see also: [[Acute Otitis Media|otitis media]] [Cameron Paeds - mastoiditis](x-devonthink-item://F7180C8F-40EE-4F1F-870E-5FDEAFF694AB?page=11&start=245&length=11&search=Mastoiditis), [Rosen Mastoiditis](x-devonthink-item://20EA4545-D70B-43A9-8493-7EFF9ABE5084?page=6) - *suppurative* infection of the mastoid air cells - most often seen in young children as a result of [[Acute Otitis Media]] - *acute mastoiditis* - with periosteitis (incipient mastoiditis) defined by presence of purulent material in the mastoid caveties - coalescent mastoiditis (acute mastoid osteitis) - destruction of the thin bony septae btwn air cells. may be followed by the formation of abscess cavities and the dissection of purulence into adjacent areas - masked mastoiditis (subacute mastoiditis) - low-grade but persistent infection in middle ear and mastoid with destruction of the bony septae btwn air cells. occurs in pts with persistent middle-ear effusion or recurrent episodes of acute otitis media - chronic mastoiditis -- suppurative infection of the mastoid air cells of long standing duration (months to years) **organisms** - strep pneumo - strep phyogenes - s aureus - pseudomonas -- in children with recurrent otitis media and recent abx use **complications** - meningitis - subdural abscess / subdural empyema - epidural abscess - septic venous thrombosis - cerebral abscess formation - facial nerve damage - bacterial labyrinthitis -- tinnitus, hearing loss, nausea, vomiting, dizziness, vertigo, nystagmus - post auricular subperiosteal abscess -- erythema, fluctuance, tender mass over mastoid bone - bezold abscess (sternocleidomastoid muscle abscess) - *hearing loss* - [[bone and joint infection (paeds)|osteomyelitis]] to adjacent bone ![[Pasted image 20240814000813.png]] ## Clinical features - febrile, appears ill - inflammation at mastoid process - erythema/ inflammation over mastoid - swelling, which may result in displacement of the ear downwards and outwards, with obliteration of the sulcus - auricular discharge - tympanic membrane inflamed or perforated -- normal TM makes acute mastoiditis less likely - +/- associated hearing loss ## Ix - CT confirms dx, shows complications eg local extension or venous sinus thrombosis - CT + contrast if suspected intracranial complications vs. MRI ## management - analgesia - IV abx : ceftriaxone or cefotaxime +/- vanc (15mg/kg) or extended spectrum penicillins in more serious illness (eg pip-taz or cefapime 50mg/kg in paeds, 2g IV in adults if thinking pseudomonas)