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{{Mastoiditis}}
{{Mastoiditis}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{MJ}}


==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==


The consequences of mastoiditis have been reduced after introduction of antimicrobial agents and adequate therapy of acute otitis media. However mastoiditis has not been omitted completely and may give rise to sever complications. The incidence of mastoiditis complications are differs from 4% to 16.6% in the 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>
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>


mastoiditis complication may be classified to extracranial and intracranial as in below table: <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>
== 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"
{| class="wikitable"
|+
!Location
| rowspan="7" |'''extracranial complications'''
!Disease
|'''Osteomyelitis'''
!Manifestations
|Mastoid infection may spread to other parts of the skull which leads to osteomyelitis.
|-
| rowspan="6" |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 as a part of Gradenigo’s syndrome (retro-orbital pain, otorrhea, abducens nerve palsy, and acute or chronic otitis media)
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 could cause labyrinthitis. Sensorineural hearing loss, tinnitus, vomiting, vertigo, and spontaneous nystagmus clinical symptoms diagnosis
|-
|-
|'''Facial nerve palsy'''
|[[Labyrinthitis]]
|May occur when the facial nerve passes throw the canal in the petrous part of temporal bone
|[[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.
|-
|-
|'''Sinus sigmoid thrombosis'''
|[[Facial nerve palsy]]
|This complication may be silent or become symptomatic if thrombotic obstruction of the internal jugular vein happens. In this situation the symptoms will be the clinical features of increased intracranial pressure.
|May occur when the [[facial nerve]] passes throw the canal in the petrous part of [[temporal bone]].
|-
|-
|'''Bezold abscess'''
|[[Bezold's abscess]]
|This abscess is a neck abscess under the digastric and sternocleidomastoid muscles. Clinical features of Bezold 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>
|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'''
|[[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 situation hearing loss may be permanent, such as middle ear ossicles damage or cochlea damage due to suppurative labyrinthitis.
|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'''
|Subperiosteal [[abscess]]
|Fluctuation, erythema and a tender mass overlying the mastoid bone are clinical clues to diagnosis of this complication.
|Fluctuation, [[erythema]], and a tender mass overlying the [[mastoid bone]] are clinical clues to diagnosis of this complication.
|-
|-
| rowspan="4" |'''Intracranial complications'''
| rowspan="4" |Intracranial complications
|'''Epidural and subdural abscess'''
|[[Epidural abscess|Epidural]] and [[subdural abscess]]
| rowspan="4" |fever, otalgia, cephalgia, and reduced general condition. An altered mental status in combination with an AM could also be a sign of intracranial complication
| 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'''
|[[Meningitis]]
|-
|-
|'''Temporal bone or brain abscess'''
|[[Temporal bone]] or [[brain abscess]]
|-
|-
|'''Venous sinus thrombosis'''
|[[Venous sinus thrombosis]]
|}
|}
====== Labyrinthitis ======
Labyrinthitis is a rare complication of AM [54]. Sensorineural hearing loss, vertigo, and spontaneous nystagmus are pathbreaking for its diagnosis. Nevertheless, the diagnosis could be very challenging in childhood. Therapy depends on removing the inflammatory focus by mastoidectomy and PC.
====== Petrositis ======
Today, this complication is rare but could be part of Gradenigo’s syndrome (retrobulbar pain, abducens nerve palsy, and ipsilateral acute or chronic otitis media) [54], [63]. A combined therapy of mastoidectomy (including the opening of mastoid cells in the petrous apex) with high-dose intravenous (i.v.) antibiotics is sufficient [54].
====== Facial palsy ======
Facial palsy is also a rare complication of AM. In addition to antibiotics, a prompt surgical management consisting of mastoidectomy and PC is indicated. Further, decompression of the mastoid portion of the nerve and steroids are recommended [38]. In cases of facial palsy as a complication of AOM without secure signs of AM, a PC and ventilation tubes (VT) are advisable. If there is no improvement within 3 days, a mastoidectomy is indicated [64].
====== Sinu sigmoideus thrombosis ======
This complication could be asymptomatic or become clinical if a thrombotic obstruction of the internal jugular vein leads to an increased intracranial pressure. The diagnostic tool of choice is a MRI-angiography [62]. Therapeutically, the sinus is exposed from the sinus-dura angle to the mastoid tip during the mastoidectomy. In cases of sepsis or suspicion of thrombosis, the sinus is punctured. If there is sign of thrombosis, the sinus is opened and the thrombosis evacuated. Further, the sinus should be obliterated with muscle or Surgicel [2]. Surgical removal of the thrombus is nowadays controversial. Some authors recommend in these cases heparin [54], [65]. In cases of sepsis, a transcervical ligation of the internal jugular vein is recommended [54].
====== Intracranial complications ======
. The diagnosis of an intracranial complication could be very challenging. The most common symptoms are fever, otalgia, cephalgia, and reduced general condition. An altered mental status in combination with an AM could also be a sign of intracranial complication [54], [61]. The diagnostic method of choice is CT or MRI. The two radiological techniques are regarded as equally effective [54], [56], [61]. The treatment of choice is mastoidectomy combined with antibiotics that penetrate the central nervous system (CNS), such as ceftriaxone. An epidural abscess can be drained during the mastoidectomy. The treatment of a brain abscess should be interdisciplinary, including neurosurgery [2].


==Prognosis==
==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.<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

Mastoiditis Microchapters

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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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