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Mastoiditis

Mastoiditides

Mastoiditis is an infection in the air cell system of the mastoid process. It is usually associated with otitis media.


Presentation

The condition of mastoiditis, often mimic the signs and symptoms of ear infection. Affected individuals, especially children often experience the following signs:

  • Discharge and drainage from the affected ear
  • Localized pain in the ear
  • Development of fever accompanied by headache
  • Hearing loss of the affected ear
  • Development of tenderness and swelling of the affected ear
  • Redness of the ear
  • In more severe cases, mastoiditis may favor the development of brain abscess. In addition, it can also cause more complications that can involve the skull. In such cases, the affected individuals may suffer from headaches and papilledema [7].
Fever
  • Her fever persisted and blood samples cultured Group A Streptococcus. Echocardiogram confirmed subacute bacterial endocarditis. Subacute bacterial endocarditis is a rare complication of mastoiditis.[ncbi.nlm.nih.gov]
  • In this report, we describe a pediatric case of sigmoid sinus thrombosis following mastoiditis, presenting with nonspecific symptoms such as fever, otalgia, and headache. Diagnosis was based on magnetic resonance imaging.[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]
  • Sigmoid sinus occlusion causes severe fevers and headache, commonly in association with meningitis. Mastoid infection may spread into the neck causing marked swelling on the side of the neck along with fever and exquisite tenderness.[tampabayhearing.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
  • 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]
  • It is characterized by earache, fever, headache, and malaise. Swelling of the mastoid process often displaces the pinna anteriorly and inferiorly.[medical-dictionary.thefreedictionary.com]
  • Diagnosis The most common systemic signs and symptoms associated with acute mastoiditis include lethargy, malaise or irritability, fever, and poor feeding.[epmonthly.com]
Collapse
  • We present a 69-year-old woman with a history of left-sided otitis media admitted to intensive care unit following collapse with a decreasing Glasgow Coma Scale.[ncbi.nlm.nih.gov]
  • The posterior -superior canal was not collapsed, as is sometimes seen in this disease. A CT-Scan was done which showed coalescence of the mastoid air cells.[entusa.com]
  • Bacteria may traverse the cochlear aqueduct in bacterial meningitis.50 Bacterial invasion of the inner ear produces irreversible damage to the neuroepithelium, atrophy of the stria vascularis, collapse of Reissner’s membrane, and endolymphatic hydrops[otologytextbook.net]
Recurrent Otitis Media
  • Mercurius solubilus Acute and recurrent otitis media with marked suppuration . Clear rhinitis ("cold") followed by thick discharge , then earache . Ear: More often affecting the right ear. Pain, discharge, hearing loss .[homeopathyforwomen.org]
  • History Most patients ( 80%) have no history of recurrent otitis media. Persistent otorrhea beyond 3 weeks is the most consistent sign that a process involving the mastoid has evolved.[emedicine.medscape.com]
Otalgia
  • We report a case of an 81-year-old immunocompetent man, who underwent a mastoidectomy because of unexplained, progressive otalgia in spite of a noninflamed and air-containing middle-ear space. Histopathology yielded Aspergillus fumigatus.[ncbi.nlm.nih.gov]
  • In this report, we describe a pediatric case of sigmoid sinus thrombosis following mastoiditis, presenting with nonspecific symptoms such as fever, otalgia, and headache. Diagnosis was based on magnetic resonance imaging.[ncbi.nlm.nih.gov]
  • The three cases presented with unilateral otalgia, otorrhea, and hearing loss associated with ipsilateral PFP. None recovered in spite of the treatment; an investigation of associated diseases was therefore undertaken.[ncbi.nlm.nih.gov]
  • Fever, irritability, otalgia, and hearing loss are also often present. Infection can be serious and may lead to sepsis, sigmoid sinus thrombosis, and intracranial abscess if not treated appropriately.[oxfordmedicine.com]
Ear Discharge
  • We report one such case of a patient who presented to us with trismus, jaw pain, and ear discharge. Imaging of the jaws revealed classical features of osteoradionecrosis and mastoiditis.[ncbi.nlm.nih.gov]
  • Chronic complaints after suppressed ear discharge . Hepar sulphuris: Scurfs on and behind the ears. Discharge of fetid pus from the ear. Whizzing and throbbing in the ear, with hardness of hearing.[homeopathyforwomen.org]
  • Culture tests: Culture testing of the ear discharge reveals the type of bacteria present. What are the Complications of Mastoiditis? Untreated mastoiditis can cause many complications.[medindia.net]
  • Symptoms of acute mastoiditis include: Pain in or behind the ear Swelling of the area behind the ear Ear discharge Fever Headache The most common cause of mastoiditis is an untreated inner ear infection ( otitis media ).[medicinenet.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]
Tinnitus
  • The presenting symptoms were varied-tinnitus, hearing loss, and cranial nerve palsies. All three cases showed a dense lymphoplasmacytic infiltrate, storiform type fibrosis as well as elevated numbers of IgG4 positive plasma cells.[ncbi.nlm.nih.gov]
  • Medical Director, Balance Center John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery , American College of Surgeons , American Medical Association , American Neurotology Society , American Tinnitus[emedicine.medscape.com]
  • Mastoiditis may cause significant health problems [ 5 ], such as a sensation of fullness or pressure in the ear, tinnitus, pain, otorrhea and even hearing loss.[journals.plos.org]
Strabismus
  • Six days after the operation the child had problems maintaining balance, and the parents noticed that she had developed a slight strabismus. No headache or involvement of the trigeminal nerve were found.[bmcearnosethroatdisord.biomedcentral.com]
Vertigo
  • We describe the case history of a 70-year-old female patient presenting with bilateral hearing disturbance, facial paralysis, and vertigo.[ncbi.nlm.nih.gov]
  • Possible Complications Destruction of the mastoid bone Dizziness or vertigo Epidural abscess Facial paralysis Meningitis Partial or complete hearing loss Spread of infection to the brain or throughout the body When to Contact a Medical Professional Call[nicklauschildrens.org]
  • Possible Complications Complications may include: Destruction of the mastoid bone Dizziness or vertigo Epidural abscess Facial paralysis Meningitis Partial or complete hearing loss Spread of infection to the brain or throughout the body When to Contact[m.ufhealth.org]
  • Some of the possible complications of mastoiditis include: Meningitis Sepsis Hearing loss Vertigo Paralysis of parts of the face If you have any other questions about ear infections and mastoiditis make an appointment to see our ear nose and throat specialist[ent-surgery.com.au]
Dizziness
  • Mastoiditis Chronic otitis media Acute otitis externa Complications of Otitis Externa Pinna perichondritis Facial nerve palsy Ramsay Hunt syndrome Sudden hearing loss Foreign body in ear Pinna haematoma Temporal bone fracture Traumatic TM perforation Dizziness[entsho.com]
  • It has been our observation that in our dizziness and hearing practice in Chicago , at least 1/100 of our patients has mastoid fluid (i.e. about 1%).[dizziness-and-balance.com]
  • Full recovery will take 3-4 weeks with possibly bouts of dizziness and headaches during this time. Over time the headaches and dizziness should diminish.[hearingcentral.com]
Cranial Nerve Involvement
  • Cranial nerve involvement. Gradenigo’s syndrome – Facial nerve paralysis, deep facial pain and otitis media . Meningitis (inflammation of membranes of the brain). Brain abscess.[medindia.net]
  • The delay between otologic symptoms and cranial nerve involvement varies from 1 week to 2–3 months [ 7 ]. In our case, the time between the onset of the initial symptoms and the registration of the abducens palsy was two weeks.[bmcearnosethroatdisord.biomedcentral.com]
  • nerve involvement Osteomyelitis Petrositis Gradenigo syndrome - Otitis media, retro-orbital pain, and abducens palsy Intracranial extension - Meningitis, cerebral abscess, epidural abscess, subdural empyema Sigmoid sinus thrombosis Abscess formation[emedicine.medscape.com]

Workup

In cases, when individuals show signs of ear infection, then ear examination will be done in order to determine whether the infection has spread from the ear to the mastoid bone. In addition, the following tests may also be done to further diagnose the condition of mastoiditis:

  • Blood tests: Complete blood count would be done to analyze the white blood cells to determine signs of infection. Sedimentation rate should also be determined which would help in deciding the plan of treatment.
  • Imaging studies such as CT scan of the temporal bone and MRI of the brain and ear are indicated. In situations, when these are not available then X-ray of the skull is carried out for diagnosing the condition. This test would reveal bone destruction along with clouding of air cells in the mastoid region [8].
  • Spinal tap tests: In this test, lumbar puncture would be performed to analyze the fluid contained in the spinal cord. This is helpful in determining the spread of the infection to these areas [9].
Pseudomonas
  • The rate of Pseudomonas aeruginosa growth in the rAM group was significantly higher compared with the AM group (40.9 and 8.9%, respectively) (p   0.001) as was found in anerobic growth (15 vs. no growth) (p   0.001) and in polymicrobial growth (59% vs[ncbi.nlm.nih.gov]
  • Both children were treated with oral antibiotics that are considered fairly active against the typical otopathogens, but with no activity at all against Pseudomonas or MRSA.[healio.com]
  • Streptococcus pyogenes , staphylococci and Pseudomonas aeruginosa account for the remaining cases of mastoiditis.[healthhype.com]
  • The most common causative agents of acute mastoiditis include staphylococcus, streptococcus, and pseudomonas species.[emdocs.net]
  • Common causative bacteria include: Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Bacteria that are less commonly implicated include staphylococcus aureus and pseudomonas.[ent-surgery.com.au]

Treatment

Long term treatment would be required for effective management of the condition. Often oral antibiotics would not be sufficient to effectively eradicate the infection. Therefore, in such cases antibiotics would be administered through the intravenous route [10].

Surgery is often the preferred method when antibiotics do not work. Surgical procedures are employed to remove part of the mastoid bone. This is done so the infection can be successfully drained. It would also be required to drain the infection from the middle ear in case the infection has spread to this area.

Prognosis

Mastoiditis can be successfully treated with appropriate management. However, in many instances, the condition can recur and in such cases treating it may become difficult [6]. It is therefore advised that such individuals should get regularly checked for signs of middle ear infection.

Etiology

Acute otitis media is the most common cause of mastoiditis. The infection may gradually spread to the mastoid bone in the skull. Untreated infection causes inflammation of the mucosal lining. With such a phenomenon, the mastoid bone gets accumulated with various infected materials; due to which, the honey-comb like structure of the mastoid bone undergoes gradual deterioration. The condition of mastoiditis most commonly strikes the children. It has been reported that children who are less than 2 years of age and are affected by the condition, usually do not present with history of otitis media.

In addition to otitis media, bacterial infections are also the common cause for mastoiditis. Various pathogens known to play foul include Staphylococcus aureus, Streptococcus pyrogenes, Streptococcus pneumoniae and Moraxella catarrhalis [2].

Epidemiology

In the US, mastoiditis is reported to occur in about 0.004% population. The incidence of acute mastoiditis as a result of untreated otitis media is higher amongst young children and in the developing nations. It was reported that the incidence of this disease significantly reduced from 61 per 100,000 children to about 37 per 100,000 children [3].

Sex distribution
Age distribution

Pathophysiology

The pathophysiology of mastoiditis involves 2 phenomenons, onset of infection, which causes the bacteria to spread from the middle ear to the mastoid cells followed by an inflammatory response of the mastoid bone. Various pathogenic microorganisms are known to cause the development of mastoiditis. The organisms that have a rare association with this condition are mycobacterium species. In some instances, mastoiditis can also be caused by cholesteatoma, which is a sac like structure in the middle ear [4] [5].

Prevention

Effective treatment of all kinds of ear infection would help in preventing the spread of the infection to the mastoid bone. Individuals should be advised to promptly seek medical intervention to treat the condition. Taking full course of oral antibiotics would be necessary to effectively treat the bacterial infection [11].

Summary

Mastoiditis is a condition caracterized by infection of the mastoid bone. It is an inflammatory disease of the mucosal lining of the mastoid bone. The condition majorly occurs due to untreated otitis media and is one of the leading causes of childhood mortality. However, with the advent of antibiotics, incidences of mastoiditis have undergone significant decline. Infections of the middle ear when left untreated can pose serious health risks and favor the development of serious complications. Mastoiditis is a common occurrence amongst children; but adults too can get affected [1].

Patient Information

  • Definition: Mastoiditis is a condition, characterized by inflammation of the mastoid bone. Children are more susceptible to contract this condition than adults. The mastoid is situated behind the ear and therefore infections of the middle ear can predispose an individual to develop mastoiditis if the former condition is not effectively treated.
  • Cause: Acute otitis media which if left untreated can favor the development of mastoiditis. In addition, various pathogens such as staphylococcus aureus, streprococcus pyrogenes, streprococcus pneumoniae, haemophillus influenza and moraxella catarrhalis can also cause mastoiditis.
  • Symptoms: Symptoms of mastoiditis include discharge and pain from the affected ear, followed by tenderness and swelling of the affected area, headache and discomfort. Individuals would also suffer from sudden onset of high fever and swelling behind the ear.
  • Diagnosis: A careful examination of the ear forms the preliminary basis of the diagnostic procedure. Ear discharge would also be tested for signs of infections. Spinal tap test which includes testing of spinal fluid is also done to analyze infection. Blood tests and imaging studies would be required for further diagnosing the condition.
  • Treatment: Antibiotics form the basis of the treatment regime. Administration of antibiotics through the intravenous route is done at the primary level. This is then followed by oral antibiotics for a specified period. Surgery is the last resort and is employed when antibiotics don’t work. Surgical procedures to remove the part of the mastoid bone are done in order to drain the infection.

References

Article

  1. Palma S, Bovo R, Benatti A, Aimoni C, Rosignoli M, Libanore M, et al. Mastoiditis in adults: a 19-year retrospective study. Eur Arch Otorhinolaryngol. Apr 16 2013
  2. Roland PS. Chronic suppurative otitis media: a clinical overview. Ear Nose Throat J 2002; 81:8.
  3. Ongkasuwan J, Valdez TA, Hulten KG, Mason EO Jr, Kaplan SL. Pneumococcal mastoiditis in children and the emergence of multidrug-resistant serotype 19A isolates. Pediatrics. Jul 2008;122(1):34-9.
  4. Wullstein HL, Wullstein SR. Cholesteatoma. Etiology, nosology and tympanoplasty. ORL J Otorhinolaryngol Relat Spec 1980; 42:313.
  5. Semaan MT, Megerian CA. The pathophysiology of cholesteatoma. Otolaryngol Clin North Am 2006; 39:1143.
  6. Oestreicher-Kedem Y, Raveh E, Kornreich L, Popovtzer A, Buller N, Nageris B. Complications of mastoiditis in children at the onset of a new millennium. Ann Otol Rhinol Laryngol. Feb 2005;114(2):147-52.
  7. Brook I. The role of anaerobic bacteria in otitis media: microbiology, pathogenesis, and implications on therapy. Am J Otolaryngol 1987; 8:109.
  8. National Cancer Institute. Radiation Risks and Pediatric Computed Tomography (CT): A Guide for Health Care Providers. National Institutes of Health. 
  9. Acuin, J. Chronic Suppurative otitis media. Burden of Illness and Management Options. World Health Organization. Geneva, Switzerland, 2004. 
  10. Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, et al. Acute mastoiditis--the antibiotic era: a multicenter study. Int J Pediatr Otorhinolaryngol. Jan 2001;57(1):1-9.
  11. Browning GG, Gatehouse S, Calder IT. Medical management of active chronic otitis media: a controlled study. J Laryngol Otol 1988; 102:491.

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Last updated: 2017-08-09 17:38