II. Epidemiology
- Rare now since the use of Antibiotics in Otitis Media
III. Pathophysiology
- Extension of middle ear disease
- Abscess and destruction of mastoid bone
IV. Predisposing factors
- Acute Otitis Media extension (most common, esp. children)
- Chronic Otitis Media with secondary Cholesteatoma with obstruction of Ear Drainage
- Leukemia
- Mononucleosis
- Temporal Bone Sarcoma
- Kawasaki Disease
V. Causes: Bacteria associated with Acute Otitis Media
- Streptococcus Pneumoniae (22%)
- Streptococcus Pyogenes (16%)
- Staphylococcus Aureus (7%)
- Haemophilus Influenzae (4%, likely much lower Incidence post-Hib Vaccine)
VI. Causes: Bacteria associated with Chronic Otitis Media
- Staphylococcus Aureus (7% overall Mastoiditis cases)
- Pseudomonas Aeruginosa (4% overall Mastoiditis cases)
- Anaerobic Bacteria
- Other atypical causes of Chronic Mastoiditis
- Nocardia
- Actinomyces
- Mycobacterium tuberculosis
VII. Symptoms
- Unresolved Otitis Media
- Hearing Loss
- Fever spikes may exceed 104 F
- Otalgia
- Headache
- Pain at mastoid, occipital and parietal regions
VIII. Signs
- Swelling and tenderness
- Postauricular
- Supraauricular
- Toxic appearance
- Inflamed and thickened TM (90% of cases)
- TM often perforated with Otorrhea
IX. Labs
- Complete Blood Count (CBC)
- Cultures
- Tympanocentesis for middle ear fluid (preferred) or
- Auditory canal culture
X. Imaging
- CT of Mastoid area (MRI if intracranial spread)
- Findings: Loss of mastoid air cells
XI. Management: Acute Mastoiditis
- Otolaryngology Consultation
- Admit for IV Antibiotics in most cases
- Uncomplicated Mastoiditis (children with first episode)
- Vancomycin (Linezolid may be used as an alternative)
- Child: 15 mg/kg IV every 6 hours
- Adult: 30-60 mg/kg IV divided every 8-12 hours
- Treat for 7-10 days, with Antibiotics based on cultures and sensitivity
- Vancomycin (Linezolid may be used as an alternative)
- Complicated Mastoiditis (chronic infection, Osteomyelitis or abscess)
- Vancomycin (or Linezolid) AND
- Piperacillin-Tazobactam (Zosyn) OR Ceftazidime OR Aztreonam
- Treat for 4-6 weeks, with Antibiotics based on cultures and sensitivity
- Surgical management
- Myringotomy drainage or
- Mastoidectomy may be needed
- Removes infected bone or mucosa
XII. Management: Chronic Mastoiditis
- External auditory canal measures
- Warm water self-irrigation of the external canal (if Tympanic Membrane intact)
- Topical Antibiotics (culture sensitivity directed if available)
- Ciprofloxacin or LevofloxacinEar Drops twice daily for 2 weeks
- Avoid Aminoglycoside drops (or systemic Antibiotics) due to Ototoxicity
- Otolaryngology Consultation
- Evaluate for Cholesteatoma
- Mastoidectomy indications
- Chronic drainage
- Osteomyelitis (e.g. Temporal Bone, petrous bone)
- CNS Spread of infection
XIII. Complications
- Osteomyelitis
- Bacterial Meningitis
- Temporal Lobe epidural or Subdural Abscess
- Septic thrombosis of lateral venous sinus
XIV. References
- (2019) Sanford Guide, accessed on IOS 11/18/2019
- Klein in Mandell (2000) Infectious Disease, p. 674
- Pfaff in Marx (2002) Rosen's Emergency Med., p. 932-3
- Lin (2010) Clin Pediatr 49(2):110-5 [PubMed]
- Loh (2018) J Laryngol 132(2): 96-104 +PMID:28879826 [PubMed]
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Related Studies
| Definition (MSHCZE) | Zánět bradavkového výčnělku, obv. jako komplikace zánětu středního ucha (otitidy). Je nebezpečný dalším šířením infekce do mozku. Akutní m. vzniká při mezotitidě, někdy však se její příznaky mohou projevit až po odeznění nedostatečně léčeného zánětu. Jsou bolesti, celkové příznaky, výtok z ucha, zhoršení hypakuze, může být tinitus pulzujícího charakteru, lokálně bývá retroaurikulární prosáknutí, bolestivost až absces. Diagnózu doplňují i rtg změny. Terapie je operační – srov. (antro)mastoidektomie. Zvl. formami jsou tzv. okultní m. (může být u kojenců), nenápadná je rovněž mukózní m. (způsobená Staphylococcus mucosus). (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (MSH) | Inflammation of the honeycomb-like MASTOID BONE in the skull just behind the ear. It is usually a complication of OTITIS MEDIA. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D008417 |
| ICD9 | 383.9 |
| ICD10 | H70.9 , H70.90 |
| SnomedCT | 194309002, 155230007, 52404001 |
| English | Mastoiditides, Unspecified mastoiditis, Mastoiditis NOS, Mastoiditis, unspecified, Mastoiditis, mastoiditis (diagnosis), mastoiditis, Unspecified mastoiditis, unspecified ear, Mastoiditis [Disease/Finding], Mastoiditis NOS (disorder), Mastoiditis (disorder), Mastoiditis, NOS |
| Dutch | mastoïditis NAO, niet-gespecificeerde mastoïditis, Mastoïditis, niet gespecificeerd, mastoïditis, Mastoiditis |
| French | Mastoïdite SAI, Mastoïdite non précisée, Mastoïdite |
| German | Mastoiditis NNB, unspezifische Mastoiditis, Mastoiditis, nicht naeher bezeichnet, Mastoiditis |
| Italian | Mastoidite non specificata, Mastoidite NAS, Mastoidite |
| Portuguese | Mastoidite NE, Mastoidite |
| Spanish | Mastoiditis no especificada, Mastoiditis NEOM, mastoiditis, SAI, mastoiditis, SAI (trastorno), mastoiditis (trastorno), mastoiditis, Mastoiditis |
| Japanese | 乳様突起炎, 詳細不明の乳様突起炎, 乳様突起炎ＮＯＳ, ﾆｭｳﾖｳﾄｯｷｴﾝNOS, ﾆｭｳﾖｳﾄｯｷｴﾝ, ｼｮｳｻｲﾌﾒｲﾉﾆｭｳﾖｳﾄｯｷｴﾝ |
| Swedish | Mastoidit |
| Czech | mastoiditida, Blíže neurčená mastoiditida, Mastoiditida, Mastoiditida NOS |
| Finnish | Mastoidiitti |
| Russian | MASTOIDIT, МАСТОИДИТ |
| Korean | 상세불명의 꼭지염 |
| Croatian | MASTOIDITIS |
| Polish | Zapalenie wyrostka sutkowatego |
| Hungarian | nem meghatározott mastoiditis, mastoiditis, mastoiditis k.m.n. |
| Norwegian | Mastoiditt |
Ontology: Chronic mastoiditis (C0155447)
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 383.1 |
| ICD10 | H70.1 , H70.10 |
| SnomedCT | 194299006, 155232004, 80645004 |
| English | Chronic mastoiditis NOS, chronic mastoiditis (diagnosis), chronic mastoiditis, Chronic mastoiditis, unspecified ear, Chronic mastoiditis NOS (disorder), Chronic mastoiditis, Chronic mastoiditis (disorder), chronic; mastoiditis, mastoiditis; chronic |
| Dutch | chronische mastoïditis, chronisch; mastoïditis, mastoïditis; chronisch, Chronische mastoïditis |
| French | Mastoïdite chronique |
| German | chronische Mastoiditis, Chronische Mastoiditis |
| Italian | Mastoidite cronica |
| Portuguese | Mastoidite crónica |
| Spanish | Mastoiditis crónica, mastoiditis crónica, SAI, mastoiditis crónica, SAI (trastorno), mastoiditis crónica (trastorno), mastoiditis crónica |
| Japanese | 慢性乳様突起炎, ﾏﾝｾｲﾆｭｳﾖｳﾄｯｷｴﾝ |
| Czech | Chronická mastoiditida |
| Korean | 만성꼭지염 |
| Hungarian | chronicus mastoiditis |
Ontology: Acute mastoiditis (C0701825)
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 383.0 |
| ICD10 | H70.0 |
| SnomedCT | 267670009, 155231006, 194297008, 17506007, 194293007, 386034005 |
| English | Acute mastoiditis NOS, acute mastoiditis (diagnosis), acute mastoiditis, Acute mastoiditis NOS (disorder), Acute mastoiditis (disorder), mastoiditis; acute, acute; mastoiditis, Acute mastoiditis, NOS, Acute mastoiditis [Ambiguous], Acute mastoiditis |
| Dutch | acute mastoïditis, acuut; mastoïditis, mastoïditis; acuut, Acute mastoïditis |
| French | Mastoïdite aiguë |
| German | akute Mastoiditis, Akute Mastoiditis |
| Italian | Mastoidite acuta |
| Portuguese | Mastoidite aguda |
| Spanish | Mastoiditis aguda, mastoiditis aguda, SAI (trastorno), mastoiditis aguda, SAI, mastoiditis aguda (trastorno), mastoiditis aguda |
| Japanese | 急性乳様突起炎, ｷｭｳｾｲﾆｭｳﾖｳﾄｯｷｴﾝ |
| Czech | Akutní mastoiditida |
| Korean | 급성 꼭지염 |
| Hungarian | heveny mastoiditis |
