Mastoiditis Flashcards
What is mastoiditis?
Inflammation of mastoid antrum and mastoid air cells
Where is the mastoid in relation to the external auditory meatus?
Posterior and inferior
What is mastoiditis usually caused by?
Infection within the middle ear
Why is mastoiditis an emergency?
If untreated it can progress rapidly and result in intracranial infection
What features are usually found on history?
Recent or concurrent acute otitis media
Deep otalgia
Progressive and recent hearing loss on affected side
Generally unwell, young children not eating or drinking as normal
What findings are revealed on examination?
Fever
Erythema, tenderness and swelling over mastoid process
Protruding auricle
Bulging tympanic membrane with fluid level or perforation with purulent discharge in ear canal
Cervical lymphadenopathy on affected side
What do bloods usually show?
Raised WCC and CRP
Check renal function to ensure patient can have imaging with contrast
What imaging should be done?
CT - will demonstrate extent of mastoid air cell opacification
With contrast - also identify intracranial infection
How is it managed?
IV antibiotics e.g ceftriaxone - good bone penetration and can cross BBB
Surgery to drain infection if progressing despite IV antibiotics
- myringotomy +/- mastoidectomy
What complications can occur?
Facial nerve damage - ipsilateral facial weakness (forehead sparing)
If erosion into cranial vault: meningitis, subdural empyema, intracerebral abscess
The mastoid bone is made up of which skull bones?
Occipital
Temporal
What are some risk factors for developing mastoiditis?
Immunosuppression DM Congenital defects of middle and outer ear Recurrent AOM Cholesteatoma
