Difference between revisions of "Mastoiditis"

(Disposition)
(Clinical Features)
 
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==Background==
 
==Background==
*Inflammation of middle ear spreads into mastoid air cells aditus ad antrum
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[[File:Gray908.png|thumb|Cross sectional ear anatomy (left).]]
**Can extend into cranial cavity and lead to brain abscess
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*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
  
==Diagnosis==
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===Etiology===
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*[[S. pneumo]] (22%)
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*[[S. pyogenes]] (16%)
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*[[S. aureus]] (7%)
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*[[H. flu]]
 +
*[[P. aeruginosa]]
 +
 
 +
[[File:Mastoiditis1.jpg|thumb|Mastoiditis with subperiostal abscess]]
 +
 
 +
==Clinical Features==
 
*Abnormal TM findings
 
*Abnormal TM findings
*Erythema, tenderness, edema over mastoid
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*Abnormal mastoid findings
*Cranial nerve VI and VII palsies
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**Erythema, edema, tenderness
 +
*Abnormal pinna findings
 +
**Protrusion of auricle, obliteration of postauricular crease
 +
*[[Cranial nerve abnormalities|Cranial nerve VI and VII palsies]]
  
==Work-Up==
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==Differential Diagnosis==
*Blood/middle ear fluid cultures
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{{Ear DDX}}
*CT mastoid
 
  
==Treatment==
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==Evaluation==
*Abx
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[[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).]]
**Ampicillin/sulbactam 100mg/kg IV q6hr until physical signs have diminished
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*Middle ear fluid cultures
***Follow by Augmentin x 2wk after discharge
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*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.
 +
{{Mastoiditis Antibiotics}}
  
 
==Disposition==
 
==Disposition==
 
*Admit
 
*Admit
**Many ENT are comfortable w/ PO abx and d/c if pt is well-appearing
 
  
==Source==
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==Complications==
Tintinalli
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Include, but are not limited to:
 +
*[[Meningitis]]
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*[[Encephalitis]]
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*[[Venous sinus thrombosis]]
 +
*[[Brain abscess]]
 +
*Facial nerve palsy
 +
*[[Sepsis]]
 +
 
 +
==See Also==
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*[[Otitis Media]]
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*[[Eponyms_(A-B)#Bezold.27s_abscess|Bezold abscess]]
 +
 
 +
==References==
 +
<References/>
  
 
[[Category:ENT]]
 
[[Category:ENT]]
 +
[[Category:ID]]

Latest revision as of 17:31, 16 August 2019

Background

Cross sectional ear anatomy (left).
  • 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

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

Complications

Include, but are not limited to:

See Also

References