Mastoiditis natural history, complications and prognosis

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Mastoiditis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Mastoiditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

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

Overview

Without treatment, mastoiditis will result in sever complications such as Intracranial extension and permanent neurological deficits or death.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 sever complications. These complications may be classified into extracranial such as osteomyelitis, labyrinthitis, facial nerve palsy, Bezold 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 may be expected for those who are managed without delay and patients recover without complications.

Natural History

Without treatment, mastoiditis will result in sever 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 sever complications. The incidence of mastoiditis complications differs from 4% to 16.6% in the multiple studies.[3][4][5][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)

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 May occur when the facial nerve passes throw the canal in the petrous part of temporal bone
Bezold 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.[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 situation 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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