TY - JOUR
T1 - High risk and low prevalence diseases
T2 - Acute mastoiditis
AU - Bridwell, Rachel E.
AU - Koyfman, Alex
AU - Long, Brit
N1 - Publisher Copyright:
© 2024
PY - 2024/5
Y1 - 2024/5
N2 - Introduction: Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality. Objective: This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Discussion: Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures. Conclusions: An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
AB - Introduction: Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality. Objective: This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Discussion: Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures. Conclusions: An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
KW - Infectious disease
KW - Mastoiditis
KW - Otitis media
KW - Otolaryngology
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U2 - 10.1016/j.ajem.2024.02.009
DO - 10.1016/j.ajem.2024.02.009
M3 - Review article
C2 - 38368849
AN - SCOPUS:85185573122
SN - 0735-6757
VL - 79
SP - 63
EP - 69
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -