The Journal of Laryngology & Otology

Main Articles

What effect has pneumococcal vaccination had on acute mastoiditis?

M Daniela1a2 c1, S Gautama1, T A Scrivenera3, C Mellera1, B Levina1 and J Curottaa1

a1 Department of Paediatric Otorhinolaryngology Head and Neck Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia

a2 National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, UK

a3 Graduate Medical Program, University of Sydney, New South Wales, Australia


Background: Streptococcus pneumoniae is a frequent cause of acute mastoiditis. Despite the recent (2005) introduction of pneumococcal vaccination, mastoiditis incidence and severity may be increasing. This study aimed to assess the incidence, severity and microbiology of acute mastoiditis over an 11-year period.

Methods: Retrospective review of paediatric acute mastoiditis cases seen at our institution (2000–2010), comparing patients seen prior to vaccination introduction (period one, 2000–2004), around the time of vaccine introduction (period two, 2005–2007) and post-vaccination (period three, 2008–2010).

Results: We reviewed 84 children. In periods one, two and three, respectively: mean annual case load was 8.4, 5 and 9 children; pneumococcal isolates were seen in 40.5, 6.7 and 29.6 per cent of cases; highest recorded fever was 38.6, 38.9 and 38.2°C and highest leukocyte count 18.9, 15.0 and 15.6 × 109/l; incidence of intracranial complications was 11.9, 0 and 7.4 per cent; mean duration of intravenous antibiotics was 6.0, 4.1 and 4.2 days; proportion treated surgically was 71.4, 60.0 and 48.1 per cent; and mean length of in-patient stay shortened.

Conclusion: Pneumococcal mastoiditis admission rates appeared to fall when vaccination was introduced, with concomitant reduction in overall mastoiditis incidence and intracranial complications; subsequently, however, admission rates rapidly returned to pre-vaccination levels.

(Accepted September 27 2012)

Key words

  • Mastoiditis;
  • Vaccination;
  • Child;
  • Otolaryngology;
  • Bacteria;
  • Pneumococcus


c1 Address for correspondence: Dr Matija Daniel, Department of Paediatric Otorhinolaryngology Head and Neck Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia 2145 Fax: +61 (0)2 9845 2078 E-mail:


  Presented orally at the Australian Society of Otolaryngology Head and Neck Surgery Meeting, 31 March 2012 to 4 April 2012, Adelaide, Australia, and as a poster at the European Society of Pediatric Otorhinolaryngology Meeting, 20 May 2012 to 23 May 2012, Amsterdam, The Netherlands

  Dr M Daniel takes responsibility for the integrity of the content of the paper

Competing interests: None declared