Difference between revisions of "Mastoiditis"

(Management)
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==Management==
 
==Management==
 +
*ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy.
 
{{Mastoiditis Antibiotics}}
 
{{Mastoiditis Antibiotics}}
*If chronic or severe, need pseudomonas coverage
 
** Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)
 
 
*ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy.
 
  
 
==Disposition==
 
==Disposition==

Revision as of 21:32, 18 July 2019

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

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

See Also

References