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Mastoiditis

Mastoiditis is a rare condition usually seen in children. The diagnosis is made on clinical examination and occasionally may be subtle in patients being treated with antibiotics. Other coexisting or complicating conditions include neck abscess (Bezold abscess), facial nerve palsy, cavernous sinus thrombosis, meningitis, and intracranial abscess.

Causes

Bacteria that cause mastoiditis such as includes:

Pneumococcus
Hemophilus influenzae
Beta-hemolytic streptococci
Staphylococci
Gram-negative organisms.

Mastoiditis is usually a complication of chronic otitis media and, less frequently, of acute otitis media.

Symptoms

Ear pain +++++
Fever ++++
Pain and fever lasting more than 4 days ++++
Discharge +++
Headache
Irritability or gastrointestinal upset may be the only symptoms in infants.

Signs

Postauricular swelling with erythema and tenderness +++++
Mastoid tenderness, especially posterior and superior to the level of the external canal (Macewen's triangle)
Pinna may be displaced outward and forward by the swelling ++++.
Signs of otitis media

Treatment

Mastoiditis may be difficult to treat because it is difficult for medications to reach deep enough into the mastoid bone.

It may require long-term treatment. Antibiotics by injection then antibiotics by mouth are given to treat the infection.

Surgery to remove part of the bone and drain the mastoid may be needed if antibiotic therapy is not successful. Surgical drainage of the middle ear through the eardrum may be needed to treat the underlying middle ear infection.

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