Mastoiditis pathophysiology

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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

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]

Overview

Pathophysiology

Pathogenesis

Mastoiditis is the infection in the cavities of mastoid process of temporal bone that occurs after otitis media. At birth, the mastoid consists of a single cavity, which is connected to the middle ear by a canal. As the child grows, the mastoid bone becomes pneumatized, resulting in a series of connected cavities, lined by a mucosa diverted from respiratory epithelium. There is a relationship between the middle ear, eustachian tube, and the mastoid. This connection has a fundamental role in the pathogenesis of mastoiditis. In the setting of acute otitis media the mucosa that lines the middle ear and also mastoid air cells becomes inflamed. In majority cases of acute otitis media inflammation resolves, but some persist leading to bacterial and fluid accumulation within the mastoid air cells. Gradually, as a result of pressure rising in the mastoid, air cell septae may be destroyed and mastoiditis could be proceed to periostitis, cavity abscess and osteomyelitis.

Transmission

  • Mastoiditis is a result of otitis media. Otitis media is transmitted through respiratory droplets through saliva or mucus, as well as direct physical contact with a contaminated individual or physical surface.

Genetics

  • There is evidence of genetic predisposition to otitis media, and thereby mastoiditis, with statistically significant evidence that it has high heritability.[4]
    • Hereditary factors comprising 45-75% of risk factors for recurrent otitis media, as revealed by heritability studies involving twins and triplets.[5]
  • The following genes have been identified as having having potential pathogenic qualities for recurrent otitis media and mastoiditis:[5][2]
    • 2p23.1
      • CAPN14
      • GALNT14
    • 20q11.21
      • BPIFA3
      • BPIFA1
    • Those that interact with the TGFβ pathway:
  • Up-regulation of the genes correlated to otitis media pathogenesis contribute to individual susceptibility to mastoiditis.

Associated Conditions

References

  1. Lin HW, Shargorodsky J, Gopen Q (2010). "Clinical strategies for the management of acute mastoiditis in the pediatric population". Clin Pediatr (Phila). 49 (2): 110–5. doi:10.1177/0009922809344349. PMID 19734439.
  2. 2.0 2.1 2.2 Pang LH, Barakate MS, Havas TE (2009). "Mastoiditis in a paediatric population: a review of 11 years experience in management". Int. J. Pediatr. Otorhinolaryngol. 73 (11): 1520–4. doi:10.1016/j.ijporl.2009.07.003. PMID 19758711.
  3. Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M (2014). "Update on otitis media - prevention and treatment". Infect Drug Resist. 7: 15–24. doi:10.2147/IDR.S39637. PMC 3894142. PMID 24453496.
  4. Hafrén L, Kentala E, Järvinen TM, Leinonen E, Onkamo P, Kere J, Mattila PS (2012). "Genetic background and the risk of otitis media". Int. J. Pediatr. Otorhinolaryngol. 76 (1): 41–4. doi:10.1016/j.ijporl.2011.09.026. PMID 22018929.
  5. 5.0 5.1 Rye MS, Warrington NM, Scaman ES, Vijayasekaran S, Coates HL, Anderson D, Pennell CE, Blackwell JM, Jamieson SE (2012). "Genome-wide association study to identify the genetic determinants of otitis media susceptibility in childhood". PLoS ONE. 7 (10): e48215. doi:10.1371/journal.pone.0048215. PMC 3485007. PMID 23133572.
  6. Coticchia JM, Chen M, Sachdeva L, Mutchnick S (2013). "New paradigms in the pathogenesis of otitis media in children". Front Pediatr. 1: 52. doi:10.3389/fped.2013.00052. PMC 3874850. PMID 24400296.

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References

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