Mastoiditis: Difference between revisions
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**Delineates extent of bony involvement | **Delineates extent of bony involvement | ||
**Helps to diagnosis abscess formation | **Helps to diagnosis abscess formation | ||
==Differential Diagnosis== | |||
{{Ear DDX}} | |||
==Treatment== | ==Treatment== |
Revision as of 22:23, 1 March 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
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
Diagnosis
- Middle ear fluid cultures
- CT mastoid with IV contrast
- Delineates extent of bony involvement
- Helps to diagnosis abscess formation
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
Treatment
- IV Abx
- Vancomycin + (ceftazidime OR cefepime OR piperacillin-tazobactam)
Disposition
- Admit
See Also
Source
Tintinalli