Mastoiditis

Background

• Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
  • Can extend into cranial cavity and lead to brain abscess
• Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, acute otitis media
  • Mastoiditis is unlikely if middle ear examination is normal

Etiology

• S. pneumo (22%)
• S. pyogenes (16%)
• S. aureus (7%)
• H. flu
• P. aeruginosa

Mastoiditis with subperiostal abscess

Clinical Features

• Abnormal TM findings
• Abnormal mastoid findings
  • Erythema, edema, tenderness
• Abnormal pinna findings
  • Protrusion of auricle, obliteration of postauricular crease
• Cranial nerve VI and VII palsies

Differential Diagnosis

Ear Diagnoses

• External
  • Auricular hematoma
  • Cholesteatoma
  • Contact dermatitis
  • Ear foreign body
  • Herpes zoster oticus (Ramsay Hunt syndrome)
  • Malignant otitis externa
  • Mastoiditis
  • Otitis externa
  • Otomycosis
  • Tympanic membrane rupture
• Internal
  • Acute otitis media
  • Bullous myringitis
  • Chronic otitis media
  • Mastoiditis
  • Otic barotrauma
• Inner/vestibular
  • Labyrinthitis
  • Meniere's disease
  • Sudden sensorineural hearing loss

Evaluation

• Middle ear fluid cultures
• CT mastoid with IV contrast
  • Delineates extent of bony involvement
  • Helps to diagnosis abscess formation

Management

Coverage against S. pneumoniae, S. pyogenes, S. aureus, H. influenzae

• Clindamycin 600mg IV q8 hours OR (if MRSA concern use Vancomycin regimen)
• Vancomycin 15-20mg/kg IV q12 hours PLUS
  • Ceftriaxone 1g (50mg/kg) IV once daily OR
  • Ampicillin/Sulbactam 3g (50mg/kg) IV q6 hours

Disposition

• Admit

See Also

• Otitis Media
• Bezold abscess

References

Authors

Jordan Swartz, Ross Donaldson, Daniel Ostermayer, Yos Yachivev, Neil Young, Michael Holtz