Manage Mastoiditis
Mastoiditis determined on CT imaging has a poor correlation with the clinical diagnosis and is seen in many incidental patients or alternative pathologies. It is suggested that without evidence of bony erosion that this finding may preferentially reported as mastoid opacification only, for further clinical correlation - Andrew Pastuszek
image by: Faye Wild mastoiditis
HWN Suggests
Acute Mastoiditis
The mastoid process is one of four anatomical divisions of the temporal bone, and is directly connected to the middle ear via a narrow channel called the aditus ad antrum. In the setting of an upper respiratory tract infection, mucosal secretions and edema accumulate in the middle ear, ultimately backing up into the mastoid air spaces. This process is termed acute otitis media (AOM). In severe cases of AOM, these secretions are unable to drain from the mastoid process, leading to bacterial proliferation, most commonly S. pneumoniae, Group A streptococcus, S. aureus, H. influenzae, and P. aeruginosa.
Once established in the mastoid air cells, the infection—now termed acute mastoiditis—spreads…
Resources
Is mastoiditis being over-diagnosed on computed tomography imaging? —radiological versus clinical findings
In summary, opacification of mastoid air cells on CT imaging is a non-specific finding seen in a range of otologic conditions from the common; OE, OM and in the rare; acute mastoiditis. Furthermore, there are a number of cases where this is a completely incidental finding. It is suggested from the analysis of available literature and the findings of this review that the radiological reporting of this finding would be better stated as “mastoid opacification for clinical correlation” if no bony erosion is seen.
Acute Otitis Media and Mastoiditis in adults
In acute mastoiditis, there is very little evidence to support a particular duration of therapy and duration will be affected by the need for surgery. A 4 week total course is recommended in the first instance.
Acute Mastoiditis – Conservative Management
Acute Mastoiditis is the most common complication of AOM – how do you diagnose it and how does the ENT physician manage it?
Acute Mastoiditis: Pearls and Pitfalls
Acute mastoiditis is the most common, and usually the initial, complication of AOM. The diagnosis can be confusing due to differing uses of the term “mastoiditis”. Radiographic mastoiditis simply refers to fluid in the mastoid air cells, which can occur with any AOM due to communication between the middle ear and the mastoid air cells. However, acute mastoiditis for the EP involves clinical evidence of mastoid inflammation such as erythema, tenderness to palpation, bogginess, and swelling over the mastoid bone.
Doc, my ear hurts when I talk
Mastoiditis is not well-studied in adults so the exact incidence is unknown, however the most common isolates are Streptococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus, including MRSA. Because of this, vancomycin is the antibiotic of choice.
The Red Ear
The three most common organisms isolated are Strep Pneumoniae, nontypeable H. influenzae, and M. catarrhalis. Clinical features include fever and ear pain, with more specific features of erythema, edema, and tenderness of the mastoid area posterior to the auricle...
Therapeutic approach to pediatric acute mastoiditis – an update
Acute mastoiditis remains the most common complication of acute otitis media. It may rarely appear also in cochlear implant patients. However, the treatment recommendations for this disease are not precisely defined or employed, and in the current literature the differences regarding both the diagnosis and management are relatively substantial.
Acute Mastoiditis
Once diagnosed on contrasted CT scan, early treatment with vancomycin plus ceftriaxone or ampicillin/sulbactam is recommended. Even in the absence of neurological symptoms and intracranial involvement on the CT scan, otolaryngology should be consulted.
WikEM
If chronic or severe, need pseudomonas coverage... Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)
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