Acute mastodititis

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Overview

Acute mastoiditis is the most common complication of acute otitis media. Although rare, the disease is carefully studied by otolaryngologists because it usually affects very young children with severe clinical course and sometimes causes serious complications. Most important risk factors are the young age (often>2 years), high fever, alteration of the laboratory findings (very high values of WBC count, absolute neutrophil count and C-reactive protein), while less important are previous antibiotic therapy or previous middle ear infections. The main pathogen of the acute mastoiditis is Streptococcus pneumoniae, followed by Streptococcus piogenes, Haemophilus influentiae, and Staphylococcus aureus. The finding of Pseudomonas aeruginosa is not uncommon, but often its presence is often considered a contamination or simultaneous infection. The complications can be extracranial (subperiosteal abscess, Bezold’s abscess); intratemporal (facial nerve palsy, labyrinthitis) and intracranial (subdural abscess). The complications have often a very serious clinical course and potentially life-threatening. Antibiotic therapy is the main treatment in not complicated forms. Considering the prevalence of Streptococcus pneumoniae, cephalosporins are the antibiotic of choice, but they have to be administrated intravenously in hospitalized patients. Combinations with other antibiotic are suggested when multibacterial flora is present. In complicated forms of acute mastoiditis, the antibiotic treatment can be particularly important, in combination with other specific drugs (i.e. anticoagulants and/or corticosteroids). Surgical treatments, such as incision of abscesses, mastoidectomy, and neurosurgical procedures, are sometimes performed in combination with medical therapy in very severe complications.

Symptoms

redness, tenderness and pain behind the ear.

swelling behind the ear that can cause it to stick out.

discharge from the ear.

a high temperature, irritability and tiredness.

headache.

hearing loss in the affected ear.

Causes

Ear infections, and particularly middle ear infections, are the most commonTrusted Source cause of mastoiditis.

The bacteria responsible can spread without effective treatment. This may happen, for example, if a person stops the course of treatment before it is complete. It may also happen if the bacteria are resistant to the prescribed antibiotics.

Less often, an abnormal growth of skin cells in the middle ear, called a cholesteatoma, can cause a blockage that allows bacteria to multiply and leads to mastoiditis.

Cholesteatomas can also cause ear polyps that may result in further obstruction.

Risk factors

Risk factors for mastoiditis are related to acute otitis media risk factors. These include: allergy, upper respiratory tract infection, snoring, previous history of acute otitis media, passive smoker, smoking during pregnancy, and low social status. Exposure of infants to day-care centers is a controversial risk factor. [1]


Common Risk Factors

Risk factors for mastoiditis are related to acute otitis media risk factors.


Risk factors for acute mastoiditis

Allergy

Upper respiratory tract infection

Snoring

Previous history of acute otitis media

Passive smoker

Smoking during pregnancy

Low social status

Risk factors for subacute mastoiditis

Infancy

Elderly

Diabetic

Immunosuppressed and debilitated patients

Less Common Risk Factors

A controversial risk factor is the exposure of infants to day-care centers. Day care attendance may cause an increased incidence of upper respiratory infections and acute otitis media and therefore, mastoiditis. Countries with variations in the age of starting a day-care have shown differences in incidence peaks of acute otitis media.


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Complications

Hearing loss.

Facial nerve palsy.

Cranial nerve involvement.

Osteomyelitis.

Petrositis.

Labyrinthitis.

Gradenigo syndrome - Otitis media, retro-orbital pain, and abducens palsy.

Intracranial extension - Meningitis, cerebral abscess, epidural abscess, subdural empyema.

Prevention

The best way to prevent mastoiditis is to prevent ear infections (otitis media) and treat any ear infection you have with antibiotic therapy. Ways to prevent acute middle ear infections include: Wash hands frequently to prevent the spread of cold and flu viruses. Keep children away from secondhand smoke.

You can prevent mastoiditis by effectively treating all ear infections. Seek prompt medical attention and follow your doctor's advice if you develop an ear infection. This may include taking oral antibiotics for 7 to 10 days.