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Mastoiditis

Mastoiditis is an infection of the mastoid process, the portion of the temporal bone of the skull that is behind the ear. It is usually caused by untreated acute otitis media (middle ear infection) and used to be a leading cause of child mortality. With the development of antibiotics, however, mastoiditis has become quite rare in developed countries, most likely due to antibiotic treatment of otitis media before it can spread. It is treated with medications and/or surgery. If untreated, the infection can spread to surrounding structures, including the brain, causing serious complications. more...

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Medicines

Features

Some common symptoms and signs of mastoiditis include pain and tenderness in the mastoid region, as well as swelling. There may be earaches or ear pain otalgia, and the ear or mastoid region may be red (erythematous). Fever or headaches may also be present. Infants usually show nonspecific symptoms, such as poor feeding, diarrhea, or irritability. Drainage from the ear occurs in more serious cases.

Diagnosis

The diagnosis of mastoiditis is clinical—based on the medical history and physical examination. Imaging studies may provide additional information; the study of choice is the CT scan, which may show focal destruction of the bone or signs of an abscess (a pocket of infection). X-rays are not as useful. If there is drainage, it is often sent for culture, although this will often be negative if the patient has begun taking antibiotics.

Pathophysiology

The pathophysiology of mastoiditis is straightforward: bacteria spread from the middle ear to the mastoid air cells, where the inflammation causes damage to the bony structures. The bacteria most commonly observed to cause mastoiditis are Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and gram-negative bacilli. Other bacteria include Moraxella catarrhalis, Streptococcus pyogenes, and rarely, Mycobacterium species. Some mastoiditis is caused by cholesteatoma, which is a sac of keratinizing squamous epithelium in the middle ear that usually results from repeated middle-ear infections. If left untreated, the cholesteatoma can erode into the mastoid process, producing mastoiditis, as well as other complications.

Treatment

The primary treatment for mastoiditis is administration of intravenous antibiotics. Initially, broad-spectrum antibiotics are given, such as ticarcillin/clavulanate (Timentin) plus gentamicin, or ciprofloxacin (Cipro). As culture results become available, treatment can be switched to more specific antibiotics. Long-term antibiotics may be necessary to completely eradicate the infection. If the condition does not quickly improve with antibiotics, surgical procedures may be performed (while continuing the medication). The most common procedure is a myringotomy, a small incision in the tympanic membrane (eardrum), or the insertion of a tympanostomy tube into the eardrum. These serve to drain the pus from the middle ear, helping to treat the infection. The tube is extruded spontaneously after a few weeks to months, and the incision heals naturally. If there are complications, or the mastoiditis does not respond to the above treatments, it may be necessary to perform a mastoidectomy in which a portion of the bone is removed and the infection drained.

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Mastoiditis in an immunocompetent adult.(Case Report) : An article from: Southern Medical Journal $5.95 Fibromatosis presenting as acute mastoiditis: a case report. : An article from: Ear, Nose and Throat Journal $5.95
Clinical experiences with acute mastoiditis--1988 through 1998 : An article from: Ear, Nose & Throat Journal $20.00 Mastoiditis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References $28.95
Otogenic Fusobacterium meningitis, sepsis, and mastoiditis in an adolescent.(Case Report) : An article from: Southern Medical Journal $5.95 Mastoiditis and acute Otitis media in children with Cochlear implants: Recommendations for medical management : An article from: The Annals of Otology, Rhinology & Laryngology $10.00
Stereoscopic atlas of mastoidotympanoplastic surgery $45.00 Gale Encyclopedia of Medicine : Mastoiditis $2.30
Small Rise in Mastoiditis During Watchful Waiting.(Brief Article) : An article from: Family Practice News $5.95 'Watchful waiting' of AOM tied to mastoiditis: Small risk in a Netherlands study. (Infectious Diseases).(acute otitis media) : An article from: Pediatric News $5.95

Fibromatosis presenting as acute mastoiditis: a case report
Abstract We describe the case of a middle-aged man who presented with manifestations of acute mastoiditis caused by fibromatosis of the mastoid region.
Mastoiditis
Mastoiditis is an infection of the spaces within the mastoid bone. It is almost always associated with otitis media, an infection of the middle ear. In ...
Small Rise in Mastoiditis During Watchful Waiting - Brief Article
Restricting the use of antibiotics in children with acute otitis media may be associated with higher rates of mastoiditis, said Dr. Diederick A. Van ...
Clinical experiences with acute mastoiditis—1988 through 1998 - Brief Article
Abstract The incidence of acute mastoiditis has declined dramatically during the postantibiotic era. Even so, antibiotic-resistant or unusual pathogens ...
Acute mastoiditis and its complications: A problem still with us
Although it is generally accepted that acute mastoiditis is an uncommon disease, there is evidence that it may be on the increase, although serious complications ...
Otitis externa: providing relief while avoiding complications: treatment options may be equally effective, but risks of ototoxicity vary
Practice recommendations * Topical antimicrobial otic drops, supplemented by oral analgesics, provide prompt and effective therapy (B). * Fluoroquinolones ...
Brain abscess
Brain abscess is a bacterial infection within the brain.
Otitis media
Otitis media is an infection of the middle ear space, behind the eardrum (tympanic membrane).

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