Mastoiditis

Background

• Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
  • Can extend into cranial cavity and lead to brain abscess
• 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

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

Diagnosis

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

Treatment

• IV Abx
  • Vancomycin + (ceftazidime OR cefepime OR piperacillin-tazobactam)

Disposition

• Admit

See Also

• Otitis Media
• Bezold abscess

Source

Tintinalli