PANCE Blueprint EENT (9%)

Mastoiditis (ReelDx)

VIDEO-CASE-PRESENTATION-REEL-DX

Patient will present as → a 10-year-old presents with ear pain. Examination reveals edema of the external auditory canal producing an anterior and inferior displacement of the auricle with percussion tenderness posteriorly

Acute mastoiditis is a suppurative infection of the mastoid air cells, usually a complication from preceding acute otitis media

  • Clinical features include fever, otalgia, pain & erythema posterior to the ear, and forward displacement of the external ear
  • Organisms: S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes

History and physical exam. Most cases of mastoiditis can be clinically diagnosed

  • CT scan of the temporal bone with contrast is the imaging of choice for complicated mastoiditis or toxic-appearing patients

For simple mastoiditis, oral antibiotic treatment should cover the most common pathogens (strep pneumo, strep pyogenes, and staph aureus)

  • Consider IV antibiotics and ENT referral in more serious cases or with patients with unreliable follow-up
  • Drainage by procedures such as tympanocentesis or myringotomy may also be considered
Question 1
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 post auricular tenderness and erythema. Which of the following is the treatment of choice in this patient?
A
IV antibiotics
B
Mastoidectomy
Hint:
Mastoidectomy is reserved for patients with mastoiditis who fail medical therapy.
C
IM steroids
Hint:
IM steroids are not indicated in the treatment of mastoiditis.
D
Ventilating tube placement
Hint:
Ventilating tube placement is indicated in patients with auditory tube dysfunction and chronic serous otitis media.
Question 1 Explanation: 
IV antibiotics are the treatment of choice in a patient with mastoiditis.
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