Mastoiditis pathophysiology: Difference between revisions

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==Overview==
==Overview==
Acute mastoiditis infection of the temporal bone mostly after otitis media of less than one month. In a setting of [[acute otitis media]] The mechanism of spread to mastoid air cells is by direct erosion of bone or through the mastoid emissary veins. Impaired air cell drainage in this context causes mastoiditis.<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>
Acute mastoiditis infection of the temporal bone mostly after otitis media of less than one month. Mucosa lining the middle ear and also mastoid air cell becomes inflamed in the setting of [[acute otitis media]]. Most of cases the infection will resolve, but some times it will persist, and bacteria and fluid can accumulate within the mastoid air cells. With increasing pressure mastoid air cells may be damaged.<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>
 
During an episode of AOM, the mucosa lining the middle ear, and often that lining the mastoid, becomes inflamed [1]. In almost all cases, the inflammation resolves as the AOM improves. When inflammation persists, purulent material accumulates within the mastoid cavities (acute mastoiditis with periosteitis) [1,5,6]. As the pressure increases, the thin bony septae between air cells may be destroyed (coalescent mastoiditis)
 
 
== Pathogenesis ==
== Pathogenesis ==
* Most common bacteria causing acute Mastoiditis Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus  
* Most common bacteria causing acute Mastoiditis Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus  
* The number of pneumococcal isolates and the percentage of isolates with high-level penicillin resistance from cultures taken from children with OM or mastoiditis for clinical indications have decreased following PCV13 use, largely due to decreases in serotype 19A isolates. <ref name="pmid25648240">{{cite journal |vauthors=Kaplan SL, Center KJ, Barson WJ, Ling-Lin P, Romero JR, Bradley JS, Tan TQ, Hoffman JA, Peters TR, Gurtman A, Scott DA, Trammel J, Gruber WC, Hulten KG, Mason EO |title=Multicenter surveillance of Streptococcus pneumoniae isolates from middle ear and mastoid cultures in the 13-valent pneumococcal conjugate vaccine era |journal=Clin. Infect. Dis. |volume=60 |issue=9 |pages=1339–45 |year=2015 |pmid=25648240 |doi=10.1093/cid/civ067 |url=}}</ref>
* Staphylococci, Pseudomonas spp. and polymicrobials present predominantly seen in non-acute Mastoiditis.<ref name="pmid22578647">{{cite journal |vauthors=Chien JH, Chen YS, Hung IF, Hsieh KS, Wu KS, Cheng MF |title=Mastoiditis diagnosed by clinical symptoms and imaging studies in children: disease spectrum and evolving diagnostic challenges |journal=J Microbiol Immunol Infect |volume=45 |issue=5 |pages=377–81 |year=2012 |pmid=22578647 |doi=10.1016/j.jmii.2011.12.008 |url=}}</ref>
* Staphylococci, Pseudomonas spp. and polymicrobials present predominantly seen in non-acute Mastoiditis.<ref name="pmid22578647">{{cite journal |vauthors=Chien JH, Chen YS, Hung IF, Hsieh KS, Wu KS, Cheng MF |title=Mastoiditis diagnosed by clinical symptoms and imaging studies in children: disease spectrum and evolving diagnostic challenges |journal=J Microbiol Immunol Infect |volume=45 |issue=5 |pages=377–81 |year=2012 |pmid=22578647 |doi=10.1016/j.jmii.2011.12.008 |url=}}</ref>
* Pseudomonas aeruginosa may be find in children with acute mastoiditis as a consequence of recurrent acute otitis media and  antibiotic use<ref name="pmid22578647">{{cite journal |vauthors=Chien JH, Chen YS, Hung IF, Hsieh KS, Wu KS, Cheng MF |title=Mastoiditis diagnosed by clinical symptoms and imaging studies in children: disease spectrum and evolving diagnostic challenges |journal=J Microbiol Immunol Infect |volume=45 |issue=5 |pages=377–81 |year=2012 |pmid=22578647 |doi=10.1016/j.jmii.2011.12.008 |url=}}</ref>
* Pseudomonas aeruginosa may be find in children with acute mastoiditis as a consequence of recurrent acute otitis media and  antibiotic use<ref name="pmid22578647">{{cite journal |vauthors=Chien JH, Chen YS, Hung IF, Hsieh KS, Wu KS, Cheng MF |title=Mastoiditis diagnosed by clinical symptoms and imaging studies in children: disease spectrum and evolving diagnostic challenges |journal=J Microbiol Immunol Infect |volume=45 |issue=5 |pages=377–81 |year=2012 |pmid=22578647 |doi=10.1016/j.jmii.2011.12.008 |url=}}</ref>

Revision as of 16:26, 22 June 2017

Mastoiditis Microchapters

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

Overview

Acute mastoiditis infection of the temporal bone mostly after otitis media of less than one month. Mucosa lining the middle ear and also mastoid air cell becomes inflamed in the setting of acute otitis media. Most of cases the infection will resolve, but some times it will persist, and bacteria and fluid can accumulate within the mastoid air cells. With increasing pressure mastoid air cells may be damaged.[1][2]

Pathogenesis

  • Most common bacteria causing acute Mastoiditis Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus
  • Staphylococci, Pseudomonas spp. and polymicrobials present predominantly seen in non-acute Mastoiditis.[3]
  • Pseudomonas aeruginosa may be find in children with acute mastoiditis as a consequence of recurrent acute otitis media and antibiotic use[3]

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 3.0 3.1 Chien JH, Chen YS, Hung IF, Hsieh KS, Wu KS, Cheng MF (2012). "Mastoiditis diagnosed by clinical symptoms and imaging studies in children: disease spectrum and evolving diagnostic challenges". J Microbiol Immunol Infect. 45 (5): 377–81. doi:10.1016/j.jmii.2011.12.008. PMID 22578647.

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