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Acute Mastoiditis

  1. Definition:
    Inflammation of the mucosal lining of the mastoid antrum and its air cell system
  2. Organisms:
    1. β - hemolytic streptococcus: Most common
    2. Strept pneumoniae
    3. Anaerobes
  3. Symptoms
    1. Ear discharge. Mucopurulent or purulent discharge, often pulsatile (light-house effect), may be seen coming through a central perforation of pars tensa.
    2. Perforation of tympanic membrane. Usually, a small perforation is seen in pars tensa with congestion of the rest of tympanic membrane. Perforation may sometimes appear as a nipple-like protrusion. Sometimes, tympanic membrane is intact but dull and opaque especially in those who have received inadequate antibiotics.
    3. Hearing loss. Conductive type of hearing loss is always present.
  4. Signs
    1. Tenderness over the mastoid antrum
    2. Retroauricular swelling
    3. Pinna displaced forwards and downwards
    4. Postero-superior canal wall sagging
    5. Tragal sign-ve
    6. Movement of pinna: Not painful
    7. Cervical lymphadenopathy: Absent
    8. Swelling over the mastoid. Initially, there is oedema of periosteum, imparting a smooth “ironed out” feel over the mastoid. Later retroauricular sulcus becomes obliterated and pinna is pushed forward and downward. When pus burst through the bony cortex a subperiosteal fluctuant abscess is formed. “Ironed OutMastoid” is the 1s ct sign of acute mastoiditis
    9. Pus may break through the mastoid cortex to produce sub-periosteal abscess
    10. Nipple like protrusion on TM after ASOM¯
    11. Continuous /recurrent
      1. Pus from ear
      2. Fever
    12. Profuse discharge from ear: Mucopurulent or purulent discharge, often pulsatile (light-house effect), may be seen coming through a central perforation of pars tensa.
      X- rays: Clouding of mastoid air cells- Lysis of septae occurs in empyema of the mastoid

P.S.: First sign of acute mastoiditis Ironing Of The Mastoid

  1. Abscess in relation to mastoid infection

  1. Complications of Acute Mastoiditis
    1. Subperiosteal abscess
    2. Labyrinthitis
    3. Facial paralysis
    4. Petrositis
    5. Extradural abscess
    6. Subdural abscess
    7. Meningitis
    8. Brain abscess
    9. Lateral sinus thrombophlebitis
    10. Otitic hydrocephalous.
  2. Treatment:
    1. i.v. antibiotics
    2. myringotomy: If pus under tension
    3. Cortical mastoidectomy
      1. If intracranial/infratemporal complications - sub periosteal abscess
      2. If patient deteriorates after 48 hrs despite adequate treatment
      3.  The Reservoir sign
    4. Approaches to the Petrous apex air cells:
      1. Eagietons
      2. Thornwaldt’s Almoor’s
      3. Lempert Ramadier's
      4. Frenckner's

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