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Mastoiditis

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Mastoiditis

  • Epidemiology
  1. Rare now since the use of antibiotics in Otitis Media
  • Pathophysiology
  1. Extension of middle ear disease
  2. Abscess and destruction of mastoid bone
  • Predisposing factors
  • Etiologies
  • 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
  • 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
  • Radiology
  1. CT of Mastoid area (MRI if intracranial spread)
  2. Findings: Loss of mastoid air cells
  • 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
  • Complications
  1. Temporal Lobe abscess
  2. Septic thrombosis of lateral sinus
  • References
  1. Klein in Mandell (2000) Infectious Disease, p. 674
  2. Pfaff in Marx (2002) Rosen's Emergency Med., p. 932-3