TM) perforation are typically considered “drained” and therefore do not undergo additional surgical intervention at presentation. The clinical significance of TM perforation in this setting remains unclear. This study aimed to compare the clinical characteristics and outcomes of pediatric mastoiditis patients with and without TM perforation, hypothesizing that perforation may represent a marker of more aggressive disease.
Materials and Methods: A retrospective cohort study analyzed pediatric patients hospitalized with AM. Patients were divided into two groups: intact TM versus TM perforation,( including pre-existing VT) at presentation.
Results: Of 174 patients, 33 (19.0%) presented with TM perforation, including 4 with VT. Compared with those without perforation, these patients exhibited higher peak temperature at home (40.0°C [39.2–40.5] vs. 39.3°C [38.7–40.0], p=0.019) and underwent imaging more frequently (10 [30.3%] vs. 17 [12.1%], p=0.009). Rates of subperiosteal abscess were comparable between groups (7 [21.2%] vs. 24 [17.0%], p=0.571). However, intracranial complications were significantly more common in the perforation group (6 [18.2%] vs. 4 [2.8%], p=0.004).
Conclusions: Pediatric mastoiditis with TM perforation is associated with a more severe clinical course and a higher rate of intracranial complications. These findings challenge the traditional treatment paradigm and suggest that such patients may require closer monitoring and potentially earlier and more aggressive management.
References
Laryea et al, Pediatric acute mastoiditis: A comparison of patients with and without intracranial complications Int J Pediatr Otorhinolaryngol. 2025
Cassano et al, Acute mastoiditis in children Acta Biomed. 2020
Principi et al, Acute otitis media with spontaneous tympanic membrane perforation Eur J Clin Microbiol Infect Dis. 2017