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An inflammatory process of the mastoid air cells and/or posterior process of the temporal bone, most commonly a suppurative complication of acute otitis media (AOM)
- Clinical manifestations of mastoiditis typically appear 3 weeks after the first middle ear symptoms.
- Stiffness and thickening of the tympanic membrane (TM) is common.
- Acute mastoiditis: symptoms <1 month in duration; subdivided according to the pathologic stages:
- Acute mastoiditis with periostitis (incipient mastoiditis): purulent material in the mastoid cavities
- Coalescent mastoiditis (acute mastoid osteitis): destruction of the thin bony septae between air cells; followed by the formation of abscess cavities pus dissecting into adjacent areas
- Masked mastoiditis (subacute mastoiditis): low grade, persistent infection with destruction of the bony septae between air cells; occurs in patients with persistent middle ear effusion or recurrent episodes of inadequately treated AOM
- Chronic mastoiditis: associated with failed treatment of chronic otitis media. Often associated with cholesteatoma; symptoms last months to years.
Highest incidence in children <2 years
- Routine prescription of antibiotics and routine childhood immunizations have reduced the number of cases of AOM and mastoiditis.
1 to 4 cases per 100,000 children per year (1)
Etiology and Pathophysiology
- Subclinical stage begins with AOM and inflammation of mastoid air cells.
- Obstruction of the aditus ad antrum (connecting the tympanic cavity and mastoid)
- Blocks outflow tract of mastoid air cells
- Edema and accumulation of purulent material with penetration of periosteum (acute mastoiditis with periosteitis)
- Increased pressure from fluid within the air cells leads to destruction of bony septae (acute mastoid osteitis/acute coalescent mastoiditis).
- Acute mastoid osteitis can spread to adjacent areas in head and neck with abscess formation:
- Subperiosteal abscess (most common complication), Bezold abscess, suppurative labyrinthitis, suppurative CNS complications
- AOM: Haemophilus influenzae, Streptococcus pneumoniae
- Acute mastoiditis: S. pneumoniae (most common), Streptococcus pyogenes, H.influenzae, Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA])
- Chronic mastoiditis: Pseudomonas aeruginosa, S. aureus, Enterobacteriaceae, anaerobic bacteria, polymicrobials (2)
No known genetic pattern
- Recurrent AOM or chronic suppurative otitis media
- Immunocompromised state
- Ensure appropriate vaccinations (particularly pneumococcal vaccine).
- Referral to ENT for chronic otitis media
- Appropriate diagnosis and treatment of AOM
- Prevent recurrent AOM.
- Treat chronic eustachian tube dysfunction (pressure equalization tubes).
- Early diagnosis of cholesteatoma