Mastoiditis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray908.png|thumb|Cross sectional ear anatomy (left).]] | |||
*Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum" | *Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum" | ||
*Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, [[acute otitis media]] | |||
*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 | **Mastoiditis is unlikely if middle ear examination is normal | ||
===Etiology=== | |||
*[[S. pneumo]] (22%) | |||
*[[S. pyogenes]] (16%) | |||
*[[S. aureus]] (7%) | |||
*[[H. flu]] | |||
*[[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 | ||
*Cranial nerve VI and VII palsies | *[[Cranial nerve abnormalities|Cranial nerve VI and VII palsies]] | ||
==Differential Diagnosis== | |||
{{Ear DDX}} | |||
== | ==Evaluation== | ||
[[File:OtitisMedia Mastoiditis RightSide 153.png|thumb|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 | *Middle ear fluid cultures | ||
*CT mastoid with IV contrast | *CT mastoid with IV contrast | ||
** 90% sensitive | |||
**Delineates extent of bony involvement | **Delineates extent of bony involvement | ||
**Helps to diagnosis abscess formation | **Helps to diagnosis [[abscess]] formation | ||
== | ==Management== | ||
* | *ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy. | ||
{{Mastoiditis Antibiotics}} | |||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
==Complications== | |||
Include, but are not limited to: | |||
*[[Meningitis]] | |||
*[[Encephalitis]] | |||
*[[Venous sinus thrombosis]] | |||
*[[Brain abscess]] | |||
*Facial nerve palsy | |||
*[[Sepsis]] | |||
==See Also== | ==See Also== | ||
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*[[Eponyms_(A-B)#Bezold.27s_abscess|Bezold abscess]] | *[[Eponyms_(A-B)#Bezold.27s_abscess|Bezold abscess]] | ||
== | ==References== | ||
<References/> | |||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:ID]] | [[Category:ID]] |
Latest revision as of 17:31, 16 August 2019
Background
- Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
- 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
Evaluation
- 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
- 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
Complications
Include, but are not limited to:
- Meningitis
- Encephalitis
- Venous sinus thrombosis
- Brain abscess
- Facial nerve palsy
- Sepsis