Mastoiditis: Difference between revisions
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*[[H. flu]] | *[[H. flu]] | ||
*[[P. aeruginosa]] | *[[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 | ||
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{{Ear DDX}} | {{Ear DDX}} | ||
== | ==Diagnostic Evaluation== | ||
*Middle ear fluid cultures | *Middle ear fluid cultures | ||
*CT mastoid with IV contrast | *CT mastoid with IV contrast | ||
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==Management== | ==Management== | ||
{{Mastoiditis Antibiotics}} | {{Mastoiditis Antibiotics}} | ||
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==References== | ==References== | ||
<References/> | |||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 07:07, 7 September 2015
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
Etiology
- S. pneumo (22%)
- S. pyogenes (16%)
- S. aureus (7%)
- H. flu
- P. aeruginosa
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
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Diagnostic Evaluation
- Middle ear fluid cultures
- CT mastoid with IV contrast
- 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
- Ceftriaxone 1g (50mg/kg) IV once daily OR
- Ampicillin/Sulbactam 3g (50mg/kg) IV q6 hours
- If chronic or severe, need pseudomonas coverage
- Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)
Disposition
- Admit