Mastoiditis

Aka: Mastoiditis, Acute Mastoiditis, Chronic Mastoiditis

advertisement

II. Epidemiology

  1. Rare now since the use of Antibiotics in Otitis Media

III. Pathophysiology

  1. Extension of middle ear disease
  2. Abscess and destruction of mastoid bone

IV. Predisposing factors

  1. Acute Otitis Media extension (most common, esp. children)
  2. Chronic Otitis Media with secondary Cholesteatoma with obstruction of Ear Drainage
  3. Leukemia
  4. Mononucleosis
  5. Temporal Bone Sarcoma
  6. Kawasaki Disease

V. Causes: Bacteria associated with Acute Otitis Media

  1. Streptococcus Pneumoniae (22%)
  2. Streptococcus Pyogenes (16%)
  3. Staphylococcus aureus (7%)
  4. Haemophilus Influenzae (4%, likely much lower Incidence post-Hib Vaccine)

VI. Causes: Bacteria associated with Chronic Otitis Media

  1. Staphylococcus aureus (7% overall Mastoiditis cases)
  2. Pseudomonas aeruginosa (4% overall Mastoiditis cases)
  3. Anaerobic Bacteria
  4. Other atypical causes of Chronic Mastoiditis
    1. Nocardia
    2. Actinomyces
    3. Mycobacterium tuberculosis

VII. Symptoms

  1. Unresolved Otitis Media
  2. Hearing Loss
  3. Fever spikes may exceed 104 F
  4. Otalgia
  5. Headache
  6. Pain at mastoid, occipital and parietal regions

VIII. Signs

  1. Swelling and tenderness
    1. Postauricular
    2. Supraauricular
  2. Toxic appearance
  3. Inflamed and thickened TM (90% of cases)
  4. TM often perforated with Otorrhea

IX. Labs

  1. Complete Blood Count (CBC)
    1. Leukocytosis
  2. Cultures
    1. Tympanocentesis for middle ear fluid (preferred) or
    2. Auditory canal culture

X. Imaging

  1. CT of Mastoid area (MRI if intracranial spread)
  2. Findings: Loss of mastoid air cells

XI. Management: Acute Mastoiditis

  1. Otolaryngology Consultation
  2. Admit for IV Antibiotics in most cases
  3. Uncomplicated Mastoiditis (children with first episode)
    1. Vancomycin (Linezolid may be used as an alternative)
      1. Child: 15 mg/kg IV every 6 hours
      2. Adult: 30-60 mg/kg IV divided every 8-12 hours
    2. Treat for 7-10 days, with Antibiotics based on cultures and sensitivity
  4. Complicated Mastoiditis (chronic infection, Osteomyelitis or abscess)
    1. Vancomycin (or Linezolid) AND
    2. Piperacillin-Tazobactam (Zosyn) OR Ceftazidime OR Aztreonam
    3. Treat for 4-6 weeks, with Antibiotics based on cultures and sensitivity
  5. Surgical management
    1. Myringotomy drainage or
    2. Mastoidectomy may be needed
      1. Removes infected bone or mucosa

XII. Management: Chronic Mastoiditis

  1. External auditory canal measures
    1. Warm water self-irrigation of the external canal (if Tympanic Membrane intact)
    2. Topical Antibiotics (culture sensitivity directed if available)
      1. Ciprofloxacin or LevofloxacinEar Drops twice daily for 2 weeks
      2. Avoid Aminoglycoside drops (or systemic Antibiotics) due to Ototoxicity
  2. Otolaryngology Consultation
    1. Evaluate for Cholesteatoma
    2. Mastoidectomy indications
      1. Chronic drainage
      2. Osteomyelitis (e.g. Temporal Bone, petrous bone)
      3. CNS Spread of infection

XIII. Complications

  1. Osteomyelitis
  2. Bacterial Meningitis
  3. Temporal Lobe epidural or Subdural Abscess
  4. Septic thrombosis of lateral venous sinus

XIV. References

  1. (2019) Sanford Guide, accessed on IOS 11/18/2019
  2. Klein in Mandell (2000) Infectious Disease, p. 674
  3. Pfaff in Marx (2002) Rosen's Emergency Med., p. 932-3
  4. Lin (2010) Clin Pediatr 49(2):110-5 [PubMed]
  5. Loh (2018) J Laryngol 132(2): 96-104 +PMID:28879826 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Mastoiditis." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Related Topics in Infectious Disease

advertisement