Mastoiditis
Mastoiditis is an acute infection and inflammation of the mastoid air cells (part of the temporal bone), usually developing as a complication of acute otitis media.
This updated UKMLA guide to mastoiditis is based on the BSO guideline, which covers causes, symptoms, diagnosis and management.
Cause
Most cases of mastoiditis result from the progression of acute otitis media [Ref]
Most common caused by the spread of bacterial pathogens
- Streptococcus pneumoniae
- Streptococcus pyogenes
- Staphylococcus aureus
- Pseudomonas aeruginosa
Clinical Features
Mastoiditis usually develops as a complication of acute otitis media, patients typically present with both:
- Features of acute otitis media, and
- Mastoid inflammatory signs
Features suggestive of mastoiditis (mastoid inflammatory signs):
- Pinna protrusion (displaced anteriorly)
- Loss of post-auricular sulcus
- Post-auricular swelling / fluctuant mass / erythema
- Fever
Typical features of acute otitis media:
- Acute onset of otalgia (ear pain)
- Fever
- Ear tugging / rubbing / holding (more common in children)
- Otoscopic findings
- Red / yellow / cloudy tympanic membrane
- Bulging tympanic membrane
- Air-fluid level behind the tympanic membrane
Investigation and Diagnosis
Suspected mastoiditis requires hospital admission for investigations and management.
Mastoiditis is primarily a clinical diagnosis
Imaging (CT petrous bones and brain with contrast) is NOT routinely needed, indicated in:
- Clinical findings suggesting extracranial complications
- Clinical findings suggesting intracranial complications
- Failure to improve after 24 hours of IV antibiotics
- Severe illness or toxic appearance
Management
Suspected mastoiditis requires hospital admission for investigations and management.
1st line: medical management
- IV ceftriaxone + IV metronidazole
- Consider topical antibiotics (e.g. ciprofloxacin)
Consider surgical management (myringotomy + mastoidectomy) if:
- Presence of subperiosteal abscess
- Failed to improve after 24 hours of antibiotics