Mastoiditis - Definition, Causes, Symptoms and Treatment
Mastoiditis is an infection of the spaces within the mastoid bone. It is almost always associated with otitis media, an infection of the middle ear. In the most serious cases, the bone itself becomes infected. It may spread into small cavities in the bone, blocking their drainage. Very severe cases infect the whole middle ear cleft.
Although the prognosis is good with early treatment, possible complications include meningitis, facial paralysis, brain abscess, and suppurative labyrinthitis. An acute infection of the mastoid bone is considered an urgent situation as life-threatening complications can develop.
Mastoiditis is usually a consequence of a middle ear infection. Although there is always a degree of inflammation within the mastoid when an ear infection occurs, in patients with acute mastoiditis. The infection may spread from the ear to the mastoid bone of the skull. The mastoid bone fills with infected materials and its honeycomb-like structure may deteriorate. Mastoiditis can range from a simple case of some fluid escaping into the mastoid air cells during a middle ear infection, to a more complex infection which penetrates through to the lining of the mastoid bone.
Mastoiditis most commonly affects children. Before antibiotics, mastoiditis was one of the leading causes of death in children. Now it is a relatively uncommon and much less dangerous disorder. Coalescence of the mastoid air cells may precede rupture of the tympanic membrane. Streptococcal mastoiditis is generally preceded by early rupture of the tympanic membrane and copious otorrhea.
Symptoms of mastoiditis may at first be the same as symptoms of an early middle ear infection. Symptoms of mastoiditis are usually noticed 2 weeks or more after untreated acute otitis media, due to destruction of one of the mastoid processes
Other symptoms of the mastoiditis may be included:
The first line of treatment is frequent cleanings of the ear in the office by an ear specialist combined with use of topical therapy (ear drops or irrigations) at home.
The primary treatment for mastoiditis is administration of intravenous antibiotics. Initially, broad-spectrum antibiotics are given, such as ticarcillin, clavulanate plus gentamicin, or ciprofloxacin (Cipro).
I.V. penicillin is the initial drug of choice for at least a 2-week duration.
Surgery to remove part of the bone and drain the mastoid may be needed if antibiotic therapy is not successful. Surgical drainage of the middle ear through the eardrum may be needed to treat the underlying middle ear infection.
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