eMedicine Specialties > Emergency Medicine > Infectious Diseases

Mastoiditis: Follow-up

Author: 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
Coauthor(s): 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
Contributor Information and Disclosures

Updated: Sep 28, 2009

Follow-up

Further Inpatient Care

  • Myringotomy with tympanostomy tube insertion may be performed. 
  • Mastoidectomy is indicated in cases of advanced disease such as mastoid osteitis, intracranial extension, abscess formation, when cholesteatoma is involved, or if little improvement occurs after 24-48 hours of intravenous antibiotics.  

Further Outpatient Care

  • Two weeks of oral antibiotics with the same spectrum of coverage as the intravenous antibiotics should be taken after discontinuation of intravenous antibiotics. 
  • The patient should follow up with an ear, nose, and throat (ENT) specialist as well as have an audiogram performed to assess hearing function.

Deterrence/Prevention

  • Physicians should be aware of the signs and symptoms of mastoiditis and the complications related to this disease. Patients with chronic otitis media should be referred to an ENT specialist for evaluation.

Complications

Complications of mastoiditis include the following:

  • Hearing loss
  • Facial nerve palsy
  • Cranial nerve involvement
  • Osteomyelitis
  • Petrositis
  • Abscess formation – Bezold's abscess (abscess of soft tissues that track along the sternomastoid sheath), Citelli abscess (extension to occipital bone, calvarium), subperiosteal abscess (abscess between the periosteum and mastoid bone, resulting in the typical appearance of a protruding ear)
Mastoiditis with subperiosteal abscess. Note the ...

Mastoiditis with subperiosteal abscess. Note the loss of the skin crease and the pointed abscess.

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Mastoiditis with subperiosteal abscess. Note the ...

Mastoiditis with subperiosteal abscess. Note the loss of the skin crease and the pointed abscess.

  • Labyrinthitis
  • Gradenigo syndrome – Otitis media, retro-orbital pain, and abducens palsy
  • Intracranial extension – Meningitis, cerebral abscess, epidural abscess, subdural empyema
  • Sigmoid sinus thrombosis

Prognosis

  • If no complications occur, the patient should expect a full recovery.

Miscellaneous

Medicolegal Pitfalls

  • Medicolegal pitfalls include failure to diagnose, failure to treat, and failure to detect complications.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Dominique C Fontenette, MD, Ewen N Wang, MD, and Alyssa K Hamman, MD, to the development and writing of this article.



More on Mastoiditis

Overview: Mastoiditis
Differential Diagnoses & Workup: Mastoiditis
Treatment & Medication: Mastoiditis
Follow-up: Mastoiditis
Multimedia: Mastoiditis
References
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References

  1. 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].

  2. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. Bahadori RS, Schwartz RH, Ziai M. Acute mastoiditis in children: an increase in frequency in Northern Virginia. Pediatr Infect Dis J. Mar 2000;19(3):212-5. [Medline].

  8. 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].

  9. 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].

  10. 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].

  11. Klein JO. Mastoiditis. In: Mandell: Principles and Practice of Infectious Diseases. 5th ed. Churchill Livingstone; 2000:674-675.

  12. Kvestad E, Kvaerner KJ, Mair IW. Acute mastoiditis: predictors for surgery. Int J Pediatr Otorhinolaryngol. Apr 15 2000;52(2):149-55. [Medline].

  13. 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].

  14. 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].

  15. Taylor MF, Berkowitz RG. Indications for mastoidectomy in acute mastoiditis in children. Ann Otol Rhinol Laryngol. Jan 2004;113(1):69-72. [Medline].

  16. Wang NE, Burg JM. Mastoiditis: a case-based review. Pediatr Emerg Care. Aug 1998;14(4):290-2. [Medline].

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Further Reading

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Keywords

mastoiditis, acute otitis media, chronic mastoiditis, classic mastoiditis, latent mastoiditis, cholesteatoma

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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