Medical versus Surgical

Treatment of Pediatric
Acute Mastoiditis :
A Systematic Review
Wulan Mega
Gustria
Tutor :

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 There is no Evaluate the Determine
Pediatric acute
standard of care efficacy of PAM clinical question
mastoiditis
management treatment options and PICO

Search Engine
Seek the
from PUBMED
evidence from
and
PICO
Embase,Medline

Background
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3
Introduction
Otalgia

Pediatric Acute
Fever

Mastoiditis
Sagging posterior
superior ear canal

Retroauricular redness,
pain, swelling,
Fluctuation
Introduction
Antibiotik intravena
alone

Antibiotik and
Myringotomi/Tympanostomi
tube placement
SPA incision and
drainase

Mastoidecty

Variabilities In treatment
options makes it difficult to
discern the best approach
OBJECTIVE To evaluating
cure rates with
OF THIS medical and
STUDY surgical
treatment options
Eligibility Criteria
• Human subjects
• English-language literature
• Medical therapy as the sole Case Report
treatment or as the initial treatment
were included in our review of
medical therapy of acute
mastoiditis.
• Surgical procedures included
myringotomy with or without tube
placement, SPA incision and
drainage, and mastoidectomy

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SEARCH
STRATEGY

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Discussion
 Acute mastoiditis most common complication of AOM
 Currently there is no accepted standard of care for the treatment of pediatric AM or its associated
complications
 There is no consensus regarding the best management options or treatment protocols for pediatric AM
 To evaluate overall success rates for the most commonly used treatment options, mainly myringotomy with
or without tube, Mastoidectomy with or without tube, SPA drainage, or intravenous antibiotics in isolation
 Medical terapy as the initial treatment, nearly 75% of the patients were cured without surgical therapy.
 Myringotomi with or without tube placement achieved a nearly 94% cure rate.
 Incision and drainage of the SPA with concurrent myringotomy with or without tube placement had a lower
success rate of 86,5%
 Surgical option mastoidectomy achieved a 100% cure rate
 Reasons for surgical therapy : Presence of complication, lack of improvement, or progression of disease.
 In patients who do not improve or who worsen clinically, surgery should be considered as a reasonable
next step., myringotomy with or withour tube placement is reasonable initial surgical option that may be
combain witd concurrent SPA drainage if SPA is present

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Limitation
All the studies were large case series or retrospective
review

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JOURNAL APPRAISAL

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Journal Appraisal
P
• Children with Acute mastoiditis

I
• Surgical theraphy

C
• Medical theraphy

O
• Cure rates
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VALIDITY

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Does the systematic review address a focused
question (PICO)?
✔
Q
This paper: Yes No  Unclear 
️
Comment:

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Use it to direct the search and select articles for
inclusion? Q
️This paper: Yes No  Unclear ✔️

Comment:

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 Funnel Plot

Funnel plot show us The study maybe

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Have the studies been critically appraised?
✔
A
This paper: Yes ️ No  Unclear 
Comment:

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Did they only include high quality studies?
I
This paper: Yes No ✔️ Unclear 
Comment:

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Did they only include high quality studies?
✔
I
This paper: Yes  No ️ Unclear 
Comment:

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Have the results been totalled up with appropriate
summary tables and plots?
✔
T
This paper: Yes ️ No  Unclear 
Comment:

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Have the results been totalled up with appropriate
summary tables and plots?
✔
T
This paper: Yes ️ No  Unclear 
Comment:

21
Have the results been totalled up with appropriate
summary tables and plots?
✔
T
This paper: Yes ️ No  Unclear 
Comment:

22
Have the results been totalled up with appropriate
summary tables and plots?
✔
T
This paper: Yes ️ No  Unclear 
Comment:

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Heterogeneity between studies assessed
and explained? H
✔
This paper: Yes ️
No  Unclear 
Comment:

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How well was the research done? (Internal YES NO UNCLEAR
validity)
Question – Does the systematic review address a
focused question (PICO)?
......and use it to direct the search and select articles for
inclusion?
Find – Did the search find all the relevant evidence?

Appraise – Have the studies been critically appraised?

Include – Did they only include high quality studies?

Total up – Have the results been totaled up with

Heterogeneity – ......and heterogeneity between

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 We have to find NNT and Confident Interval From this
journal
NNT formula is
RR = EER / CER
ARI = CER – EER
NNT = 1/ARI

Confident interval (CI) formula is

+/- 1.96 CER x (1-CER) + EER x (1-EER)

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What measure was used, how large was the effect
(could it have been due to chance)?

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What measure was used, how large was the effect
(could it have been due to chance)?

Cure Rates

NNT =
95 % CI NNT =

Recovery Rate
Severe - Profound
 NNT = 4.2
95 % CI NNT = 3 - 8
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APPLICABILITY

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Applicability
Is my patient so different to those in the study that the results
cannot apply?
• No

Will the potential benefits of treatment outweigh the potential

Is the treatment feasible in my setting?

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