10 y/o with ear pain worsening over the last 5 days (View on ReelDx)
Patient will present as → a 10-year-old boy with otalgia, worsening over the last 5-days and associated with nasal congestion. The patient is afebrile with a temperature of 98 ° F. 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 and 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
IV antibiotic treatment is initiated immediately with a drug that provides central nervous system penetration, such as ceftriaxone 1 to 2 g once a day continued for ≥ 2 weeks
- Vancomycin or linezolid are alternatives
- Oral treatment with a quinolone may be acceptable in certain cases
- A subperiosteal abscess usually requires a simple mastoidectomy, in which the abscess is drained, the infected mastoid cells are removed
Question 1 |
IV antibiotics | |
Mastoidectomy Hint: Mastoidectomy is reserved for patients with mastoiditis who fail medical therapy. | |
IM steroids Hint: IM steroids are not indicated in the treatment of mastoiditis. | |
Ventilating tube placement Hint: Ventilating tube placement is indicated in patients with auditory tube dysfunction and chronic serous otitis media. |
