Background. Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus regarding the management of AM has been identified. The current guidelines include a conservative approach (parenteral antibiotics alone, antibiotics plus minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess through retro-auricolar incision or needle aspiration) or surgical treatment (mastoidectomy). The main aim of this review was to evaluate and summarize the current knowledge about the management of pediatric AM by analyzing the current evidence in the literature. Methods. We examined the following bibliographic electronic databases: Pubmed and the Cochrane Library, from the inception date until February 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISM). The key words used for the search across electronic databases were: `mastoiditis` and `management`; `mastoiditis` and `surgery`; `mastoiditis` and `conservative`; `mastoiditis` and `antibiotics`; `mastoiditis` and `myringotomy`; `mastoiditis` and `grommet`; `mastoiditis` and `drainage`; and `mastoiditis` and `mastoidectomy`. Results. We selected 12 articles involving 1124 episodes of mastoiditis. Some of these studies considered medical therapy alone as a valid first step, whereas others considered a minor surgical intervention as an initial approach along with antibiotic therapy. Considering the studies that evaluated medical therapy as the initial sole treatment option, the success rate of antibiotics alone was 24.6%. Overall, the success rate of minor surgical procedures, excluding mastoidectomy, was 87.7%, whereas the mastoidectomy success rate was 97%. Conclusions. Overall, there is no shared consensus on the diagnostic or therapeutic approach to mastoiditis. Conservative therapy has gained considerable ground in recent times, quite limiting the predominant role of mastoidectomy. Further studies will be necessary to definitely develop standardized protocols shared in the scientific community.

Acute mastoiditis (AM) is a common complication of acute otitis media in children. There is currently no consensus on criteria for diagnosis. Head CT is the most frequent diagnostic tool used in the ED although the increasing awareness on the use of ionized radiations in children has questioned the use of CT imaging versus solely using clinical criteria. Our research aimed to understand if CT imaging was essential in making a diagnosis of AM. We retrospectively analyzed medical records from pediatric patients who accessed our Pediatric Emergency Department (ED) between January 2014 and December 2020, with a clinical suspicion of AM. We reviewed clinical symptoms upon presentation, head CT and lab values (white blood cell count or WBC, C-Reactive Protein or CRP) when done, presence of complications and discharge diagnosis. A multilogistic regression model was specified to establish the role of clinical features and of CT in the diagnosis of AM based on 77 patients. Otalgia (OR= 5.01; 95% CI= 1.52-16.51), protrusion of the auricle (OR= 8.42; 95% CI= 1.37-51.64) and hyperemia (OR= 4.07; 95% CI= 1.09-15.23) of the mastoid were the symptoms strongly associated with a higher probability of AM. In addition to clinical features, the adjusted OR conferred by head CT was 3.09 (95% CI = 0.92-10.34). Clinical signs were most likely predictive of AM in our sample when compared to Head CT. Most common symptoms were protrusion of the auricle, hyperemia or swelling behind the ear and otalgia. (www.actabiomedica.it)

The Central European Journal of Urology is an open access quarterly-issued journal, which provides a forum for the presentation of original clinical, experimental and other research studies...

The Central European Journal of Urology is an open access quarterly-issued journal, which provides a forum for the presentation of original clinical, experimental and other research studies...

Growth hormone deficiency (GHD) is a frequent cause of impaired linear growth and may also affect skeletal development and bone mass acquisition. This narrative review summarizes the current evidence on bone health in pediatric GHD, with a focus on clinical findings, response to recombinant human growth hormone (rhGH) therapy, and practical approaches to bone assessment. Available pediatric studies consistently show decreased BMD and bone mineral content at diagnosis, often involving the lumbar spine and total body, together with alterations in bone structure. During rhGH treatment, gradual improvements in bone turnover markers and BMD are generally observed, although responses are variable and may depend on age, growth response, and treatment intensity. Full normalization is achieved only in a subset of patients, highlighting heterogeneity in skeletal recovery. Given these findings, a structured clinical approach is recommended. An integrated algorithm for bone health evaluation in children with GHD should include biochemical assessment (IGF-1, calcium-phosphate metabolism, vitamin D status, and bone turnover markers) plus imaging evaluation, primarily using dual-energy X-ray absorptiometry (DXA) with appropriate pediatric and size-adjusted interpretation. Early initiation of rhGH therapy, alongside optimization of calcium and vitamin D intake, is essential to support bone accrual. Overall, pediatric GHD is associated with impaired skeletal development, but timely diagnosis and standardized monitoring through a combined clinical, biochemical, and imaging algorithm can improve the final bone outcomes. Further prospective studies are needed to refine assessment tools and optimize long-term management strategies.