Long-term outcomes of surgical treatment for paediatric acute mastoiditis: the role of mastoidectomy

Purpose: Despite the declining incidence of acute mastoiditis (AM) due to antibiotics, complications persist, necessitating surgical intervention in severe cases. Recent studies suggest conservative treatments, avoiding mastoidectomy, show high recovery rates. However, this trend raises concerns about severe complications, prolonged treatment, increased antibiotic use, and declining surgical skills. While much research focuses on AM pathogenesis and treatment, the long-term consequences, especially post-mastoidectomy ear function, are less understood. To address this, we studied the permanent effects of surgically treated AM and mastoidectomy on ear function. Methods: A cohort of patients that received surgical treatment for AM in the form of mastoidectomy was invited to be tested after at least 5 years since the operation. Test battery included COMQ-12 questionnaire, physical exam and otomicroscopy, extended high pure tone audiogram, DPAOE and middle ear impedance testing. Results were compared with a control group and a group which received surgical treatment in the form of tympanostomy for acute otitis media with impeding mastoiditis. Results: The COMQ-12 questionnaire yielded higher scores in questions about hearing in quiet environments, hearing in noise, tinnitus, and ear discomfort. Minor structural changes were observed in the test groups during otomicroscopy, but not in the control group. Pure tone audiometry revealed a median elevation of around 10 dB in high and extended high frequencies, with similar results observed in DPAOE testing. In middle ear impedance testing, only an elevation of the stapedial reflex threshold was noted; other tests did not show any statistically significant differences. Conclusions: In the long term, the majority of patients post-AM have minor functional in structural consequences. In the context of treatment of AM, the effects of mastoidectomy are negligible when compared to less invasive surgical procedures.