Mastoiditis history and symptoms
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Mastoiditis Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
History and symptoms of mastoiditis ranges from not symptomatic disease to symptomatic and progressive mastoiditis with serious life-threatening complications.
History
Obtaining the history is a very important aspect of making a diagnosis of mastoiditis. It provides insight into cause, precipitating factors and associated comorbid conditions.
The history taking should be considering below items:
- Onset, duration and progression of symptoms
- Allergies
- Previous history of acute otitis media
- Upper respiratory tract infection
- Associated symptoms(otalgia, fever, confusion)
- Medications
- Snoring
- Attendance to day care
- History of Trauma
- Co-morbid conditions like diabetes, immunodeficiency
- Smoking: contributes to fluid buildup and blockage in the eustachian tube
- Mother smoking during pregnancy
- Occupations involving exposure to air pollution.[2]
- Social status
- The presentation is determined by age, stage of infection, and the path of drainage of purulent material [1,7,26]. (See 'Pathogenesis' above.) Acute mastoiditis — Characteristic features of acute coalescent mastoiditis include [1,38,39]: ●Postauricular tenderness, erythema, swelling (with loss of the postauricular crease), fluctuance (or draining fistula), or mass (picture 1) ●Protrusion of the auricle (picture 2) ●Ear pain, which is a nonspecific finding and may manifest as irritability in young children In a systematic review of the diagnostic criteria for acute mastoiditis (65 studies published between 1980 and 2007), the relative frequencies of clinical findings were as follows: ●Lethargy/malaise (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) Approximately 40 percent of children had a history of previous otitis media, and 50 percent had received antibiotics before admission. Examination of the tympanic membrane usually reveals abnormal findings (eg, bulging, middle-ear effusion, perforation); however, often the tympanic membrane cannot be seen due to swelling of the external auditory canal. On average, 80 percent of children in the systematic review had acute otitis media (AOM) (picture 3) at the time of presentation [39]. However, the absence of AOM (current or recent) does not exclude a diagnosis of acute mastoiditis. Middle-ear effusion may be absent if there is obstruction of the aditus ad antrum with a patent eustachian tube (figure 1) [1]. (See 'Pathogenesis' above.) Fever is a nonspecific symptom but is sensitive and may be predictive of complications or the need for surgical intervention [5,14,39,40]. High-spiking "picket-fence" fevers may be indicative of sigmoid sinus thrombophlebitis [41]. Other systemic symptoms and signs may include lethargy, malaise, irritability, poor feeding, or diarrhea [39]. Masked mastoiditis — Clinical features of masked (subacute) mastoiditis include fever, cough, ear pain, and tympanic membrane findings compatible with AOM (picture 3). Masked mastoiditis occasionally presents with an extracranial or intracranial complication without signs of AOM or mastoiditis [3]. Masked mastoiditis should be considered in children with AOM that is not responding to antibiotics and in children with signs of intracranial infection without another focus of infection. (See "Acute otitis media in children: Diagnosis", section on 'Otoscopy'.)
Common Symptoms[edit | edit source]
- In this section you can list the common symptoms that the patient may experience.
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Less Common Symptoms[edit | edit source]
- In this section you can list the less common symptoms that the patient may experience.
- For an example of the the less common symptoms section within a history and symptoms
Some common symptoms and signs of mastoiditis include pain and tenderness in the mastoid region, as well as swelling. There may be ear pain (otalgia), and the ear or mastoid region may be red (erythematous). Fever or headaches may also be present. Infants usually show nonspecific symptoms, such as anorexia, diarrhea, or irritability. Drainage from the ear occurs in more serious cases.