eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Middle Ear & Mastoid

Middle Ear, Mastoiditis: Workup

Author: PP Devan, MBBS, MS, Chief of ENT, A J Institute of Medical Sciences, India
Coauthor(s): John D Donaldson, MD, FRCS(C), FAAP, FACS, Chairman, Board of Directors, Lee Memorial Health System; Vice-President, Florida Pediatric Society
Contributor Information and Disclosures

Updated: Mar 19, 2008

Workup

Laboratory Studies

  • Microbiology: Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available).
  • A CBC count and sedimentation rate are obtained for baseline studies used to evaluate efficacy of therapy.
  • Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process.

Imaging Studies

  • CT scanning of the temporal bone is the standard for evaluation of mastoiditis. The following findings are used to differentiate AOM/acute mastoiditis without osteitis, ASM, and chronic mastoiditis:  
    • Opacification of the mastoid air cells and middle ear by inflammatory swelling of mucosa and by collection of fluid
    • Loss of sharpness or visibility of mastoid cell walls due to demineralization, atrophy, or necrosis of bony septa
    • Haziness or distortion of the mastoid outline, possibly with visible defects of the tegmen or mastoid cortex
    • Enhancement of areas of abscess formation
    • Elevation of periosteum of mastoid process or posterior cranial fossa
    • Osteoblastic activity in chronic mastoiditis
  • MRI is not typically the radiographic study of choice; however, it is helpful in showing inflammatory processes and differentiating certain tumors. Do not use MRI as a method of evaluating the mastoid, although it is the standard for evaluation of contiguous soft tissue, particularly the intracranial structures. However, MRI is the preferred imaging modality for the potential complications of ASM (ie, abscess formation, sinus thrombosis).
  • Plain radiography: In areas of the world where CT scanning is not immediately available, plain radiographs of the mastoids demonstrate clouding of the air cells with bone destruction in ASM. In the vast majority of cases, radiographs suffice to establish the diagnosis but lack the sensitivity to differentiate the stages of the disease and fail to show the petrous apex in any great detail.

Other Tests

  • In the light of the prevailing medicolegal climate, an audiometric evaluation must be obtained. Audiometry is seldom appropriate or useful for children with ASM, but it must be performed after convalescence from the acute phase and with children who have chronic mastoiditis. In the at-risk population (children <2 y), thresholds for air and bone conduction under headphones are only rarely obtained.

Diagnostic Procedures

  • Tympanocentesis/myringotomy
    • A culture from the middle ear fluid should be obtained prior to beginning antimicrobial therapy. While it is ideal to use an operating microscope and specifically designed suction traps, an otoscope, spinal needle, and syringe can also be used in obtaining specimens from the middle ear.
    • Sterilize the canal with an antiseptic, and, with the child restrained, aspirate from the anterior half of the tympanic membrane.
  • Lumbar puncture: Perform a spinal tap if intracranial spread of infection is suspected.

More on Middle Ear, Mastoiditis

Overview: Middle Ear, Mastoiditis
Workup: Middle Ear, Mastoiditis
Treatment: Middle Ear, Mastoiditis
Follow-up: Middle Ear, Mastoiditis
Multimedia: Middle Ear, Mastoiditis
References
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References

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  2. 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]. [Full Text].

  3. 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].

  4. 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]. [Full Text].

  5. American Academy of Pediatrics. Red Book: Report of the Committee on Infectious Diseases,. In: Pneumococcal infections. 24th ed. 1997:410-419.

  6. Antonelli PJ, Dhanani N, Giannoni CM, Kubilis PS. Impact of resistant pneumococcus on rates of acute mastoiditis. Otolaryngol Head Neck Surg. Sep 1999;121(3):190-4. [Medline].

  7. Arenberg IK, Stahle J, Glasscock ME 3rd, Shambaugh GE Jr. Endolymphatic sac valve implant surgery. I: The technique. Laryngoscope. Jul 1979;89(7 Pt 2 Suppl 17):1-20. [Medline].

  8. Bluestone CD, Klein JO. Complications and sequelae: intratemporal. Otitis Media in Infants and Children. 1988;233-237.

  9. Bluestone CD, Klein JO. Pediatric Otolaryngology. In: Intratemporal complications and sequelae of otitis media. 1. 2nd ed. Philadelphia, Penn: WB Saunders; 1990:521-526.

  10. Fink JN, McAuley DL. Mastoid air sinus abnormalities associated with lateral venous sinus thrombosis: cause or consequence?. Stroke. 2002 Sep;33(9):2148-9; author reply 2148-9. Sep 2002;33(9):2148-9. [Medline]. [Full Text].

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

  15. Mustafa A, Debry Ch, Wiorowski M, Martin E, Gentine A. Treatment of acute mastoiditis: report of 31 cases over a ten year period. Rev Laryngol Otol Rhinol (Bord). 2004;125(3):165-9. [Medline].

  16. Shambaugh GE, Glasscock ME. Pathology and clinical course of inflammatory diseases of the middle ear. Surgery of the Ear. 1967;186-220.

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Further Reading

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Keywords

mastoiditis, acute surgical mastoiditis, ASM, chronic middle ear inflammatory disease, chronic suppurative otitis media, acute otitis media, AOM, acute mastoiditis, earache, ear ache, ear pain, ear infection, hearing loss, cholesteatoma, middle ear disease, coalescent mastoiditis, mastoid, mastoidectomy, tympanocentesis, mastoid disease

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Contributor Information and Disclosures

Author

PP Devan, MBBS, MS, Chief of ENT, A J Institute of Medical Sciences, India
Disclosure: Nothing to disclose.

Coauthor(s)

John D Donaldson, MD, FRCS(C), FAAP, FACS, Chairman, Board of Directors, Lee Memorial Health System; Vice-President, Florida Pediatric Society
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: None None None

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
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: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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