Mastoiditis
Basics
Description
Description
- Inflammation of the mastoid air cells of the temporal bone, generally caused by direct extension of acute purulent otitis media
- Middle ear and mastoid air cells are contiguous via the aditus to mastoid antrum
- Fluid accumulation from closure of channel due to otitis media creates opportunity for infection
- Manifestation ranges from clinically insignificant inflammation of mastoid air cells to infection and destruction of the bone
- Acute mastoiditis:
- Occurs to some degree in all cases of otitis media
- Early signs and symptoms are those of acute otitis media
- Usually secondary to contamination with infectious material trapped in the mastoid by inflammatory obstruction of the channel between middle ear and mastoid air cells
- Acute mastoiditis with periostitis:
- As infection progresses, periosteum of the mastoid bone is involved, causing periostitis
- Subperiosteal abscess may be present
- Acute mastoid ostitis (also called coalescent mastoiditis):
- Progression of the infection within the mastoid air cells leads to destruction of the mastoid trabeculae, causing coalescence of bony trabeculae
- Mastoid empyema or a draining fistula may be present
- May progress to severe head and neck complications if untreated
- Masked mastoiditis:
- Mastoid infection, which lingers after an acute otitis media has been treated
- May progress to acute or coalescent mastoiditis
- Chronic mastoiditis:
- Infection lasting >3 mo
- Mastoiditis can be a complication of a primary disorder:
- Leukemia
- Mononucleosis
- Sarcoma of the temporal bone
- HIV
- Kawasaki disease
- Mastoiditis more common prior to the use of antibiotics for acute otitis media
- More common in young children and infants
Etiology
Etiology
- Organisms in acute mastoiditis are similar to those in acute otitis media, but differ in frequency:
- Streptococcus pneumoniae
- Group A streptococcus
- Staphylococcus aureus
- Haemophilus influenzae
- Gram-negative enteric bacteria most common with chronic mastoiditis:
- Pseudomonas aeruginosa
- Escherichia coli
- Proteus mirabilis
- Bacteroides species
- Other less common causes:
- Mycobacterium tuberculosis
- Aspergillus species in immunocompromised states
Pediatric Considerations
- More frequently seen in the pediatric population due to strong association with otitis media
- S. pneumoniae is the most common cause in children
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Citation
Schaider, Jeffrey J., et al., editors. "Mastoiditis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307426/all/Mastoiditis.
Mastoiditis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307426/all/Mastoiditis. Accessed December 1, 2024.
Mastoiditis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307426/all/Mastoiditis
Mastoiditis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307426/all/Mastoiditis.
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