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{{Mastoiditis}}
{{Mastoiditis}}


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==Overview==
==Overview==
If left untreated, [[mastoiditis]] will result in severe complications such as intracranial extension and permanent neurological deficits or death. The consequences of [[mastoiditis]] have been reduced since the introduction of [[antimicrobial]] agents and adequate therapy of [[acute otitis media]]. However, if [[mastoiditis]] is not eradicated completely, it may give rise to severe complications. These complications can be extracranial, such as [[osteomyelitis]], [[labyrinthitis]], [[facial nerve palsy]], [[Bezold's abscess]], [[hearing loss]], [[subperiosteal]] [[abscess]], or intracranial, such as [[epidural]] and [[subdural abscess]], [[meningitis]], [[temporal bone]] or [[brain abscess]] and [[venous sinus thrombosis]]. The prognosis of [[mastoiditis]] is good with treatment. Excellent outcomes can be expected for those who are managed without delay.


==Natural History, Complications and Prognosis==
==Natural History==


Although the incidence of clinically significant mastoiditis has decreased since the introduction of antimicrobial agents [2], it has not been eliminated altogether and may still lead to significant and life-threatening complications, such as abscess formation, venous sinus thrombophlebitis, cranial nerve paralysis, meningitis, and osteomyelitis of the temporal bone [1]. The reported incidence of mastoiditis complications ranges from 4% to 16.6%, depending on the specific definition used in the various studies [3–10].
If left untreated, [[mastoiditis]] will result in severe complications such as intracranial extension and permanent neurological deficits or death.<ref name="pmid9807067">{{cite journal |vauthors=Goldstein NA, Casselbrant ML, Bluestone CD, Kurs-Lasky M |title=Intratemporal complications of acute otitis media in infants and children |journal=Otolaryngol Head Neck Surg |volume=119 |issue=5 |pages=444–54 |year=1998 |pmid=9807067 |doi=10.1016/S0194-5998(98)70100-7 |url=}}</ref><ref name="pmid19487433">{{cite journal |vauthors=Anderson KJ |title=Mastoiditis |journal=Pediatr Rev |volume=30 |issue=6 |pages=233–4 |year=2009 |pmid=19487433 |doi=10.1542/pir.30-6-233 |url=}}</ref>
 
== Complications ==
The consequences of [[mastoiditis]] have been reduced after introduction of antimicrobial agents and adequate therapy of [[acute otitis media]]. However, [[mastoiditis]] has not been eradicated completely and may give rise to severe complications. The incidence of [[mastoiditis]] complications ranges from 4% to 16.6% according to multiple studies.<ref name="pmid10767461">{{cite journal |vauthors=Go C, Bernstein JM, de Jong AL, Sulek M, Friedman EM |title=Intracranial complications of acute mastoiditis |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=52 |issue=2 |pages=143–8 |year=2000 |pmid=10767461 |doi= |url=}}</ref><ref name="pmid14551488">{{cite journal |vauthors=Katz A, Leibovitz E, Greenberg D, Raiz S, Greenwald-Maimon M, Leiberman A, Dagan R |title=Acute mastoiditis in Southern Israel: a twelve year retrospective study (1990 through 2001) |journal=Pediatr. Infect. Dis. J. |volume=22 |issue=10 |pages=878–82 |year=2003 |pmid=14551488 |doi=10.1097/01.inf.0000091292.24683.fc |url=}}</ref><ref name="pmid15757196">{{cite journal |vauthors=Oestreicher-Kedem Y, Raveh E, Kornreich L, Popovtzer A, Buller N, Nageris B |title=Complications of mastoiditis in children at the onset of a new millennium |journal=Ann. Otol. Rhinol. Laryngol. |volume=114 |issue=2 |pages=147–52 |year=2005 |pmid=15757196 |doi=10.1177/000348940511400212 |url=}}</ref><ref name="pmid17493691">{{cite journal |vauthors=Benito MB, Gorricho BP |title=Acute mastoiditis: increase in the incidence and complications |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=71 |issue=7 |pages=1007–11 |year=2007 |pmid=17493691 |doi=10.1016/j.ijporl.2007.02.014 |url=}}</ref>
 
Mastoiditis complications may be classified into extracranial and intracranial as in the table below:<ref name="pmid10767461">{{cite journal |vauthors=Go C, Bernstein JM, de Jong AL, Sulek M, Friedman EM |title=Intracranial complications of acute mastoiditis |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=52 |issue=2 |pages=143–8 |year=2000 |pmid=10767461 |doi= |url=}}</ref><ref name="pmid25587371">{{cite journal |vauthors=Minovi A, Dazert S |title=Diseases of the middle ear in childhood |journal=GMS Curr Top Otorhinolaryngol Head Neck Surg |volume=13 |issue= |pages=Doc11 |year=2014 |pmid=25587371 |pmc=4273172 |doi=10.3205/cto000114 |url=}}</ref><ref name="pmid21982482">{{cite journal |vauthors=Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC |title=Intratemporal complications from acute otitis media in children: 17 cases in two years |journal=Acta Otorrinolaringol Esp |volume=63 |issue=1 |pages=21–5 |year=2012 |pmid=21982482 |doi=10.1016/j.otorri.2011.06.007 |url=}}</ref><ref name="pmid18617870">{{cite journal |vauthors=van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG |title=A systematic review of diagnostic criteria for acute mastoiditis in children |journal=Otol. Neurotol. |volume=29 |issue=6 |pages=751–7 |year=2008 |pmid=18617870 |doi=10.1097/MAO.0b013e31817f736b |url=}}</ref>
{| class="wikitable"
!Location
!Disease
!Manifestations
|-
| rowspan="6" |Extracranial complications
|[[Osteomyelitis]]
|[[Mastoid]] infection may spread to other parts of the [[skull]] which leads to [[osteomyelitis]].
 
Petrositis is [[Petrous part|petrous]] bone [[osteomyelitis]], which could be a part of Gradenigo’s syndrome (retro-[[Orbit (anatomy)|orbital]] pain, [[otorrhea]], [[abducens nerve palsy]], and acute or chronic [[otitis media]]).
|-
|[[Labyrinthitis]]
|[[Inflammation]] or [[infection]] of the bony part of [[Labyrinth (inner ear)|labyrinth]] could cause [[labyrinthitis]]. [[Sensorineural hearing loss]], [[tinnitus]], [[vomiting]], [[vertigo]], and spontaneous [[nystagmus]] may be the presenting symptoms.
|-
|[[Facial nerve palsy]]
|May occur when the [[facial nerve]] passes throw the canal in the petrous part of [[temporal bone]].
|-
|[[Bezold's abscess]]
|This [[abscess]] is a neck [[abscess]] under the [[digastric]] and [[sternocleidomastoid]] muscles. Clinical features of [[Bezold's abscess]] include [[swelling]] and [[tenderness]] below the [[mastoid process]] and below the [[sternocleidomastoid]] muscle.<ref name="pmid15967073">{{cite journal |vauthors=Leskinen K |title=Complications of acute otitis media in children |journal=Curr Allergy Asthma Rep |volume=5 |issue=4 |pages=308–12 |year=2005 |pmid=15967073 |doi= |url=}}</ref>
|-
|[[Hearing loss]]
|Acute mastoiditis can cause [[hearing loss]] because of [[middle ear]] effusion or [[external auditory canal]] obstruction. This condition can be transient and resolves with appropriate treatment. However, in some situations, [[hearing loss]] may be permanent, such as middle ear [[ossicles]] damage or [[cochlea]] damage due to suppurative [[labyrinthitis]].
|-
|Subperiosteal [[abscess]]
|Fluctuation, [[erythema]], and a tender mass overlying the [[mastoid bone]] are clinical clues to diagnosis of this complication.
|-
| rowspan="4" |Intracranial complications
|[[Epidural abscess|Epidural]] and [[subdural abscess]]
| rowspan="4" |[[Fever]], [[otalgia]], [[cephalgia]] are general clinical features. An [[altered mental status]] along with an [[otitis media]] may also be a sign of intracranial complication.
|-
|[[Meningitis]]
|-
|[[Temporal bone]] or [[brain abscess]]
|-
|[[Venous sinus thrombosis]]
|}


Clinical, laboratory, and microbiological differences between children with simple or complicated mastoiditis Efraim Bilavsky a, *, Havatzelet Yarden-Bilavsky b
==Prognosis==
==Prognosis==
With prompt treatment, it is possible to cure mastoiditis. Seeking medical care early is important. However, it is difficult for antibiotics to penetrate to the interior of the mastoid process and so it may not be easy to cure the infection; it also may recur. Mastoiditis has many possible complications, all connected to the infection spreading to surrounding structures. [[Hearing loss]] may result, or inflammation of the [[labyrinth (inner ear)|labyrinth]] of the [[inner ear]] ([[labyrinthitis]]) may occur, producing [[Vertigo_(medical)|vertigo]]. The infection may also spread to the [[facial nerve]] (cranial nerve VII), causing [[facial-nerve palsy]] which can produce weakness or paralysis of some facial muscles on that side of the face. Other complications include [[Bezold's abscess]], an abscess (a collection of pus surrounded by inflamed tissue) behind the [[sternocleidomastoid muscle]] in the neck, or a subperiosteal abscess, between the periosteum and mastoid bone ( resulting in the typical appearance of a protruding ear). Serious complications result if the infection spreads to the brain. These include [[meningitis]] (inflammation of the protective membranes surrounding the brain), [[epidural abscess]] (abscess between the skull and outer membrane of the brain), dural venous [[thrombophlebitis]] (inflammation of the [[vein|venous]] structures of the brain), or [[brain abscess]].
The prognosis of [[mastoiditis]] is good with treatment. Excellent outcomes may be expected for those who are managed without delay and patients recover without complications.<ref name="pmid19758711">{{cite journal |vauthors=Pang LH, Barakate MS, Havas TE |title=Mastoiditis in a paediatric population: a review of 11 years experience in management |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=73 |issue=11 |pages=1520–4 |year=2009 |pmid=19758711 |doi=10.1016/j.ijporl.2009.07.003 |url=}}</ref>


==References==
==References==

Latest revision as of 16:48, 3 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]

Overview

If left untreated, mastoiditis will result in severe complications such as intracranial extension and permanent neurological deficits or death. The consequences of mastoiditis have been reduced since the introduction of antimicrobial agents and adequate therapy of acute otitis media. However, if mastoiditis is not eradicated completely, it may give rise to severe complications. These complications can be extracranial, such as osteomyelitis, labyrinthitis, facial nerve palsy, Bezold's abscess, hearing loss, subperiosteal abscess, or intracranial, such as epidural and subdural abscess, meningitis, temporal bone or brain abscess and venous sinus thrombosis. The prognosis of mastoiditis is good with treatment. Excellent outcomes can be expected for those who are managed without delay.

Natural History

If left untreated, mastoiditis will result in severe complications such as intracranial extension and permanent neurological deficits or death.[1][2]

Complications

The consequences of mastoiditis have been reduced after introduction of antimicrobial agents and adequate therapy of acute otitis media. However, mastoiditis has not been eradicated completely and may give rise to severe complications. The incidence of mastoiditis complications ranges from 4% to 16.6% according to multiple studies.[3][4][5][6]

Mastoiditis complications may be classified into extracranial and intracranial as in the table below:[3][7][8][9]

Location Disease Manifestations
Extracranial complications Osteomyelitis Mastoid infection may spread to other parts of the skull which leads to osteomyelitis.

Petrositis is petrous bone osteomyelitis, which could be a part of Gradenigo’s syndrome (retro-orbital pain, otorrhea, abducens nerve palsy, and acute or chronic otitis media).

Labyrinthitis Inflammation or infection of the bony part of labyrinth could cause labyrinthitis. Sensorineural hearing loss, tinnitus, vomiting, vertigo, and spontaneous nystagmus may be the presenting symptoms.
Facial nerve palsy May occur when the facial nerve passes throw the canal in the petrous part of temporal bone.
Bezold's abscess This abscess is a neck abscess under the digastric and sternocleidomastoid muscles. Clinical features of Bezold's abscess include swelling and tenderness below the mastoid process and below the sternocleidomastoid muscle.[10]
Hearing loss Acute mastoiditis can cause hearing loss because of middle ear effusion or external auditory canal obstruction. This condition can be transient and resolves with appropriate treatment. However, in some situations, hearing loss may be permanent, such as middle ear ossicles damage or cochlea damage due to suppurative labyrinthitis.
Subperiosteal abscess Fluctuation, erythema, and a tender mass overlying the mastoid bone are clinical clues to diagnosis of this complication.
Intracranial complications Epidural and subdural abscess Fever, otalgia, cephalgia are general clinical features. An altered mental status along with an otitis media may also be a sign of intracranial complication.
Meningitis
Temporal bone or brain abscess
Venous sinus thrombosis

Prognosis

The prognosis of mastoiditis is good with treatment. Excellent outcomes may be expected for those who are managed without delay and patients recover without complications.[11]

References

  1. ↑ Goldstein NA, Casselbrant ML, Bluestone CD, Kurs-Lasky M (1998). "Intratemporal complications of acute otitis media in infants and children". Otolaryngol Head Neck Surg. 119 (5): 444–54. doi:10.1016/S0194-5998(98)70100-7. PMID 9807067.
  2. ↑ Anderson KJ (2009). "Mastoiditis". Pediatr Rev. 30 (6): 233–4. doi:10.1542/pir.30-6-233. PMID 19487433.
  3. ↑ 3.0 3.1 Go C, Bernstein JM, de Jong AL, Sulek M, Friedman EM (2000). "Intracranial complications of acute mastoiditis". Int. J. Pediatr. Otorhinolaryngol. 52 (2): 143–8. PMID 10767461.
  4. ↑ Katz A, Leibovitz E, Greenberg D, Raiz S, Greenwald-Maimon M, Leiberman A, Dagan R (2003). "Acute mastoiditis in Southern Israel: a twelve year retrospective study (1990 through 2001)". Pediatr. Infect. Dis. J. 22 (10): 878–82. doi:10.1097/01.inf.0000091292.24683.fc. PMID 14551488.
  5. ↑ Oestreicher-Kedem Y, Raveh E, Kornreich L, Popovtzer A, Buller N, Nageris B (2005). "Complications of mastoiditis in children at the onset of a new millennium". Ann. Otol. Rhinol. Laryngol. 114 (2): 147–52. doi:10.1177/000348940511400212. PMID 15757196.
  6. ↑ Benito MB, Gorricho BP (2007). "Acute mastoiditis: increase in the incidence and complications". Int. J. Pediatr. Otorhinolaryngol. 71 (7): 1007–11. doi:10.1016/j.ijporl.2007.02.014. PMID 17493691.
  7. ↑ Minovi A, Dazert S (2014). "Diseases of the middle ear in childhood". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc11. doi:10.3205/cto000114. PMC 4273172. PMID 25587371.
  8. ↑ Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC (2012). "Intratemporal complications from acute otitis media in children: 17 cases in two years". Acta Otorrinolaringol Esp. 63 (1): 21–5. doi:10.1016/j.otorri.2011.06.007. PMID 21982482.
  9. ↑ van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG (2008). "A systematic review of diagnostic criteria for acute mastoiditis in children". Otol. Neurotol. 29 (6): 751–7. doi:10.1097/MAO.0b013e31817f736b. PMID 18617870.
  10. ↑ Leskinen K (2005). "Complications of acute otitis media in children". Curr Allergy Asthma Rep. 5 (4): 308–12. PMID 15967073.
  11. ↑ Pang LH, Barakate MS, Havas TE (2009). "Mastoiditis in a paediatric population: a review of 11 years experience in management". Int. J. Pediatr. Otorhinolaryngol. 73 (11): 1520–4. doi:10.1016/j.ijporl.2009.07.003. PMID 19758711.

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