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

Middle Ear, Mastoiditis: Follow-up

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

Outcome and Prognosis

  • Expect patients with ASM to recover completely provided that the facial nerve, vestibule, and intracranial structures are not involved.
  • Cosmetic deformity of the operated ear can usually be prevented with judicious placement of the incision and the development of flaps to pull the ears posteriorly when replaced.
  • Conductive hearing loss should resolve provided that the ossicular chain remains intact. Conduct testing after otorrhea has ended and the ear has healed.

Future and Controversies

Incidence of mastoiditis and, thus, mastoidectomy should decline further with the availability and administration of the conjugated pneumococcal vaccine.

In a study by Oestreicher-Kedem et al, the mean interval from onset of illness to mastoiditis was found to be 4.5 days.3 Ear cultures most often grew S pneumoniae and P aeruginosa (23.7% each). Complications occurred in 15.8% of cases. The only factor differentiating children with and without complications was the white blood cell count (high in children with complications). These findings indicate that acute mastoiditis is not only a complication of prolonged infection of the middle ear but also may present as an acute infection of the mastoid bone that can progress within 48 hours. The complication rate remains high, and antibiotic treatment at the onset of symptoms does not prevent complications. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

A study done by Roddy et al shows that in the post pneumococcal vaccine era, ceftriaxone nonsusceptibility was seen in 30% of post-PCV S pneumoniae isolates compared with 7% of pre-PCV isolates.4 We can conclude that empiric antimicrobial therapy with ceftriaxone alone is insufficient in the post-PCV era.

 


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

  1. 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. 2001;57(1):1-9. [Medline]. [Full Text].

  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].

  11. Gliklich RE, Eavey RD, Iannuzzi RA, Camacho AE. A contemporary analysis of acute mastoiditis. Arch Otolaryngol Head Neck Surg. Feb 1996;122(2):135-9. [Medline].

  12. Kaplan SL, Mason EO Jr, Wald ER, Kim KS, Givner LB, Bradley JS, et al. Pneumococcal mastoiditis in children. Pediatrics. Oct 2000;106(4):695-9. [Medline].

  13. Krejovic-Trivic S, Djeric D, Trivic A. [Mastoiditis in adults: diagnostic and therapeutic aspects]. Acta Chir Iugosl. 2004;51(1):109-12. [Medline].

  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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