PANCE Blueprint EENT (7%)

Mastoiditis (ReelDx)


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. 

Mastoiditis is often a complication of what?
Mastoiditis is often a complication of a preceding otitis media
What is the diagnostic test of choice when evaluating a suspected case of mastoiditis? What findings would you expect?
Computerized Tomography (CT scan). Radiographic findings would be the destruction of the mastoid air cell septa with an accumulation of pus.

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
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?
IV antibiotics
Mastoidectomy is reserved for patients with mastoiditis who fail medical therapy.
IM steroids
IM steroids are not indicated in the treatment of mastoiditis.
Ventilating tube placement
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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References: Merck Manual · UpToDate

Other abnormalities of the ear (PEARLS) (Prev Lesson)
(Next Lesson) Meniere disease (Lecture)
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