Acute mastoiditis (AM) is the most probable complication of acute otitis media [1]. In more than fifty percent of diagnosed patients, it is the first evident manifestation of acute otitis media [2] [3] [4]. AM is caused by bacterial infection and can overshadow other conditions or develop into a chronic form.

AM typically presents with mastoid area erythema, proptosis of the auricle, fever, otorrhea, lethargy and pain. Fever may be quite high. Pain is located deep in or behind the ear and is usually worse at night. Persisting pain is an indication of a more serious condition of the mastoid. Hearing loss is frequently reported in AM and should recover back to normal after the infection has worn off [5].

If left untreated, AM can pave the way for severe complications like sigmoid sinus thrombosis, brain abscess, facial paralysis, otitic hydrocephalus, and in rare cases to Bezold's abscess [6].

The infection of the mastoid bone is most likely caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, less probably by group A Streptococci, Staphylococcus aureus, and the Pseudomonas species. The mean gap time between infection and onset of AM is 4.5 days [7].

AM is more likely in children than in adults. Risk factors include a recent untreated bacterial infection of the middle ear and cholesteatoma. In infants, it is advisable to look out for general symptoms that may be consistent with infections like diarrhea, irritability, or malnutrition [3].

• Fever

  A two-year-old boy presented with fever, otalgia, otorrhoea and bilateral protruding ears. He was treated for 72 hours with intravenous antibiotics but failed to improve. [ncbi.nlm.nih.gov]

  Case Two: A 23-month-old female presents to the emergency department with five days of fever, cheek swelling, and not allowing family to touch her face or ears. She was seen three days prior with complaints of fever and left ear pain... [epmonthly.com]

  AM typically presents with mastoid area erythema, proptosis of the auricle, fever, otorrhea, lethargy and pain. Fever may be quite high. Pain is located deep in or behind the ear and is usually worse at night. [symptoma.com]

  Symptoms of acute mastoiditis: 1) Fever and malaise: Fever is persistent, in spite of adequate antibiotics. It can be as high as 40 degree C 2) Pain: It is usually post-aural. [specialist-ent.com]

• Malaise

  Acute mastoiditis is a serious complication of AOM in childhood with postauricular swelling, erythema, and tenderness, protrusion of the auricle, high fever and general malaise. The disease may protrude intracranially. [ncbi.nlm.nih.gov]

  There is also fever and malaise. The pain intensifies if the affected area is touched. There is clear swelling behind the ear, and the skin is red. [ic.steadyhealth.com]

  Symptoms of acute mastoiditis: 1) Fever and malaise: Fever is persistent, in spite of adequate antibiotics. It can be as high as 40 degree C 2) Pain: It is usually post-aural. [specialist-ent.com]

  Diagnosis The most common systemic signs and symptoms associated with acute mastoiditis include lethargy, malaise or irritability, fever, and poor feeding. [epmonthly.com]

• Pneumonia

  All S. pneumoniae organisms were isolated between 1996 and 2001. [ncbi.nlm.nih.gov]

• Aspiration

  Postauricular pus aspiration resolved the subperiosteal abscess in 14 of 17 patients. The length of the hospital stay of patients who underwent aspiration was shorter than that of patients who underwent cortical mastoidectomy. [ncbi.nlm.nih.gov]

• Erythema

  According to a recent meta-analysis, the three most common local findings associated with mastoiditis are post-auricular changes (e.g., erythema, tenderness, edema, fluctuance), abnormal TM findings (e.g., erythema, dullness, bulging), and external auditory [epmonthly.com]

  Frequent symptoms included mastoid area erythema in 54 children (94.7%), proptosis of the auricle in 52 children (91.2%) and fever in 43 children (75.4%). [ncbi.nlm.nih.gov]

• Torticollis

  Its characteristic symptom is persistent torticollis despite a resolved infection. The knowledge of this condition helps early diagnosis and treatment. [ncbi.nlm.nih.gov]

  […] painful infiltrate over the ear and anterior to it; apical (Betelgeuse) abscess - pus breakthrough through the inner wall of the terminal cells proliferation under the sternoclavicular muscle (pain behind the lower jaw, forced position of the head - torticollis [lecheniebolezni.com]

• Otalgia

  A two-year-old boy presented with fever, otalgia, otorrhoea and bilateral protruding ears. He was treated for 72 hours with intravenous antibiotics but failed to improve. [ncbi.nlm.nih.gov]

  Younger age (less than two years old), male sex, prior antimicrobial therapy, absence of otalgia were more common in complicated cases (p ≤ 0,05). [revistas.rcaap.pt]

• Ear Discharge

  Cultures were obtained at admission in 83 (72%) episodes (71 by tympanocentesis and 12 from ear discharges). Overall 43 pathogens were isolated: 34 at admission; 14 at surgery; and 5 at both occasions. [ncbi.nlm.nih.gov]

  NIH: National Institute on Deafness and Other Communication Disorders Cholesteatoma (Medical Encyclopedia) Ear discharge (Medical Encyclopedia) Ear examination (Medical Encyclopedia) Ear infection - acute (Medical Encyclopedia) Ear infection - chronic [icdlist.com]

  When ear discharge was present, the middle ear fluid was directly collected from the tympanic membrane perforation after cleaning of the external ear canal with a dry cotton swab. [link.springer.com]

  The presence of unilateral headache is suggestive of impending intracranial complications 3) Ear discharge: The discharge is purulent, profuse and foul smelling. [specialist-ent.com]

  It is symptomatic with persistent ear discharge, deep eye pain, and diplopia due to paresis of cranial nerve VI. [rrnursingschool.biz]

• Tinnitus

  […] dysfxn presentation and defintion Often follows URI or allergic rhinitis Eustachian tube swelling inhibits eustachian tube's ability to autoinsufflate= Negative pressure eustachian tube dysfxn sxs and dx Sxs- ear fullness, popping, underwater feeling, tinnitus [quizlet.com]

  } Chronic Ear Infection (Mastoiditis), Auto immune disease, Tinnitus, Hot Flushes, Weight Loss – Kangen Water Testimonial | Health Benefits Drinking … | Health |… [pinterest.co.uk]

  Please advise me if any thing could be done to get rid of tinnitus. [doctor.ndtv.com]

  Bell’s Palsy (early) Before the nerve is paralyzed, patients will often report sharp pain or tinnitus. Foreign bodies Always inspect the ear and look for them. Temporal arteritis Elderly; temporal tenderness. [hippoed.com]

  […] other symptoms and after-effects that point to a otitis media acuta: Feeling of weakness Redness and swelling of the mastoid process Sensation of pressure and fullness in the ear Dizziness Fever Headache Conductive hearing loss Ringing in the ears (tinnitus [hear.com]

• Withdrawn

  ClinicalTrials.gov Identifier: NCT00502450 Recruitment Status : Withdrawn First Posted : July 17, 2007 Last Update Posted : July 19, 2013 Sponsor: Information provided by: Rabin Medical Center Brief Summary: Following acute mastoiditis there is a possible [clinicaltrials.gov]

• Stupor

  When the patient has clinical signs of CNS involvement (ex. stupor, altered mental status). When there is evidence of cranial nerve involvement (ie. Gradeningo’s Syndrome ). When there is a history of cholesteatoma. [pedemmorsels.com]

The diagnosis of AM is based on patient history and clinical examination. There is no well-defined consensus which symptoms are crucial in diagnosing AM.

It is usually not necessary to go beyond the clinical diagnosis but it may be advisable to consider computed tomography (CT) or magnetic resonance imaging (MRI) of the temporal bone as a possibility to better assess the extent of the infection and screen for other possible reasons of the inflammation. Some experts consider CT scan a necessary procedure in AM diagnosis [8]. Both in CT and MRI, AM presents with a partial to total opacification of the mastoid air cells.

If ear drainage occurs, it is highly advisable to analyze the material for cultures, Gram stain, and acid-fast stain. If there is no spontaneous drainage, ear fluid could be obtained within a tympanocentesis and/or myringotomy procedure. The tympanic membrane will recover fast and extraction of excess ear fluid will likely ease acute symptoms. It is often possible to carry out both procedures in one session without additional discomfort for the patient. Tympanostomy tube insertion is often performed to allow for continued drainage and easier administration of antimicrobial agents [9].

An audiometric test should be scheduled after complete recovery.

CONCLUSION: Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy [ncbi.nlm.nih.gov]

[…] diffusion restriction 5 Signal characteristics Typical findings in mastoiditis include 4,5 : T1 : low signal T2 : high signal DWI/ADC : diffusion restriction may be present T1 C+ : mucosal contrast enhancement is present in the majority Treatment and prognosis [radiopaedia.org]

Prognosis The prognosis for the vast majority of cases that are diagnosed early is excellent with a low chance of complications or severe hearing loss. [patient.info]

The prognosis of mastoiditis depends on the extent of the infection. Fortunately, if detected early prior to intracranial involvement, the prognosis is very good. [hawaii.edu]

Prognosis Mastoiditis is curable with treatment but may be hard to treat and may recur. [healthofchildren.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Bacterial etiology was established in 43 patients (68.2% isolation rate). Pseudomonas aeruginosa and Streptococcus pneumoniae were the most frequently isolated agents. [ncbi.nlm.nih.gov]

A retrospective review of children discharged with a diagnosis of acute mastoiditis was undertaken to describe the epidemiology, clinical presentation, microbiology, and treatment of acute mastoiditis over past years. [ncbi.nlm.nih.gov]

"Acute mastoiditis in children: epidemiologic, clinical, microbiologic, and therapeutic aspects over past years". Clin Pediatr (Phila). 43 (3): 261–7. doi : 10.1177/000992280404300307. PMID 15094950. ^ a b Brook I (2005). [en.wikipedia.org]

Acute mastoiditis in children: epidemiologic, clinical, microbiologic, and therapeutic aspects over past years. Clinical Pediatrics ;43:261 -7. Kvaerner KJ. Lessons learned: no increase despite clinical of acute mastoiditis. [revistas.rcaap.pt]

This review presents an overview of the anatomical and pathophysiological considerations in acute mastoiditis and offers pediatricians a practical, evidence-based algorithm for the diagnostic and therapeutic approach to this disease. [ncbi.nlm.nih.gov]

The pathophysiology and symptoms of the disease are described and in showing the case our way of solving complications is described. [hrcak.srce.hr]

Drainage from the ear occurs in more serious cases, often manifest as brown discharge on the pillowcase upon waking. [4] [5] Pathophysiology [ edit ] The pathophysiology of mastoiditis is straightforward: bacteria spread from the middle ear to the mastoid [en.wikipedia.org]

We report one case of acute mastoiditis with epidural abscess, in which mastoidectomy with tympanic exploration was needed to ensure drainage throughout the cavities and to prevent pressure rebuilding in the mastoid and tympanic cavities. [ncbi.nlm.nih.gov]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]

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8. Saat R, Laulajainen-Hongisto AH, Mahmood G et al. MR imaging features of acute mastoiditis and their clinical relevance. AJNR Am J Neuroradiol. 2014;36(2):361-367.
9. Abdel-Aziz M, El-Hoshy H. Acute mastoiditis: A one year study in the pediatric hospital of Cairo university. BMC Ear, Nose and Throat Disorders. 2010;10:1.