Mastoiditis physical examination: Difference between revisions

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{{Mastoiditis}}
{{Mastoiditis}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}}{{MJ}}


==Overview==
==Overview==
Acute mastoiditis patients are usually ill-appearing and usually present with low-grade [[fever]]. Patients with complicated mastoiditis may appear severly ill. Mastoiditis physical examination findings include posterior auricular signs such as postauricular [[swelling]], [[erythema]], [[tenderness]], protrusion of [[pinna]], and sagging [[external ear]] canal. [[Otoscopy|Otoscopic]] examination findings include [[erythema]], bulging, cloudy appearance, and immobility of the [[tympanic membrane]].


==Physical Examination==
==Physical Examination==
Recent episode of (sub)acute otitis media
Patients with mastoiditis may present with some or all of the following signs:<ref name="pmid24466073">{{cite journal |vauthors=Zhang Y, Xu M, Zhang J, Zeng L, Wang Y, Zheng QY |title=Risk factors for chronic and recurrent otitis media-a meta-analysis |journal=PLoS ONE |volume=9 |issue=1 |pages=e86397 |year=2014 |pmid=24466073 |pmc=3900534 |doi=10.1371/journal.pone.0086397 |url=}}</ref><ref name="pmid6877011">{{cite journal |vauthors=Holt GR, Gates GA |title=Masked mastoiditis |journal=Laryngoscope |volume=93 |issue=8 |pages=1034–7 |year=1983 |pmid=6877011 |doi= |url=}}</ref><ref name="pmid18617870">{{cite journal |vauthors=van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG |title=A systematic review of diagnostic criteria for acute mastoiditis in children |journal=Otol. Neurotol. |volume=29 |issue=6 |pages=751–7 |year=2008 |pmid=18617870 |doi=10.1097/MAO.0b013e31817f736b |url=}}</ref><ref name="pmid19734439">{{cite journal |vauthors=Lin HW, Shargorodsky J, Gopen Q |title=Clinical strategies for the management of acute mastoiditis in the pediatric population |journal=Clin Pediatr (Phila) |volume=49 |issue=2 |pages=110–5 |year=2010 |pmid=19734439 |doi=10.1177/0009922809344349 |url=}}</ref><ref name="pmid19758711">{{cite journal |vauthors=Pang LH, Barakate MS, Havas TE |title=Mastoiditis in a paediatric population: a review of 11 years experience in management |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=73 |issue=11 |pages=1520–4 |year=2009 |pmid=19758711 |doi=10.1016/j.ijporl.2009.07.003 |url=}}</ref>


otalgia
=== Appearance of the Patient ===
Patients with mastoiditis usually appear ill and have marked [[inflammation]] and [[edema]] of the periauricular area.


otorrhea
=== Vital Signs ===
Patients with mastoiditis may have the following [[vital signs]], which are suggestive of [[infection]]:
* [[Fever]]
* [[Hypotension]]
* [[Tachycardia]]
* [[Tachypnea]]


Postauricular swelling
=== Skin ===
Patients with mastoiditis may present with the following skin findings:
* [[Erythema]] of the periauricular skin
* [[Edema]] of the periauricular skin
[[image:Mastoiditisphe.jpg|200px]]


Postauricular erythema
=== HEENT ===
Patients with mastoiditis may have the following HEENT findings on physical examination:


Postauricular tenderness
==== Head ====
Patients with mastoiditis may present with the following signs:
* Evidence of recent [[Orbit (anatomy)|eye]] [[trauma]]
* Evidence of recent [[insect bites]]


Protrusion of pinna
==== Ear ====
Patients with mastoiditis may present with the following signs:
* [[Otorrhea]]
* Postauricular [[swelling]]
* Postauricular [[erythema]]
* Postauricular [[tenderness]]
* Protrusion of [[pinna]]
* Sagging [[external ear]] canal
* Blurred [[tympanic membrane]]


Fever
Mastoiditis patients may present with signs that are suggestive of [[Otitis interna|inner]] or [[Otitis media|middle ear infection]]:
* [[Erythema]], [[edema]], and [[discharge]] present on [[otoscopy]]
* [[Hearing loss]]
* Children may show signs of "tugging" on the affected ear


Sagging external ear canal
==== Throat/Oral ====
Patients with mastoiditis may present with signs which are suggestive of [[oral]], [[pharyngeal]], or [[Upper respiratory tract infection|upper respiratory tract]] infections:
* [[Erythematous]] [[oropharynx]]
* [[Exudative]] [[Tonsil|tonsils]]
* [[Dental caries]]
* [[Tooth abscess]]


Blurred tympanic membrane
=== Neck ===
 
Patients with mastoiditis may present with tender [[cervical lymph nodes]], which are suggestive of regional [[infection]].
Systemic signs of infection
 
Fever
 
Postauricular swelling or fluctuation, erythema, tenderness, and abnormal tympanic membrane were the most frequently reported symptoms
 
Systemic signs and symptoms were reported in 54 studies (Fig. 2). Fever was the most frequent sign, present on average in 76% of the patients in 46 of 65 studies
 
(96 percent)
 
Abnormal tympanic membrane (82 percent)
 
Postauricular erythema, postauricular tenderness, and/or protrusion of the pinna (80 percent)
 
Fever (76 percent)
 
Narrowing of the external auditory canal (71 percent)
 
Ear pain (67 percent)
 
Otorrhea (50 percent)
 
The diagnosis of mastoiditis is clinical&mdash;based on the [[medical history]] and [[physical examination]]. Imaging studies may provide additional information; the study of choice is the [[CT scan]], which may show focal destruction of the bone or signs of an [[abscess]] (a pocket of infection). [[X-rays]] are not as useful. If there is drainage, it is often sent for [[microbiological culture|culture]], although this will often be negative if the patient has begun taking antibiotics.
==Gallery==
<gallery heights="125" widths="200">
Image:Mastoidectomy Arrowheads LABELED.jpg|Picture of a right mastoidectomy, surgeon's view.  Note the blue color of the skeletonized sigmoid sinus.<ref>http://www.ghorayeb.com</ref>
Image:Mastoidectomy labeled1.jpg|Picture of a left mastoidectomy, surgeon's view.<ref>http://www.ghorayeb.com</ref>
Image:Mastoidectomy labeled.jpg|In this left canal wall up mastoidectomy, the tympanic membrane has been elevated forward and a cholesteatoma sac is visible in the attic.<ref>http://www.ghorayeb.com</ref>
Image:Mastoid cutaneous fistula trim.jpg|This patient has a recurrent cholesteatoma which has found its way to the surface of the post-auricular skin, forming a mastoid cutaneous fistula.<ref>http://www.ghorayeb.com</ref>
Image:Cholesteatoma sac eroding mastoid.jpg|This cholesteatoma sac has eroded the lateral surface of the mastoid bone and was found immediately under the post-auricular skin.<ref>http://www.ghorayeb.com</ref>
Image:Mastoidectomy Bowl.jpg|Left canal wall down mastoidectomy.This patient had a modified radical mastoidectomy with tympanoplasty.  The posterior bony canal has been removed and part of the dry "mastoid bowl" is visible posterior and superior to the reconstructed tympanic membrane <ref>http://www.ghorayeb.com</ref>.
Image:Mastoidectomy Bowl 008.jpg|Magnification of the previous picture <ref>http://www.ghorayeb.com</ref>.
</gallery>


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Otolaryngology]]
[[Category:Surgery]]

Latest revision as of 22:39, 29 July 2020

Mastoiditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Mastoiditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]

Overview

Acute mastoiditis patients are usually ill-appearing and usually present with low-grade fever. Patients with complicated mastoiditis may appear severly ill. Mastoiditis physical examination findings include posterior auricular signs such as postauricular swelling, erythema, tenderness, protrusion of pinna, and sagging external ear canal. Otoscopic examination findings include erythema, bulging, cloudy appearance, and immobility of the tympanic membrane.

Physical Examination

Patients with mastoiditis may present with some or all of the following signs:[1][2][3][4][5]

Appearance of the Patient

Patients with mastoiditis usually appear ill and have marked inflammation and edema of the periauricular area.

Vital Signs

Patients with mastoiditis may have the following vital signs, which are suggestive of infection:

Skin

Patients with mastoiditis may present with the following skin findings:

  • Erythema of the periauricular skin
  • Edema of the periauricular skin

HEENT

Patients with mastoiditis may have the following HEENT findings on physical examination:

Head

Patients with mastoiditis may present with the following signs:

Ear

Patients with mastoiditis may present with the following signs:

Mastoiditis patients may present with signs that are suggestive of inner or middle ear infection:

Throat/Oral

Patients with mastoiditis may present with signs which are suggestive of oral, pharyngeal, or upper respiratory tract infections:

Neck

Patients with mastoiditis may present with tender cervical lymph nodes, which are suggestive of regional infection.

References

  1. ↑ Zhang Y, Xu M, Zhang J, Zeng L, Wang Y, Zheng QY (2014). "Risk factors for chronic and recurrent otitis media-a meta-analysis". PLoS ONE. 9 (1): e86397. doi:10.1371/journal.pone.0086397. PMC 3900534. PMID 24466073.
  2. ↑ Holt GR, Gates GA (1983). "Masked mastoiditis". Laryngoscope. 93 (8): 1034–7. PMID 6877011.
  3. ↑ van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG (2008). "A systematic review of diagnostic criteria for acute mastoiditis in children". Otol. Neurotol. 29 (6): 751–7. doi:10.1097/MAO.0b013e31817f736b. PMID 18617870.
  4. ↑ Lin HW, Shargorodsky J, Gopen Q (2010). "Clinical strategies for the management of acute mastoiditis in the pediatric population". Clin Pediatr (Phila). 49 (2): 110–5. doi:10.1177/0009922809344349. PMID 19734439.
  5. ↑ Pang LH, Barakate MS, Havas TE (2009). "Mastoiditis in a paediatric population: a review of 11 years experience in management". Int. J. Pediatr. Otorhinolaryngol. 73 (11): 1520–4. doi:10.1016/j.ijporl.2009.07.003. PMID 19758711.

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