Mastoiditis: Difference between revisions

	Mastoiditis Microchapters
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Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Mastoiditis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
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Cost-Effectiveness of Therapy
Future or Investigational Therapies
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Revision as of 20:48, 21 June 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2], Faizan Sheraz, M.D. [3]

Overview

Mastoiditis is the infection of mastoid ear cells in the process of temporal bone. It is mostly a complication of ear diseases such as Acute Otitis Media and chronic otitis media, and it tends to occur in children. However after developments of antibiotics acute otitis media complications have decreased significantly.

Historical perspective

Classification

Epidemiology

Pathophysiology

Causes

Symptoms and Signs

Prognosis

Diagnosis

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Surgery

Prevention

In general, mastoiditis is rather simple to prevent. If the patient with an ear infection seeks treatment promptly and receives complete treatment, the antibiotics will usually cure the infection and prevent its spread. For this reason, mastoiditis is rare in developed countries.

Gallery

Picture of a right mastoidectomy, surgeon's view. Note the blue color of the skeletonized sigmoid sinus.^[1]
Picture of a left mastoidectomy, surgeon's view.^[2]
In this left canal wall up mastoidectomy, the tympanic membrane has been elevated forward and a cholesteatoma sac is visible in the attic.^[3]
This patient has a recurrent cholesteatoma which has found its way to the surface of the post-auricular skin, forming a mastoid cutaneous fistula.^[4]
This cholesteatoma sac has eroded the lateral surface of the mastoid bone and was found immediately under the post-auricular skin.^[5]
Left canal wall down mastoidectomy.This patient had a modified radical mastoidectomy with tympanoplasty. The posterior bony canal has been removed and part of the dry "mastoid bowl" is visible posterior and superior to the reconstructed tympanic membrane ^[6].
Magnification of the previous picture ^[7].

@@ Line 25: / Line 25: @@
 ==Treatment==
-The primary treatment for acute mastoiditis without [[osteitis]] is the administration of [[intravenous]] [[antibiotics]] after obtaining cultures.  The choice of antimicrobial agents is similar to that for [[otitis media|acute otitis media]]—antibiotics against ''[[Streptococcus pneumoniae]]'' and ''[[Haemophilus influenzae]]''.  Additional coverage for ''[[Staphylococcus aureus]]'' and [[Gram-negative bacilli]] may be considered for protracted disease until the results of cultures become available.<ref name="pmid18092706">{{cite journal| author=Ramakrishnan K, Sparks RA, Berryhill WE| title=Diagnosis and treatment of otitis media. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 11 | pages= 1650-8 | pmid=18092706 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18092706  }} </ref><ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages =  }}</ref>  [[Ciprofloxacin]] (500 mg twice a day) may be considered in [[immunocompromised]] patients with [[diabetes]] or [[HIV infection]] or in infections involving the skin and periauricular areas.  Long-term antibiotics may be necessary to completely eradicate the infection.  [[Otalgia]] associated with otitis externa may be managed with topical anesthesic agent such as [[benzocaine]].
-===Antimicrobial Regimen===
+===Medical Therapy===
-===Mastoiditis===
-*'''1. Acute Mastoiditis''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+===Primary Prevention===
-:*'''1.1 Causative pathogens:'''
-::*Streptococcus pneumoniae
+===Secondary Prevention===
-::*Streptococcus pyogenes
-::*Staphylococcus aureus
-::*Hemophilus influenzae
-::*Pseudomonas aeruginosa
-:*'''1.2 Acute mastoiditis, outpatient'''
-::*'''1.2.1 Empiric antimicrobial therapy'''
-:::*Preferred regimen (no abx in past month): [[Amoxicillin]] 50 mg/kg/day PO q6h
-:::*Preferred regimen (abx in past month): [[Amoxicillin-Clavulanate]] 90 mg/kg/day PO q12h {{or}} [[Cefdinir]] 14 mg/kg PO q24h {{or}} [[Cefpodoxime]] 10 mg/kg/day PO q12h (maximum dose is 400 mg/day) {{or}}  [[Cefprozil]] 30 mg/kg/day PO q12h (maximum dose is 1 g/day) {{or}} [[Cefuroxime]] 15 mg/kg/day PO q12h (Maximum dose is 1 g/day)
-:::*Note: Duration of treatment in children <2 years-old is 10 days. In children ≥2 years, recommended duration is 5–7 days.
-::*'''1.2.2 Pathogen-directed antimicrobial therapy'''
-:::*'''1.2.2.1 Staphylococcus aureus (MSSA)'''
-::::*Preferred regimen: [[Oxacillin]] 37 mg/kg IV q6h (maximum dose is 8-12 g/day)
-:::*'''1.2.2.2 Staphylococcus aureus (MRSA)'''
-::::*Preferred regimen: [[Vancomycin]] 40 mg/kg/day IV q6-8h
-::::*Note: Maintain [[Vancomycin]] serum trough concentrations of 15-20 mcg/mL
-:*'''1.3 Acute mastoiditis, inpatient'''
-::*'''1.3.1 Empiric antimicrobial therapy'''
-:::*Preferred regimen: [[Cefotaxime]] 1-2 g IV q4-8h {{or}} [[Ceftriaxone]] 1 g IV q24h
-::*'''1.3.2 Pathogen-directed antimicrobial therapy'''
-:::*'''1.3.2.1 Staphylococcus aureus (MSSA)'''
-::::*Preferred regimen: [[Oxacillin]] 37 mg/kg IV q6h (maximum dose is 8-12 g/day)
-:::*'''1.3.2.2 Staphylococcus aureus (MRSA)'''
-::::*Preferred regimen: [[Vancomycin]] 40 mg/kg/day IV q6-8h
-::::*Note: Maintain [[Vancomycin]] serum trough concentrations of 15-20 mcg/mL
-*'''2. Chronic Mastoiditis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:*'''2.1 Causative pathogens:'''
-::*Polymicrobial
-::*Enterobacteriaceae
-::*Staphylococcus aureus
-::*Pseudomonas aeruginosa
-:*'''2.2 Empiric antimicrobial therapy'''
-::*Preferred regimen: [[Imipenem]] 0.5 g IV q6h {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q4-6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q6h
-::*Note: Treatment is reserved for acute exacerbations or perioperatively. It is recommended not to treat without surgical cultures
 ===Surgery===
-If the condition does not respond to antibiotics or is associated with [[osteitis]], surgical procedures may be performed while continuing the medication.  The most common procedure is [[myringotomy]] with [[tympanostomy tube]] placement for drainage and culture of effusion.  When an [[abscess]] has formed in the [[mastoid bone]], a [[mastoidectomy]] should be performed after antimicrobial agents have controlled [[sepsis]].
 ==Prevention==