6099 Presentation and management of paediatric acute mastoiditis and why the sudden increase?

Objectives To evaluate increase in incidence acute mastoiditis in the paediatric population and assess for any preceding factors and ass ociation with the increased incidence of streptococcal infections during this period. Methods Retrospectively collected data on all 15 cases of acute mastoiditis presenting between December 2022 to April 2023 at Homerton Hospital. Review clinical presentation, preceding illness, blood and microbiological investigations as well as radiological findings looking at complications of the infection. Look at conservative or surgical management of these patients. Assess re-occurrence/re-presentation of patients. Results 14 out 15 cases were confirmed mastoiditis who met our diagnosis criteria with a mean age of 2.4 years (age range of 0–10yrs). 12 were fully immunised with 2 partially immunised. 93% had a preceding illness in the week before presentation. No one tested positive for RSV, Covid, Flu A or Flu B. 43% presented with established otitis media and 92% had fever on presentation. Half of the patients were already started on oral antibiotics <1week before presentation, of which 3 were started <24hrs of presentation. Only 3 patients with otitis media started antibiotics >24 hours prior to presentation. 3 patients had ears swabs, 1 was positive for pseudomonas aeruginosa, all 14 blood cultures were negative. 2 LP were done which were also negative. 1 blood PCR was done and was positive for streptococcus pneumonia. 12 underwent CT imaging, with 100% showing partial to complete opacification of the mastoid air cells, 5 showed erosion of adjacent areas. Complications including abscesses and venous sinus thrombosis were noted in 6 cases. All treated with prolonged course of antibiotics with a minimum of 10 days, initially with IV antibiotics and then oral ± ear drops. 3 underwent surgical management alongside medical. On follow up one re-presented to hospital with further complications and 1 re-presented to GP that required longer duration of oral antibiotics. All other patients have fully recovered. Conclusion Preceding illness, particularly otitis media is associated with acute mastoiditis. Although, our microbiology results from blood cultures show predominantly negative results and no evidence of association with streptococcal infections. Ear swabs or Pneumoccal PCR investigations when suspected mastoiditis may help identify an organism. Early treatment of otitis media may help reduce the incidence of acute mastoiditis.