Mastoiditis physical examination

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

Physical Examination

Recent episode of (sub)acute otitis media

otalgia

otorrhea

Postauricular swelling

Postauricular erythema

Postauricular tenderness

Protrusion of pinna

Fever

Sagging external ear canal

Blurred tympanic membrane

Systemic signs of infection

Fever

Postauricular swelling or fluctuation, erythema, tenderness, and abnormal tympanic membrane were the most frequently reported symptoms

Systemic signs and symptoms were reported in 54 studies (Fig. 2). Fever was the most frequent sign, present on average in 76% of the patients in 46 of 65 studies

(96 percent)

Abnormal tympanic membrane (82 percent)

Postauricular erythema, postauricular tenderness, and/or protrusion of the pinna (80 percent)

Fever (76 percent)

Narrowing of the external auditory canal (71 percent)

Ear pain (67 percent)

Otorrhea (50 percent)

The diagnosis of mastoiditis is clinical—based on the medical history and physical examination. Imaging studies may provide additional information; the study of choice is the CT scan, which may show focal destruction of the bone or signs of an abscess (a pocket of infection). X-rays are not as useful. If there is drainage, it is often sent for culture, although this will often be negative if the patient has begun taking antibiotics.

Gallery

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  Picture of a right mastoidectomy, surgeon's view. Note the blue color of the skeletonized sigmoid sinus.

• 

  Picture of a left mastoidectomy, surgeon's view.

• 

  In this left canal wall up mastoidectomy, the tympanic membrane has been elevated forward and a cholesteatoma sac is visible in the attic.

• 

  This patient has a recurrent cholesteatoma which has found its way to the surface of the post-auricular skin, forming a mastoid cutaneous fistula.

• 

  This cholesteatoma sac has eroded the lateral surface of the mastoid bone and was found immediately under the post-auricular skin.

• 

  Left canal wall down mastoidectomy.This patient had a modified radical mastoidectomy with tympanoplasty. The posterior bony canal has been removed and part of the dry "mastoid bowl" is visible posterior and superior to the reconstructed tympanic membrane .

• 

  Magnification of the previous picture .