An analysis of weighted clinical parameters for decision making: surgical or conservative treatment in acute mastoiditis

Introduction Acute mastoiditis is a serious complication of otitis media requiring rapid therapeutic intervention. In addition to primary surgical intervention, conservative therapy and a step-by-step approach based on the severity of the illness is internationally observed. An international standard for treatment on a differential-therapeutic approach does not currently exist and physicians must decide patient treatment on a case-by-case basis.

Materials and Methods Literature research identified 21 studies on the treatment of mastoiditis. The criteria for decision making and differential therapy were collected and compared with 15 patients. The criteria for decision making were then analyzed using a two-dimensional weighted comparison model.

Results Compared to international studies, 10 patients in our department were primarily surgically treated with a mastoidectomy. An initial conservative approach with intravenous antibiotics was performed in 2 patients, with mastoidectomy followed in 1 case due to a lack of improvement. In 3 patients systemic antibiosis with paracentesis was first performed. In none of these cases therapy escalation with a mastoidectomy was necessary. The analysis of the decision criteria showed that in the German patient population the observed clinical condition and the manifestation of the subperiosteal abscess had the greatest influence on the choice of treatment.

Discussion The treatment of mastoiditis does not have to be primarily surgical. However, decision-making requires decision-making criteria based on clinical experience and scientific knowledge. Comparison with international literature and the systematic weighting of the decision parameters represent a well-founded tool to justify the choice between mastoidectomy and conservative therapy.

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Publication History

Article published online:
10 June 2020