Difference between revisions of "Mastoiditis"

(Background)
(Background)
Line 1: Line 1:
 
==Background==
 
==Background==
[[File:Gray907.png|thumb|Ear anatomy]]
+
[[File:Gray908.png|thumb|Cross sectional ear anatomy (left).]]
 
*Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
 
*Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
 
*Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, [[acute otitis media]]
 
*Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, [[acute otitis media]]

Revision as of 02:18, 16 August 2019

Background

Cross sectional ear anatomy (left).
  • Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
  • Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, acute otitis media
    • Mastoiditis is unlikely if middle ear examination is normal

Etiology

Mastoiditis with subperiostal abscess

Clinical Features

  • Abnormal TM findings
  • Abnormal mastoid findings
    • Erythema, edema, tenderness
  • Abnormal pinna findings
    • Protrusion of auricle, obliteration of postauricular crease
  • Cranial nerve VI and VII palsies

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

Evaluation

CT scan: Otitis media (single arrow) and mastoiditis (double arrow) of the right side (left side in image). The external auditory canal is partially occupied by suppuration (triple arrow).
  • Middle ear fluid cultures
  • CT mastoid with IV contrast
    • 90% sensitive
    • Delineates extent of bony involvement
    • Helps to diagnosis abscess formation

Management

  • ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy.

Coverage against S. pneumoniae, S. pyogenes, S. aureus, H. influenzae

Disposition

  • Admit

Complications

Include, but are not limited to:

See Also

References