Mastoiditis

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Introduction

• Develops as a complication of acute suppurative otitis media, mostly in children
• Follows acute otitis media (untreated or inadequately treated), or due to particularly virulent organisms
• Infection spreads from the tympanum posteriorly into the mastoid antrum and aircells
• Colliquative necrosis of the air cells and suppuration in the mastoid bone follows
• A subperiosteal abscess forms behind the ear in a child with a discharging ear

Clinical features

• Fever
• Pain behind the ear
• Mucopurulent ear discharge
• Progressive inflammatory swelling over the mastoid region
• Swelling is tender and fluctuant

Differential diagnosis

• Suppurating post-aural lymphadenitis from otitis externa

Complications

• Spread of infection into cranial cavity with:
• Extradural abscess
• Meningitis
• Brain abscess
• Lateral sinus thrombophlebitis

Investigations

• Ear swab for microscopy, culture, culture, and sensitivity
• Radiographs of the mastoid
• CT Scan of petromastoid
• MRI of the petromastoid

Treatment goals

• Control and eradicate infection
• Prevent more serious complications

Non-drug treatment

• Cortical mastoidectomy to open the mastoid
• Exenterate the infected air cells and drain the mastoid

Drug treatment

• Antibiotics: Large doses of parenteral antibiotics
  • Amoxicillin
    • Adult: 500 mg -1 g intravenously 6-8 hourly for 7 days
    • Child: 50 - 100 mg/kg intravenously 6 - 8 hourly in divided doses daily for 7 days
  • Ceftriaxone
    • Adult: 1 g 12 hourly intravenously for 7 days
    • Child:
      • 13 years and above: by intravenous infusion over 60 minutes
      • 1 month - 12 years (body weight under 50 kg) 50 mg/kg once daily, up to 80 mg/kg in severe infections
      • Neonates: 20 -50 mg/kg once daily, by deep intramuscular injection or by intravenous injection over 2 - 4 minutes, or by intravenous infusion
• Analgesics
  • Paracetamol
    • Adult: 500 mg -1 g orally 4 - 6 hourly (to a maximum of 4 g daily) for 5 - 7 days
    • Child
      • over 50 kg: same as adult dosing
      • 6 - 12 years: 250 - 500 mg;
      • 3 months - 5 years:125 - 250 mg taken orally 4 - 6 hourly for 5 - 7 days

Supportive measures

• Bed rest: in-patient care
• Intravenous infusion as appropriate

Prevention

• Adequate and timely treatment of acute otitis media