Mastoiditis

Background

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

  • Middle ear fluid cultures
  • CT mastoid with IV contrast
    • 90% sensitive
    • Delineates extent of bony involvement
    • Helps to diagnosis abscess formation

Management

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

  • Clindamycin 600mg IV q8 hours OR (if MRSA concern use Vancomycin regimen)
  • Vancomycin 15-20mg/kg IV q12 hours PLUS
  • If chronic or severe, need pseudomonas coverage
    • Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)

Disposition

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

See Also

References