Mastoiditis natural history, complications and prognosis
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Mastoiditis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Natural History, Complications and Prognosis
The consequences of mastoiditis have been reduced after introduction of antimicrobial agents and adequate therapy of acute otitis media. However mastoiditis has not been omitted completely and may give rise to sever complications. The incidence of mastoiditis complications are differs from 4% to 16.6% in the multiple studies.[1],[2],[3], [4]
mastoiditis complication may be classified to extracranial and intracranial as in below table:
Labyrinthitis
Labyrinthitis is a rare complication of AM [54]. Sensorineural hearing loss, vertigo, and spontaneous nystagmus are pathbreaking for its diagnosis. Nevertheless, the diagnosis could be very challenging in childhood. Therapy depends on removing the inflammatory focus by mastoidectomy and PC.
Petrositis
Today, this complication is rare but could be part of Gradenigo’s syndrome (retrobulbar pain, abducens nerve palsy, and ipsilateral acute or chronic otitis media) [54], [63]. A combined therapy of mastoidectomy (including the opening of mastoid cells in the petrous apex) with high-dose intravenous (i.v.) antibiotics is sufficient [54].
Facial palsy
Facial palsy is also a rare complication of AM. In addition to antibiotics, a prompt surgical management consisting of mastoidectomy and PC is indicated. Further, decompression of the mastoid portion of the nerve and steroids are recommended [38]. In cases of facial palsy as a complication of AOM without secure signs of AM, a PC and ventilation tubes (VT) are advisable. If there is no improvement within 3 days, a mastoidectomy is indicated [64].
Sinu sigmoideus thrombosis
This complication could be asymptomatic or become clinical if a thrombotic obstruction of the internal jugular vein leads to an increased intracranial pressure. The diagnostic tool of choice is a MRI-angiography [62]. Therapeutically, the sinus is exposed from the sinus-dura angle to the mastoid tip during the mastoidectomy. In cases of sepsis or suspicion of thrombosis, the sinus is punctured. If there is sign of thrombosis, the sinus is opened and the thrombosis evacuated. Further, the sinus should be obliterated with muscle or Surgicel [2]. Surgical removal of the thrombus is nowadays controversial. Some authors recommend in these cases heparin [54], [65]. In cases of sepsis, a transcervical ligation of the internal jugular vein is recommended [54].
Intracranial complications
The following intracranial complications are described: epidural and subdural abscess, meningitis, and brain abscess. The diagnosis of an intracranial complication could be very challenging. The most common symptoms are fever, otalgia, cephalgia, and reduced general condition. An altered mental status in combination with an AM could also be a sign of intracranial complication [54], [61]. The diagnostic method of choice is CT or MRI. The two radiological techniques are regarded as equally effective [54], [56], [61]. The treatment of choice is mastoidectomy combined with antibiotics that penetrate the central nervous system (CNS), such as ceftriaxone. An epidural abscess can be drained during the mastoidectomy. The treatment of a brain abscess should be interdisciplinary, including neurosurgery [2].
Prognosis
References
- ↑ Go C, Bernstein JM, de Jong AL, Sulek M, Friedman EM (2000). "Intracranial complications of acute mastoiditis". Int. J. Pediatr. Otorhinolaryngol. 52 (2): 143–8. PMID 10767461.
- ↑ Katz A, Leibovitz E, Greenberg D, Raiz S, Greenwald-Maimon M, Leiberman A, Dagan R (2003). "Acute mastoiditis in Southern Israel: a twelve year retrospective study (1990 through 2001)". Pediatr. Infect. Dis. J. 22 (10): 878–82. doi:10.1097/01.inf.0000091292.24683.fc. PMID 14551488.
- ↑ Oestreicher-Kedem Y, Raveh E, Kornreich L, Popovtzer A, Buller N, Nageris B (2005). "Complications of mastoiditis in children at the onset of a new millennium". Ann. Otol. Rhinol. Laryngol. 114 (2): 147–52. doi:10.1177/000348940511400212. PMID 15757196.
- ↑ Benito MB, Gorricho BP (2007). "Acute mastoiditis: increase in the incidence and complications". Int. J. Pediatr. Otorhinolaryngol. 71 (7): 1007–11. doi:10.1016/j.ijporl.2007.02.014. PMID 17493691.