Trends in Otitis Media and Mastoiditis

Trends in Otitis Media and Mastoiditis
Mastoiditis is uncommon, and fewer than one third of children who develop it have recent diagnoses of AOM.
Has the watch-and-wait approach to managing children with acute otitis media (AOM) increased the incidence of mastoiditis? Investigators used a general practice U.K. database of more than 2.5 million children (age range, 3 months to 15 years) to examine trends in diagnosis of AOM and mastoiditis from 1990 through 2006.
Of 854 children with diagnoses of mastoiditis, only 36% had received diagnoses of AOM during the previous 3 months. During the 16-year study, the incidence of mastoiditis remained stable (average incidence, 1.2 per 10,000 child-years), whereas the incidence of AOM diagnoses declined 34%, and the proportion of children with AOM who were treated with antibiotics declined significantly from 77% to 58%. Risk for developing mastoiditis was 53% lower in children with AOM who received antibiotics than in children with AOM who did not receive antibiotics (1.8 vs. 3.8 per 10,000 episodes). However, the authors estimate that 4831 children with AOM would have to be treated with antibiotics to prevent one case of mastoiditis.
Comment: In the U.S., AOM diagnoses have declined recently for a number of reasons, including use of the conjugate pneumococcal vaccine. In addition, the number of children with AOM who receive antibiotics has declined because some clinicians have adopted a watch-and-wait approach rather than treating children immediately with antibiotics. These reassuring data indicate that mastoiditis is uncommon and that about two thirds of children who develop it do not have recent diagnoses of AOM. Because these data were collected before introduction of the conjugate pneumococcal vaccine in the U.K., the authors speculate that the incidences of AOM and mastoiditis are even lower for countries in which the vaccine is used.
— Howard Bauchner, MD
Published in Journal Watch Pediatrics and Adolescent Medicine March 4, 2009