Mastoiditis diagnosis

Thirty children with acute mastoiditis were identified over a 12-year-period and their hospital records were reviewed retrospectively. All had abnormal tympanic membranes and 26 (87%) had swelling above or posterior to the ear that deviated the pinna. Findings on mastoid roentgenograms included clouding (n = 12) and osteitis (n = 7); six were normal. From 13 patients, bacteria were recovered from normally sterile sites and included Pneumococcus (n = 5), group A streptococcus (n = 3), Haemophilus (n = 2), and anaerobes (n = 3). Complications occurred in 13 children, including subperiosteal abscess (n = 7), meningitis (n = 4), osteitis (n = 7), facial palsy (n = 1), and subdural empyema and brain abscess (n = 1). Four of the six children with neurological complications had no external signs of acute mastoiditis on physical examination. Overall, 19 (63%) of the children recovered without mastoidectomy. We conclude that children without meningitis or subperiosteal abscess may be treated initially with antimicrobial therapy plus myringotomy. The need for mastoidectomy should be reassessed in children who fail to respond in 24 to 48 hours.

Temporal arteritis often causes temporal pain and tenderness that can involve the ear. Other symptoms include malaise, weight loss, fever, and anorexia. It is important to recognize temporal arteritis because it can cause permanent blindness, but this is usually preventable with prompt initiation of systemic corticosteroids. Only about 40 percent of patients have tenderness in the temporal arteries, but 65 percent have at least one temporal artery abnormality (., tenderness, absent pulse, beading, prominence). 25 Although temporal arteritis is unusual in patients younger than 50 years, it should be considered if there are multiple findings indicative of the disease. 25 The disease is rare in patients with normal erythrocyte sedimentation rates and unusual if the erythrocyte sedimentation rate is less than 50 mm per hour. 25

Acute mastoiditis is the most common, and usually the initial, complication of AOM . The diagnosis can be confusing due to differing uses of the term “mastoiditis”. Radiographic mastoiditis simply refers to fluid in the mastoid air cells , which can occur with any AOM due to communication between the middle ear and the mastoid air cells. However, acute mastoiditis for the EP involves clinical evidence of mastoid inflammation such as erythema, tenderness to palpation, bogginess, and swelling over the mastoid bone . A clinical diagnosis of acute mastoiditis necessitates treatment with IV antibiotics with a consideration for tympanostomy and mastoidectomy . Occasionally, a CT scan with IV contrast should be considered to evaluate for additional complications such as abscess.

Although the incidence of acute mastoiditis has been substantially reduced since the introduction of antibiotic therapy, mastoiditis complications are still commonly seen in the pediatric population. Many of these cases require lengthy hospitalizations and extensive medical and surgical interventions. Accordingly, a safe, effective, and resourceful diagnostic and therapeutic plan must be executed for the workup and treatment of each patient suspected of having acute mastoiditis. With thorough clinical evaluations, early diagnosis, and close follow-up, a large proportion of children with severe acute otitis media or early stage mastoiditis can be managed in the primary care setting without immediate surgical specialty involvement. This review presents an overview of the anatomical and pathophysiological considerations in acute mastoiditis and offers pediatricians a practical, evidence-based algorithm for the diagnostic and therapeutic approach to this disease.

Mastoiditis diagnosis

mastoiditis diagnosis

Although the incidence of acute mastoiditis has been substantially reduced since the introduction of antibiotic therapy, mastoiditis complications are still commonly seen in the pediatric population. Many of these cases require lengthy hospitalizations and extensive medical and surgical interventions. Accordingly, a safe, effective, and resourceful diagnostic and therapeutic plan must be executed for the workup and treatment of each patient suspected of having acute mastoiditis. With thorough clinical evaluations, early diagnosis, and close follow-up, a large proportion of children with severe acute otitis media or early stage mastoiditis can be managed in the primary care setting without immediate surgical specialty involvement. This review presents an overview of the anatomical and pathophysiological considerations in acute mastoiditis and offers pediatricians a practical, evidence-based algorithm for the diagnostic and therapeutic approach to this disease.

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