Mastoiditis: The Daily PANCE Blueprint
A 32-year-old female presents complaining of spiking fevers. She was seen four weeks ago with a complaint of left ear pain and was treated for otitis media. She continues to have symptoms but now has pain behind the ear. On examination, you note left postauricular tenderness and erythema. Which of the following is the treatment of choice in this patient?
A. IV antibiotics
B. Mastoidectomy
C. IM steroids
D. Ventilating tube placement
Answer and topic summary
The answer is A. IV antibiotics are the treatment of choice in a patient with mastoiditis.
Acute mastoiditis is the most common suppurative complication of acute otitis media. It is defined as a suppurative infection of the mastoid air cells with symptoms < 1 month. The MCCs are Streptococcus pneumoniae and Streptococcus pyogenes. Symptoms include post-articular tenderness and erythema/swelling, otalgia, lethargy, abnormal TM, fever, and otorrhea. Diagnosis is usually made with contrast-enhanced computed tomography. Empiric parental antibiotic regimens include vancomycin (for those without recent antibiotic use and without a history of recurrent OAM) or vancomycin plus cefepime (for those with recent antibiotics use and history of recurrent AOM). Complications include facial nerve palsy, hearing loss, and a subperiosteal abscess.
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Covered under ⇒ PANCE Blueprint EENT ⇒ ⇒
Also covered under PAEA Emergency Medicine and Pediatric Rotation EOR topic list
