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Mastoiditis: Differential Diagnoses & Workup
Updated: Sep 28, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Basilar Skull Fracture | Otitis Externa |
| Bell Palsy | Otitis Media |
| Cellulitis | Parotitis |
| Cysts | Stroke |
| Deep Neck Infections | Trauma |
| Lymphadenopathy | Tumors |
Workup
Laboratory Studies
Laboratory studies for mastoiditis include the following:
- CBC with differential
- Blood cultures
- Myringotomy/tympanocentesis: Send fluid for cultures, Gram stain, and acid-fast stain.
- If the tympanic membrane spontaneously ruptures, fluid from the middle ear should also be sent for cultures, Gram stain, and acid-fast stain.
Imaging Studies
- Plain radiographs may show increased opacification in the mastoid region; radiography is not a reliable study for evaluation of mastoiditis.
- CT scan may show fluid collection in the middle ear and mastoid region, abscess formations, or demineralization of the mastoid trabeculae. Some argue that all suspected cases of mastoiditis warrant CT evaluation. CT scan is considered a reliable evaluation of mastoiditis with published sensitivities that range from 87-100%.5
- MRI may be useful for detailed evaluation of contiguous soft tissue, vascular structures, extra-axial fluid collections, differentiation of tumors, and inflammatory processes. However, MRI is not as applicable as CT in the ED setting.
Other Tests
- Audiography should be performed during and after treatment of mastoiditis to assess for hearing loss. This is not applicable in the ED setting.
Procedures
- Mastoidectomy is surgical removal of infected mastoid air cells. Several different types of mastoidectomy procedures are available. With a simple (or closed) mastoidectomy, the surgeon either makes an incision behind the ear to access the mastoid region or removes the infected air cells by approaching through the ear. Radical mastoidectomy, involves removal of the tympanic membrane, most middle ear structures, and closing the Eustachian tube opening. Modified radical mastoidectomy preserves the ossicles and tympanic membrane remnants.
- Myringotomy is a small incision of the tympanum to express fluid from the middle ear in chronic or recurrent otitis media; it often relieves discomfort associated with pressure from acute otitis media (AOM). Tympanostomy tube insertion is also performed in most cases to allow for continued drainage and so that administered therapeutic otic drops reach the middle ear.
- Tympanocentesis is a puncture of the tympanic membrane for aspiration of middle ear fluid, sometimes performed in the ED setting. The tympanic membrane typically heals within several days.
- Lumbar puncture should be performed if any suspicion exists of intracranial extension of the infection.
More on Mastoiditis |
| Overview: Mastoiditis |
 Differential Diagnoses & Workup: Mastoiditis |
| Treatment & Medication: Mastoiditis |
| Follow-up: Mastoiditis |
| Multimedia: Mastoiditis |
| References |
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References
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Van Zuijlen DA, Schilder AG, Van Balen FA, Hoes AW. National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media?. Pediatr Infect Dis J. Feb 2001;20(2):140-4. [Medline].
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].
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].
Vazquez E, Castellote A, Piqueras J, et al. Imaging of complications of acute mastoiditis in children. Radiographics. Mar-Apr 2003;23(2):359-72. [Medline].
Antonelli PJ, Dhanani N, Giannoni CM, et al. Impact of resistant pneumococcus on rates of acute mastoiditis. Otolaryngol Head Neck Surg. Sep 1999;121(3):190-4. [Medline].
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Butbul-Aviel Y, Miron D, Halevy R, Koren A, Sakran W. Acute mastoiditis in children: Pseudomonas aeruginosa as a leading pathogen. Int J Pediatr Otorhinolaryngol. Mar 2003;67(3):277-81. [Medline].
Gliklich RE, Eavey RD, Iannuzzi RA, et al. A contemporary analysis of acute mastoiditis. Arch Otolaryngol Head Neck Surg. Feb 1996;122(2):135-9. [Medline].
Katz A, Leibovitz E, Greenberg D, et al. Acute mastoiditis in Southern Israel: a twelve year retrospective study (1990 through 2001). Pediatr Infect Dis J. Oct 2003;22(10):878-82. [Medline].
Klein JO. Mastoiditis. In: Mandell: Principles and Practice of Infectious Diseases. 5th ed. Churchill Livingstone; 2000:674-675.
Kvestad E, Kvaerner KJ, Mair IW. Acute mastoiditis: predictors for surgery. Int J Pediatr Otorhinolaryngol. Apr 15 2000;52(2):149-55. [Medline].
Luntz M, Brodsky A, Nusem S, et al. Acute mastoiditis--the antibiotic era: a multicenter study. Int J Pediatr Otorhinolaryngol. Jan 2001;57(1):1-9. [Medline].
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].
Taylor MF, Berkowitz RG. Indications for mastoidectomy in acute mastoiditis in children. Ann Otol Rhinol Laryngol. Jan 2004;113(1):69-72. [Medline].
Wang NE, Burg JM. Mastoiditis: a case-based review. Pediatr Emerg Care. Aug 1998;14(4):290-2. [Medline].
Further Reading
Keywords
mastoiditis, acute otitis media, chronic mastoiditis, classic mastoiditis, latent mastoiditis, cholesteatoma
