Diagnostic Considerations

A high index of suspicion, judicious use of diagnostic modalities, and close follow-up care are recommended to make a diagnosis in a timely manner

Conditions to consider in the differential diagnosis of mastoiditis include the following:

Basilar Skull Fracture
Cellulitis
Cysts
Deep Neck Infections
Lymphadenopathy
Parotitis
Stroke
Trauma
Tumors
Histiocytoses
Sarcoidosis
External otitis
Mastoid trauma
Suppuration of postauricular lymph node
Furuncle of meatus of the ear
Suppuration of the postauricular (mastoid) lymph node - This node collects drainage from the scalp and becomes inflamed with infections involving this region

Catscratch disease and atypical mycobacteria tend to have poor response to antimicrobials and a high frequency of nodal abscess formation. Differentiation from acute surgical mastoiditis (ASM) is relatively easy with preservation of the skin crease and presence of a normal middle ear.

Lateral sinus thrombosis causes mastoid air sinus abnormalities; this is due to venous congestion as a consequence of this condition.

Differential Diagnoses

Bell Palsy
Otitis Externa
Otitis Media
Wegener Granulomatosis

Workup

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Media Gallery

Mastoiditis with subperiosteal abscess. Note the loss of the skin crease and the pointed abscess.
Cortical mastoidectomy in a densely sclerosed mastoid.
Preoperative preparation of the patient.
Draping the surgical area.
Injection of the area with 2% Xylocaine and 1:100,000 adrenaline to reduce bleeding.
Marking the incision site.
Placement of the incision, a few mm behind the postauricular sulcus.
Deepening the incision down to the bone.
Elevation of the periosteum to expose the mastoid cortex to the mastoid tip.
Mastoid drilling in progress with simultaneous saline irrigation.
Creation of the initial groove and the vertical line.
Exposure of the antrum and exenteration of the mastoid air cells.
Curetting the aditus to enlarge it.
Further exposure.
Healed postaural scar.
Extent of cortical mastoidectomy in a well-pneumatized mastoid.

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Author

PP Devan, MBBS, MS Professor and Head, Dept of ENT, A J Institute of Medical Sciences, Mangalore, India

Disclosure: Nothing to disclose.

Coauthor(s)

John D Donaldson, MD, FRCSC, FACS Pediatric Otolaryngologist, Chief of Surgery, Galisano Children's Hospital, Lee Memorial Health System

John D Donaldson, MD, FRCSC, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Society of Pediatric Otolaryngology, American Academy of Pediatrics, American College of Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Acknowledgements

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