Coalescent mastioditis as a complication of acute otitis media - Ratna Dwi Restuti; Harim Priyono; Dora A Marpaung; Ayu Astria Sriyana; Rangga Rayendra Saleh (Oto Rhino Laryngologica Indonesiana, 2021)
Background: Acute otitis media (AOM) is one of the most common infections in children. AOM disease can lead to complications such as coalescent mastoiditis. Mastoidectomy surgery in cases of coalescent mastoiditis in children is still a debate. Purpose: To convey the management of coalescent mastoiditis in pediatric patients as complication of AOM using an evidence-based literature search. Case Report: A 10-month old patient with a diagnosis of AOM and coalescent mastoiditis, who was given antibiotic therapy and abscess drainage incision. Clinical question: In a child with coalescent mastoiditis as a complication of otitis media, could the disease be cured with intravena antiobitic therapy only without mastoidectomy operation? Review methods: Evidence-based literature searches through Pubmed, Proquest and Cochrane were performed using the keywords mastoidectomy, antibiotics and coalescent mastoiditis. Result: The search resulted in 277 literatures, and 12 were relevant with the case, and two journals stating that in cases of uncomplicated coalescent mastoiditis, mastoidectomy operation could be postponed and intravenous antibiotic could be administered with monitoring of the patient’s condition for 48 hours. Conclusion: Intravenous antibiotic is the primary therapy in cases of coalescence mastoiditis accompanied by clinical monitoring for 48 hours. Additional mastoidectomy and other surgeries were performed in cases of clinical deterioration after intravenous antibiotic therapy, and in cases of intratemporal or intracranial complications. ABSTRAK Latar belakang: Otitis Media Akut (OMA) merupakan salah satu infeksi yang sering ditemukan pada anak. Penyakit OMA dapat mengakibatkan komplikasi seperti mastoiditis koalesens. Operasi telinga mastoidektomi untuk kasus mastoiditis koalesens anak masih merupakan perdebatan sampai saat ini. Tujuan: Mengulas tatalaksana mastoiditis koalesens akibat OMA pada pasien anak menggunakan pencarian literatur berbasis bukti. Laporan Kasus: Seorang pasien umur 10 bulan dengan OMA dan komplikasi mastoiditis koalesens. Dilakukan tatalaksana terapi antibiotik dan insisi drainase abses. Pertanyaan klinis: Pada kasus anak kecil dengan mastoiditis koalensens sebagai komplikasi otitis media akut, apakah penyakit ini dapat disembuhkan hanya dengan pemberian terapi antibiotik intravena tanpa operasi mastoidektomi? Telaah literatur: Telaah berbasis bukti dilakukan melalui Pubmed, Proquest dan Cochrane, dengan menggunakan kata kunci mastoidektomi, antibiotik dan mastoiditis koalesens. Hasil: Telaah berbasis bukti menghasilkan 277 literatur, 12 diantaranya relevan dengan kasus, dan dua literatur menyatakan bahwa pada kasus mastoiditis koalesens tanpa komplikasi, mastoidektomi bisa ditunda dan pemberian antibiotik intravena bisa diberikan dengan pemantauan kondisi pasien selama 48 jam. Kesimpulan: Pemberian antibiotik intravena merupakan terapi utama pada kasus mastoiditis koalesens disertai pemantauan klinis selama 48 jam. Terapi lanjutan berupa mastoidektomi dan operasi lainnya dilakukan pada kasus dengan perburukan klinis sesudah terapi antibiotik intravena, dan pada kasus komplikasi intratemporal atau intrakranial.Kata kunci: mastoiditis koalesens, otitis media akut, antibiotik, mastoidektomi