COMPLICATIONS OF

SUPPURATIVE OTITIS MEDIA

PART 2: MASTOIDITIS

SITI NUR BAITI BINTI SHAIK

KHAMARUDIN
012013100196
 OUTLINE
INTRATEMPORAL

Mastoiditis

i. Acute mastoiditis

ii. Masked (latent) mastoiditis

ACUTE MASTOIDITIS
 The term mastoiditis is
used when the infection
spreads from the mucosa,
lining the mastoid air cells,
to involve bony walls of
mastoid air cell system.
It follows acute
suppurative otitis
media
Virulence of organisms
Lowered resistance of
patient (measles, poor
nutrition, systemic disease
like diabetes).
Beta-haemolytic
streptococcus most
common causative
organisms.
Very often, anaerobic THE MIDDLE EAR
organisms also
 PATHOLOGY
2 main pathological processes:

Production of pus under tension

Extension of inflammation increases amount of
pus due to large surface area involved.
Swollen mucosa of the antrum and attic also
impede drainage system resulting in accumulation
of pus under tension.
Hyperaemic decalcification and
osteoclastic resorption of bony wall
Hyperaemia and engorgement of mucosa causes
dissolution calcium from the wall of mastoid air
cells.
 Both the processes
cause destruction and
coalescence of
mastoid air cells
convert into a
single irregular
cavity filled with
pus (empyema of
mastoid).
Pus may break through
the mastoid cortex =
subperiosteal
abscess, may burst on
surface leading to
discharging fistula.
Mastoiditis with fistula
 CLINICAL
SYMPTOM
FEATURES
S
1) Pain behind the ear
Subsides with establishment of perforation and
antibiotic treatment.
Persistence of pain
Increase intensity
Recurrence if once resolved
2) Fever
Persistence
Recurrence
3) Ear discharge
Profuse
Increase in purulence
In some cases, may cease due to obstruction
Persistence beyond 3 weeks - mastoiditis
SIGNS

Mastoid tenderness Sagging of

Swelling over posterosuperior meatal
mastoid wall

Ear discharge Perforation of

mucopurulent or tympanic
 INVESTIGATIONS
Blood counts
Polymorphonuclear leucocytosis
Erythrocyte sedimentation rate (ESR)
Raised
X-ray mastoid
Clouding of air cells = exudates
Bony partitions between air cells become
indistinct
Ear swab for C&S.
 Schller view: Well-developed normally
pneumatized mastoidal air cells can be
observed in the picture on the left side (double
arrow). In the picture on the right side, the mastoid
cells (arrow) are obscured, and not air-
containing, due to chronic otitis media.
 DIFFERENTIAL DIAGNOSIS
1) Suppuration of mastoid lymph nodes
Scalp infection
However no preceding otitis media, ear
discharge or deafness.
Only superficial abscess.

2) Infected sebaceous cyst

3) Furunculosis of meatus
Absence of preceding acute otitis media.
Painful movement of pinna pressure over tragus
or below cartilaginous part of meatus causes
excruciating pain.
Swelling of meatus confined to cartilaginous part
only.
Discharge is never mucoid or mucopurulent only
from middle ear, absence of mucus secreting
gland
Enlargement of pre or post-auricular lymph nodes.
Mild conducting hearing loss.
Normal tympanic membrane excludes acute
mastoiditis.
X-ray clear air system
 COMPLICATIONS OF ACUTE
MASTOIDITIS
1. Subperiosteal abscess
2. Labyrinthitis
3. Facial paralysis
4. Petrositis
5. Extradural abscess
6. Subdural abscess
7. Meningitis
8. Brain abscess
9. Lateral sinus thrombophlebitis
10.Otitic hydrocephalus
MANAGEMENT
1. Hospitilization
2. Antibiotics
- Start with broad spectrum like
amoxicillin or ampicillin
- Once result is out, add specific
antibiotics
3. Myringotomy
- To relieve the pus under tension
4. Cortical mastoidectomy
- Aim is to exenterate all the mastoid air
cells and remove any pockets of pus
- Indications:
Subperiosteal abscess
Sagging of posterosuperior meatal wall
Mastoiditis leading to complications
No change in condition of patient
MASKED (LATENT)
MASTOIDITIS
 A condition of slow destruction of
mastoid air cell without any signs
and symptoms seen in acute
mastoiditis.
No pain, no discharge, no fever, no
mastoid swelling.
Mastoidectomy may show destruction
of air cells with granulation tissue and
gelatinous material filling the mastoid.
 ETIOLOGY
Inadequate antibiotic therapy:
Dose
Frequency
Duration of administration
Most often in oral penicillin given
cases
Acute symptoms subside but
smouldering infection continues in
mastoid.
 CLINICAL FEATURES
Common in children
Not entirely feeling well
Mild pain behind ear
Persistent hearing loss
Tympanic membrane appears thick with loss
of translucency.
Slight tenderness over mastoid.
Audiometry conductive hearing loss of
variable degree.
X-ray clouding of air cells, loss of cell
outline.
REFERENCE

PL Dhingra.
Diseases of Ear,
Nose and Throat,
6th Edition. 75-81.
http://healthfixit.
com/mastoid-process
/
https://radiology-i
nformation.blogspot
.my/2011/05/benefit