Mastoiditis

Background

  • Inflammation of middle ear spreads into mastoid air cells via the "aditus ad antrum"
  • Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, acute otitis media
    • Mastoiditis is unlikely if middle ear examination is normal

Etiology

  • S. pneumo (22%)
  • S. pyogenes (16%)
  • S. aureus (7%)
  • H. flu
  • P. aeruginosa

Clinical Features

  • Abnormal TM findings
  • Abnormal mastoid findings
    • Erythema, edema, tenderness
  • Abnormal pinna findings
    • Protrusion of auricle, obliteration of postauricular crease
  • Cranial nerve VI and VII palsies

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

Evaluation

  • Middle ear fluid cultures
  • CT mastoid with IV contrast
    • 90% sensitive
    • Delineates extent of bony involvement
    • Helps to diagnosis abscess formation

Management

  • ENT consultation - cases refractory to parenteral antibiotics may require surgical irrigation and debridement with possible mastoidectomy.

Coverage against S. pneumoniae, S. pyogenes, S. aureus, H. influenzae

  • Clindamycin 600mg IV q8 hours OR (if MRSA concern use Vancomycin regimen)
  • Vancomycin 15-20mg/kg IV q12 hours PLUS
  • If chronic or severe, need pseudomonas coverage
    • Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)

Disposition

  • Admit

Complications

Include, but are not limited to:

See Also

References

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