Mastoiditis Disease

BASICS

DESCRIPTION

Inflammatory process in the mastoid air cells

Acute mastoiditis - acute suppurative inflammatory process, typically after acute otitis media
Chronic mastoiditis - usually associated with cholesteatoma and chronic ear disease
System(s) affected: Pulmonary
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Unknown
Predominant age: Children, middle age
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Otalgia
Bulging erythematous tympanic membrane
Post-auricular edema/mass
Post-auricular erythema
Post-auricular tenderness
Protrusion of auricle
Fever
Increased WBC
Clouding of mastoid air cells on plain films
Fluid density in middle ear/mastoid air cells with or without loss of bony architecture
Possible otorrhea if perforated tympanic membrane
Subperiosteal abscess

CAUSES

Acute otitis media
Inadequately treated suppurative otitis media
Cholesteatoma
Blockage of outflow tract of mastoid air cells (aditus ad antrum)

RISK FACTORS

Cholesteatoma
Recurrent acute otitis media
Immunocompromised host

DIAGNOSIS

LABORATORY

CBC with differential - increased WBC

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Inflammatory tissue in air cell system
Granulation tissue
Osteitis

SPECIAL TESTS

Consider audiogram

IMAGING

Plain mastoid films - clouding of mastoid air cells
CT scan if complication suspected. Clouded air cells - loss of bony septation of the air cell system

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Hospitalized during acute phase

GENERAL MEASURES

Keep ear dry

SURGICAL MEASURES

Myringotomy; placement of pressure equalization (PE) tube
Culture material obtained at myringotomy
Frequent cleaning of ear canal under microscope to assure PE tube patency and adequate drainage of middle ear
IV antibiotics to cover the most common organisms
Topical antibiotic drops are also usually used after insertion of PE tube
If subperiosteal abscess present, it should be aspirated. If aspiration is not sufficient, incision and drainage should be performed
Mastoidectomy is reserved for those patients failing to respond to above measures within 18-72 hours or those with meningeal or intracranial complications

ACTIVITY

Fully active, water precautions

DIET

No special diet

PATIENT EDUCATION

Griffith: Instructions for Patients; Philadelphia, W.B. Saunders Co., 1994

FOLLOW UP

PREVENTION/AVOIDANCE

Adequate antibiotic treatment for acute otitis media
Treatment of chronic eustachian tube dysfunction (PE tubes)
Early identification of cholesteatoma

POSSIBLE COMPLICATIONS

Subperiosteal abscess
Gradenigo's syndrome (sixth nerve palsy, draining ear, and retro-orbital pain)
Bezold's abscess
Sigmoid sinus thrombosis
Meningitis
Intracranial abscess (epidural/subdural/intraparenchymal)

EXPECTED COURSE AND PROGNOSIS

Dependent on severity of disease
Conductive hearing loss may require reconstructive surgery
Expect to avoid complications with early treatment

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

PE = pressure equalization

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.