Introduction
Background
Mastoiditis is any inflammatory process of the mastoid air cells or posterior process of the temporal bone.
Acute mastoiditis, also known as classic mastoiditis, is a rare complication of acute otitis media (AOM). Antibiotic treatment of acute otitis media is believed to have decreased the incidence of acute mastoiditis. Chronic mastoiditis, a more latent and sometimes clinically silent version of mastoiditis, is most commonly associated with chronic suppurative otitis media or with cholesteatoma formations. Cholesteatomas are benign tumors of squamous epithelium that can grow and alter normal structure and function of surrounding soft tissue and bone.
Pathophysiology
The mastoid bone develops from an out-pouching of the posterior epitympanum, a part of the temporal bone behind the ear. Pneumatization of the mastoid bone begins shortly after birth and is complete by approximately age 10 years. These air cells are lined with respiratory epithelium. When infection spreads to this area, a blockage of the antrum by inflamed mucosa prevents drainage of fluid. Mucopurulent build up increases air cell pressure, initiates demineralization of cell walls, and potentiates abscess formation and the possibility of extension to surrounding structures: posterior cranial fossa, middle ear fossa, canal of the facial nerve, sigmoid sinus, lateral sinus, petrous tip of the temporal bone.
Frequency
United States
The incidence of mastoiditis from acute otitis media (AOM) is 0.004%. Prior to the 1980s, the reported incidence was 0.4%. Although the incidence of acute mastoiditis decreased dramatically with the introduction of antibiotic treatment, due to contradictory publications, whether the recent incidence is increasing or decreasing is unclear.
Incidence of mastoiditis from acute otitis media is reported as 0.004% in the United States.1 Some fear that untreated otitis media increases the risk of acute mastoiditis and is the cause of higher incidences in developing countries. Rates of antibiotic treatment for otitis in the Netherlands, Norway, and Denmark were 31%, 67%, and 76%, respectively. The incidence of mastoiditis was approximately 4 cases per 100,000 children per year over 5 years. In Canada and the United States, prescription of antibiotics for otitis is greater than 96%, and the incidence was 2 cases of mastoiditis per 100,000 children per year.2
Mortality/Morbidity
Mastoiditis is a clinically significant infection with the potential of life-threatening complications. Common complications include hearing loss and extension of the infectious process beyond the mastoid system. If the spread of suppuration is anterior to the middle ear via the aditus ad antrum, often spontaneous resolution occurs. However, if the spread of infection is to the intracranial region, deadly and devastating consequences develop.
Race
The Inuit population has a high predilection for middle-ear disease and, as a likely consequence, mastoiditis.
Sex
Mastoiditis occurs equally in females and males.
Age
Acute mastoiditis affects mostly young children and peaks in those aged 6-13 months.
Clinical
History
- Recent or recurrent acute otitis media
- Otalgia
- Hearing loss
- Pain in the mastoid area
- For infants, include any nonspecific history consistent with infection such as poor feeding, fever, irritability, or diarrhea.
Physical
- Persistent or recurrent fever
- Erythematous, bulging tympanic membrane
- Erythema, swelling, or tenderness in the mastoid area
- Protrusion or displacement of the auricle
Although mastoiditis is a clinical diagnosis, it is possible to have disease with no history of otitis media, normal external anatomy, no tenderness, and no external signs of infection.
In advanced disease, various symptoms and physical findings will be consistent with the area of extension.
Causes
The distribution of causative organisms in acute mastoiditis differs from that in acute otitis media. For example, Haemophilus influenzae, a common cause of otitis media, is isolated much less often in mastoiditis. Gram-negative organisms are found to be the cause of many aggressive cases of mastoiditis. Pseudomonas and Staphylococcus aureus are more commonly isolated in cases of chronic mastoiditis. In general, the prevalence of organisms causing mastoiditis varies greatly between studies, among countries, and according to the age of the patient.
One recent study out of Houston found that, since the introduction of the 7 valent pneumococcal conjugate vaccine in 2000, the predominant serotype of pneumococcal mastoiditis was the 19A serotype. They also found that this serotype was associated with a more complicated disease course including the increased need for surgical intervention and a greater resistance to antibiotics.3
Reported pathogens are as follows:
- Streptococcus pneumoniae – Most frequently isolated pathogen in acute mastoiditis, prevalence of approximately 25%
- Group A beta-hemolytic streptococci
- Staphylococcus aureus
- Streptococcus pyogenes
- Moraxella catarrhalis
- Haemophilus influenzae
- Pseudomonas aeruginosa
- Mycobacterium species
- Aspergillus fumigatus and other fungi
- Nocardia asteroides - Recent case report4
More on Mastoiditis |
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| Differential Diagnoses & Workup: Mastoiditis |
| Treatment & Medication: Mastoiditis |
| Follow-up: Mastoiditis |
| Multimedia: Mastoiditis |
| References |
| Next Page » |
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].
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].
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
