Otolaryngology Book

http://www.fpnotebook.com/

Mastoiditis

Advertisement

  1. Epidemiology
    1. Rare now since the use of antibiotics in Otitis Media
  2. Pathophysiology
    1. Extension of middle ear disease
    2. Abscess and destruction of mastoid bone
  3. Predisposing factors
    1. Otitis Media extension (most common)
    2. Leukemia
    3. Mononucleosis
    4. Temporal Bone Sarcoma
    5. Kawasaki disease
  4. Etiologies
    1. Streptococcus Pneumoniae (22%)
    2. Streptococcus Pyogenes (16%)
    3. Staphylococcus aureus (7%)
    4. Haemophilus Influenzae (4%)
    5. Pseudomonas aeruginosa (4%)
  5. 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
  6. 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
  7. Labs
    1. Complete Blood Count (CBC): Leukocytosis
  8. Radiology
    1. CT of Mastoid area (MRI if intracranial spread)
    2. Findings: Loss of mastoid air cells
  9. Management
    1. Admit for IV antibiotics
      1. Antibiotic course for 21 days
      2. Acute Mastoiditis
        1. Cefotaxime 50 to 180 mg/kg/day up to 1 g IV q4h
        2. Ceftriaxone 50 to 75 mg/kg/day up to 1 g IV q12h
      3. Chronic Mastoiditis (cover Pseudomonas)
        1. Ticarcillin-Clavulanate
    2. Surgical management
      1. Myringotomy drainage or
      2. Mastoidectomy (required in 50% of cases)
        1. Removes infected bone or mucosa
  10. Complications
    1. Temporal Lobe abscess
    2. Septic thrombosis of lateral sinus
  11. References
    1. Klein in Mandell (2000) Infectious Disease, p. 674
    2. Pfaff in Marx (2002) Rosen's Emergency Med., p. 932-3

Mastoiditis (C0024904)

Definition (MSH)Inflammation of the honeycomb-like MASTOID BONE in the skull just behind the ear. It is usually a complication of OTITIS MEDIA.
ConceptsDisease or Syndrome (T047)
ICD9383.9
MSHD008417
EnglishMastoid empyema, Mastoid empyemia, Mastoiditides, Mastoiditis, Unspecified mastoiditis
Spanishmastoiditis
Parent ConceptsMastoiditis and related conditions (C0155442), Otitis Media (C0029882), Mastoiditis (C0024904), Osteitis (C0029400), Disorder of mastoid (C0271474), Inflammation of specific body organs (C1285331), Inflammatory disorder of head (C1285337), Duplicate concept (C1274013)
SourcesCOSTAR, DXP, ICD9CM, MSH, MTH, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree