1. Imaging in Acute Mastoiditis
Sharon Ovnat Tamir, MD
Edith Wolfson Medical Center, Tel Aviv University
Sackler Faculty Of Medicine

2. TO IMAGE OR NOT TO IMAGE ? THAT IS THE QUESTION

3. HOW TO SOLVE THE PROBLEM ?
Literature search
”Acute” AND "mastoiditis"[MeSH Terms]
OR "mastoiditis"[All Fields] OR "imaging"[All Fields]) AND (has abstract[text]
Number = 99
Only 15 relevant

4. ACUTE MASTOIDITIS: IMAGING OR NOT ?
RS = retrospective, N/A = not available, * population-based

5. ACUTE MASTOIDITIS: IMAGING OR NOT ?
Ntot = 1573

6. ACUTE MASTOIDITIS: IMAGING OR NOT ?
Summary of 15 Studies

7. COMPUTED TOMOGRAPHY – PROS AND CONS
Avoids underdiagnoses
Patients do well without
May improve occult complication diagnosis
May require fasting
Avoids over treatment
High irradiation dose
May require sedation
May take time – delaying treatment

8. MAGNETIC RESONANCE IMAGING – PROS AND CONS
Demonstrates intra-temporal complications
Patients do well without
Requires fasting
Limited availability
Interpreting difficulties
Obligatory anesthesia
Long examination acquisition

9. EXPOSURE TO IRRADIATION - DANGERS
Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumors: a retrospective cohort study.
Pearce MS et al. Lancet 2012 Aug 4;380(9840):
Conclusions:
Use of CT scans in children to deliver cumulative doses of about 50 mGy might almost triple the risk of leukaemia and doses of about 60 mGy might triple the risk of brain cancer.

10. EXPOSURE TO IRRADIATION - DANGERS
Pediatric Computed Tomography and Associated Radiation Exposure and Estimated Cancer Risk Miglioretti DL et al. JAMA Pediatr. (2013) Conclusions: Children who receive a cumulative brain dose of 50 mGy are at 2.8 times greater risk of brain cancer. Combining the two strategies of reducing unnecessary exams and reducing the highest 25% of doses could potentially prevent 62% of the projected radiation- related cancers.

11. IF WE DO NOT OBTAIN IMAGING WHAT WILL WE MISS ?
How many intra cranial complications are asymptomatic ?

12. WHAT IS THE BEST PRACTICE FOR ACUTE MASTOIDITIS IN CHILDREN?
Triological Society Best Practice in Laryngoscope 2014
Chesney J et al.
Conclusions:
CT imaging in pediatric AM should be obtained for:
patients with neurological signs, suspicion of cholesteatoma, or a deteriorated general state on admission
patients failing to improve or worsening while receiving conservative treatment (48 hours)
patients when an intracranial complication is suspected

14. Acknowledgement
Prof. Preben Homøe for his thoughts on the subject.

15. THANK YOU FOR YOUR ATTENTION