Ear - Mastoiditis
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Inflammation of the mastoid bone behind the ear
Cause
- Usually a complication of suppurative otitis media
Clinical features
- Severe pain felt over the mastoid bone
- Swelling in post auricular area (pinna is pushed down and forward)
- Current or history of pus discharge from the ear
- Fever
- Mental confusion is a grave sign of intracranial spread of infection (Refer to ENT surgeon immediately)
Differential diagnosis
- Inflamed lymph node behind ear
Investigations
- Diagnosis mainly by clinical features
- X-ray: Useful in chronic mastoiditis
- Blood: Full blood count, shows leucocytosis
- Examine ear with otoscope
ManagementTreatment
- Admit urgently; give emergency treatment
- Ceftriaxone 2-4 g by IV or deep IM once daily for 10-14 days
- Child: 50-80 mg/kg once daily
- Divide IM doses over 1 g between 2 sites
- Plus metronidazole 400 mg every 8 hours for 10-14 days
- Child: 7.5 mg/kg per dose
- Surgical drainage may be necessary to remove pus if an abscess has formed
- Refer urgently for specialist care