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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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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.

Read more at Wikipedia.org


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Small Rise in Mastoiditis During Watchful Waiting - Brief Article
From Family Pratice News, 6/1/01 by Miriam E. Tucker

Restricting the use of antibiotics in children with acute otitis media may be associated with higher rates of mastoiditis, said Dr. Diederick A. Van Zuijlen and his associates of University Medical Center Utrecht (Netherlands).

But this adds up to only about two extra cases of acute mastoiditis per 100,000 per year. This finding doesn't necessarily support abandonment of the "watchful waiting" strategy of acute otitis media (AOM) management used by most Dutch physicians. The advantages of watchful waiting include fewer antibiotic-associated costs, side effects, and resistance rates (Pediatr. Infect. Dis. J. 20:140-44, 2001).

The incidence rates of acute mastoiditis in children aged 14 years and younger during 1991-1998 ranged from 1.2 to 2 per 100,000 children per year in countries where antibiotics are prescribed for more than 96% of all children: the Unit ed States, the United Kingdom, Canada, and Australia.

The rate was 3.5 per 100,000 children in Norway, (where 67% of children with AOM get antibiotic prescriptions), 4.2 per 100,000 in Denmark (76% of children), and 3.8 per 100,000 in the Nether lands (31% of children).

Guidelines from the Dutch College of General Practitioners advise antibiotics only for children with a complicated course of AOM or for those at greater risk of complications.

Even if restrictive use of antibiotics for AOM is responsible for the difference in incidence rates, watchful waiting is not necessarily a bad idea. Acute mastoiditis is a serious AOM complication, but it can be treated in most cases with broad-spectrum intravenous antibiotics and myringotomy. In a recent study, only 25% of acute mastoiditis cases eventually require mastoidectomy.

At least 2,500 antibiotic prescriptions would be needed to prevent one episode of acute mastoiditis. Yet antibiotic use clearly promotes resistance: The percentage of penicillin resistant Streptococcus pneumoniae in the Netherlands in 1995 was 1.1%, compared with 27.5% in the United States.

COPYRIGHT 2001 International Medical News Group
COPYRIGHT 2001 Gale Group

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