Mastoiditis: Difference between revisions

 
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==Background==
==Background==
*Inflammation of middle ear spreads into mastoid air cells via the aditus ad antrum
[[File:Gray908.png|thumb|Cross sectional ear anatomy (left).]]
**Can extend into cranial cavity and lead to brain abscess
*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]]
**Mastoiditis is unlikely if middle ear examination is normal
**Mastoiditis is unlikely if middle ear examination is normal
===Etiology===
*[[S. pneumo]] (22%)
*[[S. pyogenes]] (16%)
*[[S. aureus]] (7%)
*[[H. flu]]
*[[P. aeruginosa]]
[[File:Mastoiditis1.jpg|thumb|Mastoiditis with subperiostal abscess]]


==Clinical Features==
==Clinical Features==
*Abnormal TM findings
*Abnormal TM findings
*Abnormal mastoid findings
*Abnormal mastoid findings
**Erythema, edema tenderness
**Erythema, edema, tenderness
*Abnormal pinna findings
*Abnormal pinna findings
**Protrusion of auricle, obliteration of postauricular crease
**Protrusion of auricle, obliteration of postauricular crease
*Cranial nerve VI and VII palsies
*[[Cranial nerve abnormalities|Cranial nerve VI and VII palsies]]
 
==Differential Diagnosis==
{{Ear DDX}}


==Diagnosis==
==Evaluation==
[[File:OtitisMedia Mastoiditis RightSide 153.png|thumb|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
*Middle ear fluid cultures
*CT mastoid
*CT mastoid with IV contrast
** 90% sensitive
**Delineates extent of bony involvement
**Delineates extent of bony involvement
**Helps to diagnosis [[abscess]] formation


==Treatment==
==Management==
*IV Abx
*ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy.
**Vancomycin + (ceftazidime OR cefepime OR piperacillin-tazobactam)
{{Mastoiditis Antibiotics}}


==Disposition==
==Disposition==
*Admit
*Admit
==Complications==
Include, but are not limited to:
*[[Meningitis]]
*[[Encephalitis]]
*[[Venous sinus thrombosis]]
*[[Brain abscess]]
*Facial nerve palsy
*[[Sepsis]]


==See Also==
==See Also==
*[[Otitis Media]]
*[[Otitis Media]]
*[[Eponyms_(A-B)#Bezold.27s_abscess|Bezold abscess]]


==Source==
==References==
Tintinalli
<References/>


[[Category:ENT]]
[[Category:ENT]]
[[Category:ID]]
[[Category:ID]]

Latest revision as of 17:31, 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