Suppurative complications of acute otitis media: changes in frequency over time.

OBJECTIVE To review the experience at the Children's Hospital of Philadelphia in the management of suppurative complications of acute otitis media from 2000 to 2007, with an emphasis on changes in frequency over time. DESIGN Retrospective cohort study. SETTING Academic, tertiary care children's hospital. PATIENTS The study population comprised 87 children (age <18 years) with acute mastoiditis treated at our institution over the period of January 1, 2000, to December 31, 2007. Acute mastoiditis was defined by evidence of inflammation in the middle ear space and signs of mastoid inflammation (postauricular swelling, redness, or tenderness) or radiographic evidence of destruction of mastoid air cells, sigmoid sinus thrombosis, or abscess formation. Patients with underlying cholesteatoma were excluded. MAIN OUTCOME MEASURE Frequency of cases of acute mastoiditis per year. RESULTS The frequency of cases of acute mastoiditis at our institution was positively correlated with calendar time, both for all cases of acute mastoiditis (Spearman rank correlation, r = 0.73; P = .04) and for cases of mastoid subperiosteal abscess (r = 0.96; P < .001). CONCLUSIONS We observed an increase in the frequency of cases of acute mastoiditis with subperiosteal abscess seen at our institution over the study period, controlling for case volume. These findings suggest an increase in incidence, although further population-based studies are required to definitively evaluate this possibility.