Mastoiditis is a bacterial infection of the mastoid bone, the prominent bone behind the ear. It usually occurs as a complication of acute otitis media, a middle ear infection. The infection can spread from the middle ear to the mastoid bone through small connecting air cells, leading to inflammation, destruction, and accumulation of pus within the bone.
Mastoiditis is a serious condition that can cause severe pain, swelling, and fever and even lead to life-threatening complications such as meningitis or brain abscess. Treatment typically involves a combination of antibiotics, surgical drainage, and in severe cases, mastoidectomy.
Epidemiology
Mastoiditis is an uncommon condition, and its incidence has decreased significantly since the introduction of antibiotics. In developed countries, the incidence of acute mastoiditis is estimated to be around 0.004% to 0.01% of all outpatient visits to the pediatrician. Children between the ages of 6 months and 2 years are most commonly affected, with a male preponderance.
In developing countries, however, the incidence of mastoiditis is still relatively high, with an estimated incidence of up to 30 cases per 1000 children. This is likely due to factors such as inadequate access to healthcare, poor hygiene, and a higher incidence of upper respiratory tract infections, which are risk factors for developing mastoiditis.
The incidence of complications from mastoiditis, such as intracranial abscesses and meningitis, has also decreased with the use of antibiotics. Nonetheless, complications can still occur and can lead to significant morbidity and mortality, especially in young children.
Anatomy
Pathophysiology
Mastoiditis is an infection of the mastoid air cells, which are small, air-filled spaces in the temporal bone behind the ear. The majority of infections of mastoiditis develop as a complication of otitis media acute, which is an infection of the middle ear. The cavity of the middle ear between the tympanic membrane and the cochlea includes essential structures such as the incus, malleus, Eustachian tube, and stapes.
The Eustachian tube connects the oral cavity to the middle ear and is in charge of removing air or fluid from the middle ear. If the Eustachian tube becomes obstructed, it can provide an opportunity for pathogens to grow in the middle ear. The lining of the mastoid cells is continuous with the lining of the middle ear cavity.
In acute mastoiditis, the infection can spread from the middle ear to the mastoid air cells, leading to inflammation and bony destruction. This can result in the formation of an abscess within the mastoid air cells, which can lead to further complications such as sigmoid sinus thrombosis, subperiosteal abscess, intracranial abscess, and meningitis.
The common microbe associated with mastoiditis is Streptococcus pneumoniae, but other bacteria such as Group A ß-hemolytic streptococcus, Staphylococci aureus, Streptococci pyogenes, and Hemophilus influenza can also cause the condition. Risk-based factors for mastoiditis include age under two years, immunocompromised condition, incomplete pneumatization, or process of acute recurrent otitis media of the mastoid.
Etiology
The primary cause of mastoiditis is the disease advancement of acute otitis media. The middle ear cavity, which includes structures such as the Malleus, Incus, Stapes, and Eustachian tube, extends from the tympanic membrane to the cochlea and is continuous with the inner surface of the mastoid cells, which form part of the temporal bone.
Inflammation or debris in the Eustachian tube can cause it to narrow, creating pathogens that can flourish in an adaptive environment. This lining membrane in the cavity of the middle ear, when infected, can extend to the mastoid cells, leading to acute coalescent mastoiditis, which is the erosion of bony septations and as well as the merging of tiny air cells into bigger ones filled with pus.
Streptococcal pneumonia is the most common pathogen causing mastoiditis, and other common pathogens include Group A ß-hemolytic streptococcus, Streptococcus pyogenes, Staphylococcus aureus, and Hemophilus influenza. Risk factors for mastoiditis include age under three years old, incomplete pneumatization, immunocompromised condition, acute recurrent otitis media, and mastoid progression.
Genetics
Prognostic Factors
With early diagnosis and appropriate treatment, the prognosis for mastoiditis is generally good, with most patients recovering without complications.
However, if left untreated or if treatment is delayed, mastoiditis can lead to severe and potentially life-threatening complications such as meningitis, intracranial abscess, and venous sinus thrombosis.
Despite advances in medical and surgical management, the mortality rate of mastoiditis sequela in children remains at 10%. Therefore, prompt recognition and treatment of mastoiditis is crucial to ensure the best possible outcome for the patient.
Clinical History
Clinical history
The clinical history of mastoiditis typically includes a preceding history of acute otitis media with signs and symptoms such as ear pain, fever, hearing loss, and drainage from the ear. Patients may also report symptoms of mastoiditis, such as pain and swelling behind the ear, redness of the skin over the mastoid, and headache.
As the infection progresses, patients may develop more severe symptoms such as facial weakness, neck stiffness, nausea, vomiting, and altered mental status. It is important for clinicians to obtain a thorough medical history, including any recent upper respiratory infections or ear infections, as well as any immunocompromising conditions or risk factors.
A physical exam should also be performed, including an inspection of the ear and surrounding tissues for signs of inflammation, swelling, or discharge and an assessment of neurologic function. Imaging studies, such as a CT scan or MRI, may be necessary to confirm the diagnosis and evaluate for potential complications.
Physical Examination
Physical examination
During a physical examination of a patient suspected to have mastoiditis, the healthcare provider may check for the following:
Swelling and redness behind the ear
Tenderness over the mastoid bone
Discharge from the ear
Limited movement of the ear or jaw due to pain
Enlarged lymph nodes in the neck
Fever and other signs of systemic infection
Signs of complications include meningitis, intracranial abscess, and venous sinus thrombosis.
The provider may also perform a pneumatic otoscopy, which involves blowing air into the ear canal to assess the mobility of the eardrum. This can help identify middle ear effusion, a common precursor to mastoiditis. Additionally, imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) may be performed to confirm the diagnosis and assess for complications.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential diagnosis
The differential diagnosis of mastoiditis includes other conditions that can cause similar symptoms, such as:
Acute otitis media
Otitis externa (swimmer’s ear)
Temporomandibular joint (TMJ) syndrome
Dental abscess
Sinusitis
Tension headache
Migraine
Cluster headache
Trigeminal neuralgia
It is essential to differentiate mastoiditis from these conditions as they may require different treatment approaches. A thorough medical history and physical examination can help to narrow down the potential diagnoses, and imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be helpful in making a definitive diagnosis.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The mainstay of mastoiditis therapy is antibiotics. However, additional interventions may be necessary based on the infection severity. Uncomplicated cases with no significant medical history and minimal physical examination findings can be treated as outpatients with daily intravenous ceftriaxone with fewer complications. However, the majority of patients with acute mastoiditis are admitted to the hospital.
Inpatient cases with fewer complications are manageable with high-dose intravenous steroids, myringotomy with the tube placement of a tympanostomy, and intravenous antibiotics. Physical tests are required on a regular basis as the patient’s clinical condition can quickly deteriorate. Mastoidectomy is recommended if mastoiditis fails to get better within forty-eight hours.
The preferred intravenous antibiotic for patients with no chronic otitis media is intravenous vancomycin is enough to cover the common microbes, including Streptococci pneumonia, Group A beta-hemolytic streptococcus, Staphylococci aureus, Hemophilus influenza. An anti-pseudomonal drug is given to vancomycin in patients with a history of ear infections.
Although antibiotics are effective, antibiotics alone have been shown to result in an 8.5% complication rate. Complications of mastoiditis can be life-threatening, including meningitis, intracranial abscess, and venous sinus thrombosis. Therefore, prompt and appropriate treatment is crucial for a good prognosis.
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References
https://www.ncbi.nlm.nih.gov/books/NBK560877/
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Mastoiditis is a bacterial infection of the mastoid bone, the prominent bone behind the ear. It usually occurs as a complication of acute otitis media, a middle ear infection. The infection can spread from the middle ear to the mastoid bone through small connecting air cells, leading to inflammation, destruction, and accumulation of pus within the bone.
Mastoiditis is a serious condition that can cause severe pain, swelling, and fever and even lead to life-threatening complications such as meningitis or brain abscess. Treatment typically involves a combination of antibiotics, surgical drainage, and in severe cases, mastoidectomy.
Mastoiditis is an uncommon condition, and its incidence has decreased significantly since the introduction of antibiotics. In developed countries, the incidence of acute mastoiditis is estimated to be around 0.004% to 0.01% of all outpatient visits to the pediatrician. Children between the ages of 6 months and 2 years are most commonly affected, with a male preponderance.
In developing countries, however, the incidence of mastoiditis is still relatively high, with an estimated incidence of up to 30 cases per 1000 children. This is likely due to factors such as inadequate access to healthcare, poor hygiene, and a higher incidence of upper respiratory tract infections, which are risk factors for developing mastoiditis.
The incidence of complications from mastoiditis, such as intracranial abscesses and meningitis, has also decreased with the use of antibiotics. Nonetheless, complications can still occur and can lead to significant morbidity and mortality, especially in young children.
Mastoiditis is an infection of the mastoid air cells, which are small, air-filled spaces in the temporal bone behind the ear. The majority of infections of mastoiditis develop as a complication of otitis media acute, which is an infection of the middle ear. The cavity of the middle ear between the tympanic membrane and the cochlea includes essential structures such as the incus, malleus, Eustachian tube, and stapes.
The Eustachian tube connects the oral cavity to the middle ear and is in charge of removing air or fluid from the middle ear. If the Eustachian tube becomes obstructed, it can provide an opportunity for pathogens to grow in the middle ear. The lining of the mastoid cells is continuous with the lining of the middle ear cavity.
In acute mastoiditis, the infection can spread from the middle ear to the mastoid air cells, leading to inflammation and bony destruction. This can result in the formation of an abscess within the mastoid air cells, which can lead to further complications such as sigmoid sinus thrombosis, subperiosteal abscess, intracranial abscess, and meningitis.
The common microbe associated with mastoiditis is Streptococcus pneumoniae, but other bacteria such as Group A ß-hemolytic streptococcus, Staphylococci aureus, Streptococci pyogenes, and Hemophilus influenza can also cause the condition. Risk-based factors for mastoiditis include age under two years, immunocompromised condition, incomplete pneumatization, or process of acute recurrent otitis media of the mastoid.
The primary cause of mastoiditis is the disease advancement of acute otitis media. The middle ear cavity, which includes structures such as the Malleus, Incus, Stapes, and Eustachian tube, extends from the tympanic membrane to the cochlea and is continuous with the inner surface of the mastoid cells, which form part of the temporal bone.
Inflammation or debris in the Eustachian tube can cause it to narrow, creating pathogens that can flourish in an adaptive environment. This lining membrane in the cavity of the middle ear, when infected, can extend to the mastoid cells, leading to acute coalescent mastoiditis, which is the erosion of bony septations and as well as the merging of tiny air cells into bigger ones filled with pus.
Streptococcal pneumonia is the most common pathogen causing mastoiditis, and other common pathogens include Group A ß-hemolytic streptococcus, Streptococcus pyogenes, Staphylococcus aureus, and Hemophilus influenza. Risk factors for mastoiditis include age under three years old, incomplete pneumatization, immunocompromised condition, acute recurrent otitis media, and mastoid progression.
With early diagnosis and appropriate treatment, the prognosis for mastoiditis is generally good, with most patients recovering without complications.
However, if left untreated or if treatment is delayed, mastoiditis can lead to severe and potentially life-threatening complications such as meningitis, intracranial abscess, and venous sinus thrombosis.
Despite advances in medical and surgical management, the mortality rate of mastoiditis sequela in children remains at 10%. Therefore, prompt recognition and treatment of mastoiditis is crucial to ensure the best possible outcome for the patient.
Clinical history
The clinical history of mastoiditis typically includes a preceding history of acute otitis media with signs and symptoms such as ear pain, fever, hearing loss, and drainage from the ear. Patients may also report symptoms of mastoiditis, such as pain and swelling behind the ear, redness of the skin over the mastoid, and headache.
As the infection progresses, patients may develop more severe symptoms such as facial weakness, neck stiffness, nausea, vomiting, and altered mental status. It is important for clinicians to obtain a thorough medical history, including any recent upper respiratory infections or ear infections, as well as any immunocompromising conditions or risk factors.
A physical exam should also be performed, including an inspection of the ear and surrounding tissues for signs of inflammation, swelling, or discharge and an assessment of neurologic function. Imaging studies, such as a CT scan or MRI, may be necessary to confirm the diagnosis and evaluate for potential complications.
Physical examination
During a physical examination of a patient suspected to have mastoiditis, the healthcare provider may check for the following:
Swelling and redness behind the ear
Tenderness over the mastoid bone
Discharge from the ear
Limited movement of the ear or jaw due to pain
Enlarged lymph nodes in the neck
Fever and other signs of systemic infection
Signs of complications include meningitis, intracranial abscess, and venous sinus thrombosis.
The provider may also perform a pneumatic otoscopy, which involves blowing air into the ear canal to assess the mobility of the eardrum. This can help identify middle ear effusion, a common precursor to mastoiditis. Additionally, imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) may be performed to confirm the diagnosis and assess for complications.
Differential diagnosis
The differential diagnosis of mastoiditis includes other conditions that can cause similar symptoms, such as:
Acute otitis media
Otitis externa (swimmer’s ear)
Temporomandibular joint (TMJ) syndrome
Dental abscess
Sinusitis
Tension headache
Migraine
Cluster headache
Trigeminal neuralgia
It is essential to differentiate mastoiditis from these conditions as they may require different treatment approaches. A thorough medical history and physical examination can help to narrow down the potential diagnoses, and imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be helpful in making a definitive diagnosis.
The mainstay of mastoiditis therapy is antibiotics. However, additional interventions may be necessary based on the infection severity. Uncomplicated cases with no significant medical history and minimal physical examination findings can be treated as outpatients with daily intravenous ceftriaxone with fewer complications. However, the majority of patients with acute mastoiditis are admitted to the hospital.
Inpatient cases with fewer complications are manageable with high-dose intravenous steroids, myringotomy with the tube placement of a tympanostomy, and intravenous antibiotics. Physical tests are required on a regular basis as the patient’s clinical condition can quickly deteriorate. Mastoidectomy is recommended if mastoiditis fails to get better within forty-eight hours.
The preferred intravenous antibiotic for patients with no chronic otitis media is intravenous vancomycin is enough to cover the common microbes, including Streptococci pneumonia, Group A beta-hemolytic streptococcus, Staphylococci aureus, Hemophilus influenza. An anti-pseudomonal drug is given to vancomycin in patients with a history of ear infections.
Although antibiotics are effective, antibiotics alone have been shown to result in an 8.5% complication rate. Complications of mastoiditis can be life-threatening, including meningitis, intracranial abscess, and venous sinus thrombosis. Therefore, prompt and appropriate treatment is crucial for a good prognosis.
https://www.ncbi.nlm.nih.gov/books/NBK560877/
medtigo
Mastoiditis
Updated :
August 24, 2023
Mastoiditis is a bacterial infection of the mastoid bone, the prominent bone behind the ear. It usually occurs as a complication of acute otitis media, a middle ear infection. The infection can spread from the middle ear to the mastoid bone through small connecting air cells, leading to inflammation, destruction, and accumulation of pus within the bone.
Mastoiditis is a serious condition that can cause severe pain, swelling, and fever and even lead to life-threatening complications such as meningitis or brain abscess. Treatment typically involves a combination of antibiotics, surgical drainage, and in severe cases, mastoidectomy.
Mastoiditis is an uncommon condition, and its incidence has decreased significantly since the introduction of antibiotics. In developed countries, the incidence of acute mastoiditis is estimated to be around 0.004% to 0.01% of all outpatient visits to the pediatrician. Children between the ages of 6 months and 2 years are most commonly affected, with a male preponderance.
In developing countries, however, the incidence of mastoiditis is still relatively high, with an estimated incidence of up to 30 cases per 1000 children. This is likely due to factors such as inadequate access to healthcare, poor hygiene, and a higher incidence of upper respiratory tract infections, which are risk factors for developing mastoiditis.
The incidence of complications from mastoiditis, such as intracranial abscesses and meningitis, has also decreased with the use of antibiotics. Nonetheless, complications can still occur and can lead to significant morbidity and mortality, especially in young children.
Mastoiditis is an infection of the mastoid air cells, which are small, air-filled spaces in the temporal bone behind the ear. The majority of infections of mastoiditis develop as a complication of otitis media acute, which is an infection of the middle ear. The cavity of the middle ear between the tympanic membrane and the cochlea includes essential structures such as the incus, malleus, Eustachian tube, and stapes.
The Eustachian tube connects the oral cavity to the middle ear and is in charge of removing air or fluid from the middle ear. If the Eustachian tube becomes obstructed, it can provide an opportunity for pathogens to grow in the middle ear. The lining of the mastoid cells is continuous with the lining of the middle ear cavity.
In acute mastoiditis, the infection can spread from the middle ear to the mastoid air cells, leading to inflammation and bony destruction. This can result in the formation of an abscess within the mastoid air cells, which can lead to further complications such as sigmoid sinus thrombosis, subperiosteal abscess, intracranial abscess, and meningitis.
The common microbe associated with mastoiditis is Streptococcus pneumoniae, but other bacteria such as Group A ß-hemolytic streptococcus, Staphylococci aureus, Streptococci pyogenes, and Hemophilus influenza can also cause the condition. Risk-based factors for mastoiditis include age under two years, immunocompromised condition, incomplete pneumatization, or process of acute recurrent otitis media of the mastoid.
The primary cause of mastoiditis is the disease advancement of acute otitis media. The middle ear cavity, which includes structures such as the Malleus, Incus, Stapes, and Eustachian tube, extends from the tympanic membrane to the cochlea and is continuous with the inner surface of the mastoid cells, which form part of the temporal bone.
Inflammation or debris in the Eustachian tube can cause it to narrow, creating pathogens that can flourish in an adaptive environment. This lining membrane in the cavity of the middle ear, when infected, can extend to the mastoid cells, leading to acute coalescent mastoiditis, which is the erosion of bony septations and as well as the merging of tiny air cells into bigger ones filled with pus.
Streptococcal pneumonia is the most common pathogen causing mastoiditis, and other common pathogens include Group A ß-hemolytic streptococcus, Streptococcus pyogenes, Staphylococcus aureus, and Hemophilus influenza. Risk factors for mastoiditis include age under three years old, incomplete pneumatization, immunocompromised condition, acute recurrent otitis media, and mastoid progression.
With early diagnosis and appropriate treatment, the prognosis for mastoiditis is generally good, with most patients recovering without complications.
However, if left untreated or if treatment is delayed, mastoiditis can lead to severe and potentially life-threatening complications such as meningitis, intracranial abscess, and venous sinus thrombosis.
Despite advances in medical and surgical management, the mortality rate of mastoiditis sequela in children remains at 10%. Therefore, prompt recognition and treatment of mastoiditis is crucial to ensure the best possible outcome for the patient.
Clinical history
The clinical history of mastoiditis typically includes a preceding history of acute otitis media with signs and symptoms such as ear pain, fever, hearing loss, and drainage from the ear. Patients may also report symptoms of mastoiditis, such as pain and swelling behind the ear, redness of the skin over the mastoid, and headache.
As the infection progresses, patients may develop more severe symptoms such as facial weakness, neck stiffness, nausea, vomiting, and altered mental status. It is important for clinicians to obtain a thorough medical history, including any recent upper respiratory infections or ear infections, as well as any immunocompromising conditions or risk factors.
A physical exam should also be performed, including an inspection of the ear and surrounding tissues for signs of inflammation, swelling, or discharge and an assessment of neurologic function. Imaging studies, such as a CT scan or MRI, may be necessary to confirm the diagnosis and evaluate for potential complications.
Physical examination
During a physical examination of a patient suspected to have mastoiditis, the healthcare provider may check for the following:
Swelling and redness behind the ear
Tenderness over the mastoid bone
Discharge from the ear
Limited movement of the ear or jaw due to pain
Enlarged lymph nodes in the neck
Fever and other signs of systemic infection
Signs of complications include meningitis, intracranial abscess, and venous sinus thrombosis.
The provider may also perform a pneumatic otoscopy, which involves blowing air into the ear canal to assess the mobility of the eardrum. This can help identify middle ear effusion, a common precursor to mastoiditis. Additionally, imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) may be performed to confirm the diagnosis and assess for complications.
Differential diagnosis
The differential diagnosis of mastoiditis includes other conditions that can cause similar symptoms, such as:
Acute otitis media
Otitis externa (swimmer’s ear)
Temporomandibular joint (TMJ) syndrome
Dental abscess
Sinusitis
Tension headache
Migraine
Cluster headache
Trigeminal neuralgia
It is essential to differentiate mastoiditis from these conditions as they may require different treatment approaches. A thorough medical history and physical examination can help to narrow down the potential diagnoses, and imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be helpful in making a definitive diagnosis.
The mainstay of mastoiditis therapy is antibiotics. However, additional interventions may be necessary based on the infection severity. Uncomplicated cases with no significant medical history and minimal physical examination findings can be treated as outpatients with daily intravenous ceftriaxone with fewer complications. However, the majority of patients with acute mastoiditis are admitted to the hospital.
Inpatient cases with fewer complications are manageable with high-dose intravenous steroids, myringotomy with the tube placement of a tympanostomy, and intravenous antibiotics. Physical tests are required on a regular basis as the patient’s clinical condition can quickly deteriorate. Mastoidectomy is recommended if mastoiditis fails to get better within forty-eight hours.
The preferred intravenous antibiotic for patients with no chronic otitis media is intravenous vancomycin is enough to cover the common microbes, including Streptococci pneumonia, Group A beta-hemolytic streptococcus, Staphylococci aureus, Hemophilus influenza. An anti-pseudomonal drug is given to vancomycin in patients with a history of ear infections.
Although antibiotics are effective, antibiotics alone have been shown to result in an 8.5% complication rate. Complications of mastoiditis can be life-threatening, including meningitis, intracranial abscess, and venous sinus thrombosis. Therefore, prompt and appropriate treatment is crucial for a good prognosis.
https://www.ncbi.nlm.nih.gov/books/NBK560877/
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