Mastoiditis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray908.png|thumb|Cross sectional ear anatomy (left).]] | |||
*Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum" | *Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum" | ||
*Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, [[acute otitis media]] | *Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, [[acute otitis media]] | ||
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*Abnormal pinna findings | *Abnormal pinna findings | ||
**Protrusion of auricle, obliteration of postauricular crease | **Protrusion of auricle, obliteration of postauricular crease | ||
*Cranial nerve VI and VII palsies | *[[Cranial nerve abnormalities|Cranial nerve VI and VII palsies]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Latest revision as of 17:31, 16 August 2019
Background
- Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
- 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
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
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Evaluation
- Middle ear fluid cultures
- CT mastoid with IV contrast
- 90% sensitive
- Delineates extent of bony involvement
- Helps to diagnosis abscess formation
Management
- ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy.
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
- If chronic or severe, need pseudomonas coverage
- Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)
Disposition
- Admit
Complications
Include, but are not limited to:
- Meningitis
- Encephalitis
- Venous sinus thrombosis
- Brain abscess
- Facial nerve palsy
- Sepsis