Mastoiditis natural history, complications and prognosis
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Mastoiditis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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
- ↑ 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.
- ↑ Anderson KJ (2009). "Mastoiditis". Pediatr Rev. 30 (6): 233–4. doi:10.1542/pir.30-6-233. PMID 19487433.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Leskinen K (2005). "Complications of acute otitis media in children". Curr Allergy Asthma Rep. 5 (4): 308–12. PMID 15967073.
- ↑ 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.