Mastoiditis
It may not be as common as it used to be, but you still can’t afford to miss it - Mariah Bellinger MD
image by: Faye Wild mastoiditis
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Trusting Your Mom Gut
You have probably heard the advice “trust your gut” – as a mom, you’re supposed to have a special intuition, a feeling, about what’s best for your kid. Except often times, you don’t. Or at least, I don’t. There’s so much information out there are so many opinions that it’s hard to let your gut guide you. Honestly, I don’t live based on my intuition all the time – I like to think it’s a healthy mix between a feeling and some good ol’ fashioned research and logic...
On Christmas morning, my 4-year-old daughter woke up with a high fever and complaining her ear hurt. So much so that she didn’t open a single gift, not a stocking, nothing. She didn’t even care that Santa had come and he…
Resources
When Is Fluid in the Mastoid Cells a Worrisome Finding?
A diagnosis of “mastoiditis” on a radiologist’s report, even in a patient who otherwise appears well, can be alarming. Mastoiditis is an infamously morbid disease that is discussed frequently in medical textbooks as a complication of otitis media. An incidental finding of fluid in the mastoid air cells in an otherwise healthy individual can be approached like any case of otitis media, whereas fluid in the mastoid combined with destruction of surrounding bone in a seriously ill patient is a medical emergency. Mastoiditis is ultimately a clinical diagnosis.
What Are the Complications of Mastoiditis?
Mastoiditis is an inflammatory process of the mastoid air cells. The mastoid is contiguous with the middle ear cleft and therefore it is involved in most patients with acute otitis media. However, acute mastoiditis occurs when the infection spreads beyond the mucosa of the middle ear cleft, there is osteitis in the air-cell system, or there is mastoid process periostitis. These are usually caused by direct bony erosion or through the emissary vein of the mastoid indirectly. In the pre-antibiotic era, mastoiditis was a common and feared complication of otitis media in up to 20% of all cases.
Cerebral Sinus Venous Thrombosis in the Setting of Acute Mastoiditis
Infections involving the middle ear structures such as acute otitis and mastoiditis are infrequently complicated by thrombosis of the sigmoid and transverse sinuses, which are contiguous structures.
Acute mastoiditis guideline
Contrast enhanced CT petrous bones and brain...presence of opaque air cells in the mastoid antrum does not warrant urgent intervention in the absence of other signs.
Acute Otomastoiditis and Its Complications
Acute otomastoiditis is usually due to an acute pyogenic bacterial infection of the mastoid air cells and most often is seen as a complication of acute suppurative otitis media. Less frequently, acute otomastoiditis is seen secondary to chronic diseases of the middle ear, including cholesteatoma. It is useful at the outset to determine whether there is associated causative pathology such as a nasopharyngeal mass obstructing the eustachian tube so that this possibility is not overlooked.
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.
Mastoiditis
Mastoiditis is most common in children, with the highest incidence in children <2 years old, with a median age of 12 months. There is an increased incidence in children with learning difficulties, and it is twice as common in children with autism spectrum disorder.
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...
Trusting Your Mom Gut
You have probably heard the advice “trust your gut” – as a mom, you’re supposed to have a special intuition, a feeling, about what’s best for your kid. Except often times, you don’t. Or at least, I don’t. There’s so much information out there are so many opinions that it’s hard to let your gut guide you. Honestly, I don’t live based on my intuition all the time – I like to think it’s a healthy mix between a feeling and some good ol’ fashioned research and logic.
4 Uncommon But Serious Ear Infection Complications
Chronic mastoiditis is more difficult to diagnose because swelling slowly develops and ear pain is often not present. The trapped infection leads to severe complications because bone is slowly destroyed. The mastoid bone separates the ear from the brain. When bone erosion happens, chronic middle ear infections can spread causing meningitis or a brain abscess.
Dizziness-and-balance.com
Severe mastoiditis is characterized by a swollen external auditory canal. Mild mastoiditis, may be silent, and only seen on imaging.
Patient
The tympanic cavity of the middle ear is in communication with the mastoid antrum via a small canal that runs through the petrous temporal bone. The mastoid air cells are related superiorly to the middle cranial fossa and posteriorly to the posterior cranial fossa. This means that suppuration in the mastoid may, rarely, spread to cause meningitis or a cerebral abscess. Other surrounding structures include the facial nerve canal, the sigmoid sinus and the lateral sinus.
StatPearls
With the advent of antibiotics, the development of acute mastoiditis and progression to dangerous sequela is unlikely. However, if left untreated, mastoiditis can result in life-threatening sequela, including meningitis, intracranial abscess, and venous sinus thrombosis.
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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