Difference between revisions of "Mastoiditis"

(Background)
(Disposition)
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==Disposition==
 
==Disposition==
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*ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy.
 
*Admit
 
*Admit
  

Revision as of 13:43, 23 August 2017

Background

  • Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
    • Complications include, but are not limited to: meningitis, encephalitis, venous sinus thrombosis, and brain abscesses.
  • 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

  • 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

Disposition

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

See Also

References