Difference between revisions of "Mastoiditis"

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==Background==
 
==Background==
*Inflammation of middle ear spreads into mastoid air cells aditus ad antrum
+
*Inflammation of middle ear spreads into mastoid air cells via the aditus ad antrum
 
**Can extend into cranial cavity and lead to brain abscess
 
**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
 
*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==
+
==Clinical Features==
 
*Abnormal TM findings
 
*Abnormal TM findings
*Erythema, tenderness, edema over mastoid
+
*Abnormal mastoid findings
 +
**Erythema, edema tenderness
 +
*Abnormal pinna findings
 +
**Protrusion of auricle, obliteration of postauricular crease
 
*Cranial nerve VI and VII palsies
 
*Cranial nerve VI and VII palsies
  
==Work-Up==
+
==Diagnosis==
*Blood/middle ear fluid cultures
+
*Middle ear fluid cultures
 
*CT mastoid
 
*CT mastoid
 +
**Delineates extent of bony involvement
  
 
==Treatment==
 
==Treatment==
*Abx
+
*IV Abx
**Ampicillin/sulbactam 100mg/kg IV q6hr until physical signs have diminished
+
**Vancomycin + (ceftazidime OR cefepime OR piperacillin-tazobactam)
***Follow by Augmentin x 2wk after discharge
 
  
 
==Disposition==
 
==Disposition==

Revision as of 04:18, 5 November 2011

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
    • Delineates extent of bony involvement

Treatment

  • IV Abx
    • Vancomycin + (ceftazidime OR cefepime OR piperacillin-tazobactam)

Disposition

  • Admit

Source

Tintinalli