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==Physical Examination==
==Physical Examination==
Recent episode of (sub)acute otitis media


otalgia
=== Appearance of the Patient ===
Patients with mastoiditis usually appear ill and have marked [[inflammation]] and [[edema]] of the periuricular 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 orbital cellulitis may present with the following skin findings:
* [[Erythema]] of the periuricular skin
* [[Edema]] of the periuricular skin


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 orbital or head [[trauma]], or surgery (e.g., scars, injuries, etc.)
* Evidence of recent [[insect bites]]


Protrusion of pinna
==== Ear ====
Patients with mastoiditis may present with below signs:
* otorrhea
* Postauricular swelling
* Postauricular erythema
* Postauricular tenderness
* Protrusion of pinna
* Sagging external ear canal
* Blurred tympanic membrane


Fever
Also mastoiditis patients may present with signs which are suggestive of [[Otitis interna|inner]] or [[Otitis media|middle ear infection]]:
* [[Erythema]], [[edema]] and [[discharge]] present on [[otoscopy]]
* Reduced hearing
* 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—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==
<gallery heights="125" widths="200">
<gallery heights="125" widths="200">

Revision as of 17:32, 27 June 2017

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:

Overview

Physical Examination

Appearance of the Patient

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

Vital Signs

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

Skin

Patients with orbital cellulitis may present with the following skin findings:

HEENT

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

Head

Patients with mastoiditis may present with the following signs:

  • Evidence of recent orbital or head trauma, or surgery (e.g., scars, injuries, etc.)
  • Evidence of recent insect bites

Ear

Patients with mastoiditis may present with below signs:

  • otorrhea
  • Postauricular swelling
  • Postauricular erythema
  • Postauricular tenderness
  • Protrusion of pinna
  • Sagging external ear canal
  • Blurred tympanic membrane

Also mastoiditis patients may present with signs which 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.

Gallery

  • Picture of a right mastoidectomy, surgeon's view. Note the blue color of the skeletonized sigmoid sinus.[1]
    Picture of a right mastoidectomy, surgeon's view. Note the blue color of the skeletonized sigmoid sinus.[1]
  • Picture of a left mastoidectomy, surgeon's view.[2]
    Picture of a left mastoidectomy, surgeon's view.[2]
  • In this left canal wall up mastoidectomy, the tympanic membrane has been elevated forward and a cholesteatoma sac is visible in the attic.[3]
    In this left canal wall up mastoidectomy, the tympanic membrane has been elevated forward and a cholesteatoma sac is visible in the attic.[3]
  • This patient has a recurrent cholesteatoma which has found its way to the surface of the post-auricular skin, forming a mastoid cutaneous fistula.[4]
    This patient has a recurrent cholesteatoma which has found its way to the surface of the post-auricular skin, forming a mastoid cutaneous fistula.[4]
  • This cholesteatoma sac has eroded the lateral surface of the mastoid bone and was found immediately under the post-auricular skin.[5]
    This cholesteatoma sac has eroded the lateral surface of the mastoid bone and was found immediately under the post-auricular skin.[5]
  • 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 [6].
    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 [6].
  • Magnification of the previous picture [7].
    Magnification of the previous picture [7].

References

  1. ↑ http://www.ghorayeb.com
  2. ↑ http://www.ghorayeb.com
  3. ↑ http://www.ghorayeb.com
  4. ↑ http://www.ghorayeb.com
  5. ↑ http://www.ghorayeb.com
  6. ↑ http://www.ghorayeb.com
  7. ↑ http://www.ghorayeb.com

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