Mastoidite

Epidemiology

• Rare now since the use of antibiotics in Otitis Media.
• Affects predominantly children (= OM).

Pathophysiology

• Extension of middle ear disease
• Abscess and destruction of mastoid bone
• Complications: extension: septic phlebitis lateral sinus, intracranial abcess, VII (intrapetrous) paralysis.

Predisposing factors

• OM extension (most common)
• Cholesteatome (chronic), leukemia, mononucleosis, kawasaki, temporal bone sarcoma (uncommon)

Etiologies

• Streptococcus pneumoniae (22%)
• Streptococcus pyogenes (16%)
• Staphylococcus aureus (7%)
• Hemophilus inflenzae(4%)
• Pseudomonas aeruginosa (4%)

Symptoms

• Unresolved OM
• Hearing loss
• Spikes may exceed 104 F (40°C)
• Otalgia
• Headache
• Pain at mastoid, occipital and parietal regions

Signs

• Swelling and tenderness postauricular and /or Supraauricular
• Toxic appearance
• Inflammed and thickened TM (90% of cases) often perforated

Labs

• Inflammation , neutrophilia

Radiology

• CT of Mastoid area (MRI if intracranial spread)
• Findings: loss of mastoid air cells

Management

• IV antibiotics
  • Antibiotic course for 21 days
  • Acute Mastoiditis
    • Cefotaxime / 4h
    • Ceftriaxone /12h
  • Chronic Mastoiditis (cover Pseudomonas?)
• Surgical management
  • Myringotomy drainage or
  • Mastoidectomy (required in 50% of cases): removes infected bone or mucosa