Related Subjects:
|Assessing Hearing Loss
|Benign Paroxysmal Positional Vertigo (BPPV)
|Cholesteatoma
|Epistaxis (Nosebleeds)
|Mastoiditis
|Nasal polyps
|Acute Sinusitis
|Sudden Sensorineural Hearing loss (SNHL)
|Causes of Vertigo
⚠️ Mastoiditis is a serious complication of acute otitis media.
Prompt treatment is essential to prevent infratemporal & intracranial spread.
🚨 Rare but dangerous: otitic hydrocephalus → raised ICP with headache, papilloedema, VI nerve palsy.
📖 About
- Infection & inflammation of the mastoid air cells following acute otitis media (AOM).
- More common in children but can affect adults.
- Untreated AOM → spread to mastoid → abscess, bone erosion, intracranial sepsis.
🧬 Aetiology
- Spread of bacteria from middle ear into mastoid cells.
- Common organisms: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
- Close proximity to meninges, venous sinuses → risk of meningitis, sinus thrombosis, brain abscess.
🩺 Clinical Features
- Fever, malaise, recent AOM.
- Tender, red, swollen mastoid (behind ear).
- Pinna/ear displaced forwards & outwards.
- Narrowed external canal due to swelling.
- Tympanic membrane red, bulging ± perforation/otorrhoea.
- ⚠️ Red flags: ↓ GCS, focal neurology, VII cranial nerve palsy → think intracranial spread.
🔎 Investigations
- Bloods: FBC, CRP, U&E.
- Blood cultures if septic.
- Ear swab if discharge present.
- CT/MRI temporal bone → look for bone destruction, abscess, venous sinus thrombosis. CT petrous bones and brain (if signs of extra/intracranial involvement or unresponsive to antibiotics): opacified mastoid cells, bony erosion, cerebral abscess
⚠️ Complications
- Meningitis → headache, photophobia, neck stiffness.
- Brain abscess → focal neurology, seizures.
- Lateral sinus thrombosis → raised ICP, septic signs.
- Facial nerve palsy → due to temporal bone involvement.
- Labyrinthitis → vertigo, sensorineural hearing loss.
💊 Management
- IV antibiotics (e.g. IV ceftriaxone + IV metronidazole check local protocol).
- If evidence of subperiosteal abscess: myringotomy/grommet + cortical mastoidectomy
- If signs of neurological involvement: refer to neurosurgery
- Urgent ENT referral - surgical options:
- 💉 Myringotomy ± grommet → drainage & ventilation.
- 🩺 Incision & drainage if abscess present.
- 🦴 Cortical mastoidectomy if severe or refractory.
- Supportive: analgesia, fluids, antipyretics.
📊 Prognosis & Follow-up
- Good if treated early with IV antibiotics ± surgery.
- Close ENT follow-up: recurrence risk, monitor hearing, exclude complications.
- ⚠️ Patient education: seek early help for otitis media to prevent mastoiditis.
📚 References
