Mastoiditis Differential Diagnoses

  • Author: PP Devan, MBBS, MS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Oct 5, 2011
 
 

Diagnostic Considerations

A high index of suspicion, judicious use of diagnostic modalities, and close follow-up care are recommended to make a diagnosis in a timely manner

Conditions to consider in the differential diagnosis of mastoiditis include the following:

  • Basilar Skull Fracture
  • Cellulitis
  • Cysts
  • Deep Neck Infections
  • Lymphadenopathy
  • Parotitis
  • Stroke
  • Trauma
  • Tumors
  • Histiocytoses
  • Sarcoidosis
  • External otitis
  • Mastoid trauma
  • Suppuration of postauricular lymph node
  • Furuncle of meatus of the ear
  • Suppuration of the postauricular (mastoid) lymph node - This node collects drainage from the scalp and becomes inflamed with infections involving this region

Catscratch disease and atypical mycobacteria tend to have poor response to antimicrobials and a high frequency of nodal abscess formation. Differentiation from acute surgical mastoiditis (ASM) is relatively easy with preservation of the skin crease and presence of a normal middle ear.

Lateral sinus thrombosis causes mastoid air sinus abnormalities; this is due to venous congestion as a consequence of this condition.

Differential Diagnoses

  • Bell Palsy
  • Otitis Externa
  • Otitis Media
  • Wegener Granulomatosis
Proceed to Workup
 
 
Contributor Information and Disclosures
Author

PP Devan, MBBS, MS  Professor and Head, Dept of ENT, A J Institute of Medical Sciences, Mangalore, India

Disclosure: Nothing to disclose.

Coauthor(s)

John D Donaldson, MD, FRCS(C), FAAP, FACS  Pediatric Otolaryngologist, Lee Memorial Health System

John D Donaldson, MD, FRCS(C), FAAP, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Surgeons, and American Society of Pediatric Otolaryngology

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

Additional Contributors

Karin S Chase, MD Assistant Clinical Instructor and Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center/Kings County Hospital

Karin S Chase, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Christopher I Doty, MD, FACEP, FAAEM Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Gerard J Gianoli, MD Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Vesticon, Inc. None Board membership

Alyssa K Hamman, MD Research Assistant, Division of Emergency Medicine, Stanford University

Alyssa K Hamman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, and Colorado Medical Society

Disclosure: Nothing to disclose.

Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John C Li, MD Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

N Ewen Wang, MD Consulting Staff, Department of Surgery, Division of Emergency Medicine, Stanford University Hospital

Disclosure: Nothing to disclose.

References

  1. Casula S, Castro JG, Espinoza LA. An unusual cause of mastoiditis that evolved into multiple ring-enhancing intracerebral lesions in a person with HIV infection. AIDS Read. Aug 2007;17(8):402-4. [Medline].

  2. Ongkasuwan J, Valdez TA, Hulten KG, Mason EO Jr, Kaplan SL. Pneumococcal mastoiditis in children and the emergence of multidrug-resistant serotype 19A isolates. Pediatrics. Jul 2008;122(1):34-9. [Medline].

  3. Nussinovitch M, Yoeli R, Elishkevitz K, Varsano I. Acute mastoiditis in children: epidemiologic, clinical, microbiologic, and therapeutic aspects over past years. Clin Pediatr (Phila). Apr 2004;43(3):261-7. [Medline].

  4. Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, et al. Acute mastoiditis--the antibiotic era: a multicenter study. Int J Pediatr Otorhinolaryngol. Jan 2001;57(1):1-9. [Medline].

  5. Oestreicher-Kedem Y, Raveh E, Kornreich L, Popovtzer A, Buller N, Nageris B. Complications of mastoiditis in children at the onset of a new millennium. Ann Otol Rhinol Laryngol. Feb 2005;114(2):147-52. [Medline].

  6. Niv A, Nash M, Slovik Y, Fliss DM, Kaplan D, Leibovitz E, et al. Acute mastoiditis in infancy: the Soroka experience: 1990-2000. Int J Pediatr Otorhinolaryngol. Nov 2004;68(11):1435-9. [Medline].

  7. van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG. A systematic review of diagnostic criteria for acute mastoiditis in children. Otol Neurotol. Sep 2008;29(6):751-7. [Medline].

  8. Vazquez E, Castellote A, Piqueras J, Mauleon S, Creixell S, Pumarola F, et al. Imaging of complications of acute mastoiditis in children. Radiographics. Mar-Apr 2003;23(2):359-72. [Medline].

  9. National Cancer Institute. Radiation Risks and Pediatric Computed Tomography (CT): A Guide for Health Care Providers. National Institutes of Health. Available at http://www.cancer.gov/cancertopics/causes/radiation/radiation-risks-pediatric-CT. Accessed October 2, 2011.

  10. Roddy MG, Glazier SS, Agrawal D. Pediatric mastoiditis in the pneumococcal conjugate vaccine era: symptom duration guides empiric antimicrobial therapy. Pediatr Emerg Care. Nov 2007;23(11):779-84. [Medline].

 
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Mastoiditis with subperiosteal abscess. Note the loss of the skin crease and the pointed abscess.
Cortical mastoidectomy in a densely sclerosed mastoid.
Preoperative preparation of the patient.
Draping the surgical area.
Injection of the area with 2% Xylocaine and 1:100,000 adrenaline to reduce bleeding.
Marking the incision site.
Placement of the incision, a few mm behind the postauricular sulcus.
Deepening the incision down to the bone.
Elevation of the periosteum to expose the mastoid cortex to the mastoid tip.
Mastoid drilling in progress with simultaneous saline irrigation.
Creation of the initial groove and the vertical line.
Exposure of the antrum and exenteration of the mastoid air cells.
Curetting the aditus to enlarge it.
Further exposure.
Healed postaural scar.
Extent of cortical mastoidectomy in a well-pneumatized mastoid.
 
 
 
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