Name
MASTOIDITIS
DESCRIPTION
DETAIL
CAUSES • Acute otitis media • Inadequately treated suppurative otitis media • Cholesteatoma • Blockage of outfl ow tract of mastoid air cells (aditus ad antrum) • Streptococcus pneumoniae -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS • Post-auricular inflammatory adenopathy • Severe external otitis • Post auricular cellulitis • Benign neoplasm - aneurysmal bone cyst, fi brous dysplasia • Malignant neoplasm - rhabdomyosarcoma • HIV infectionLABORATORY: * CBC with differential - increased WBC SPECIAL TESTS Consider audiogram IMAGING • Plain mastoid films - clouding of mastoid air cells; can be negative • CT scan if complication suspected. Cloud air cells - loss of bony septation of the air cell system. DIAGNOSTIC PROCEDURES Myringotomy (also therapeutic)
TYPENOTES
RISK FACTORS: Cholesteatoma, Recurrent acute otitis media, Immunocompromised hostGENERAL 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 suffi cient, 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 Water precautions DRUG(S) OF CHOICE . IV antibiotics: . Directed against most common organisms - group A beta-hemolytic strep, S. pneumonia , Haemophilus influenzae , M. catarrhatis . In patients with cholesteatoma, consider Proteus, Bacteroides and occasional S. aureus and Pseudomonas organisms . IV antibiotics for adult - ampicillin, 1-2 gm q6h or ampicillin-sulbactam (Unasyn) or cefuroxime, 750 mg q8h, to ensure coverage of beta-lactamase producing organisms . IV antibiotics for children - ampicillin, 100-200 mg/kg/day divided q6h or cefuroxime, 750 mg q8h . Topical/oral antibiotics: . Topical drops - neomycin-polymyxin B-hydrocortisone (Cortisporin) otic drops or gentamicin ophthalmic solution . Oral antibiotic - amoxicillin-clavulanate (Augmentin) PATIENT MONITORING • Postoperative - audiogram after acute process subsided • Frequent cleansing of ear canal to keep PE tube patent 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 • Periosteitis • Osteitis • Central venous sinus thrombosis EXPECTED COURSE/PROGNOSIS • Dependent on severity of disease • Conductive hearing loss may require reconstructive surgery • Expect to avoid complications with early treatment
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY MASTOID BOTH, COMPLETE BLOOD COUNT, CT SCAN