Mastoiditis

Mastoiditis in the acute phase is infection of the mastoid air cells with purulent exudate. These air cells are contiguous with the middle ear, and infection occurs as a complication of otitis media.

CASES/YEAR
4,800 (US); 288,000 (Global)
CATEGORY
Localized Infections
AGENT TYPE
Bacteria
OTHER NAMES
Acute mastoiditis;
ACUITY
Acute-Severe
INCUBATION
Estimated: days to weeks;
INITIAL SYMPTOMS
Symptoms of otitis media (otalgia, fever, decreased hearing) plus pain, swelling, and erythema of the mastoid process causing displacement of the pinna; [Harrisons, p. 251]
PRECAUTIONS
COMMENTS
Acute mastoiditis is infection of the mastoid air cells with purulent exudate. These air cells are contiguous with the middle ear, and infection occurs as a complication of otitis media. [Harrisons, p. 251] Main causes in past were S. pneumoniae and H influenzae--pathogens may be changing due to increasing prevalence of vaccination. Main indications for antibiotics are pain, erythema, leukocytosis, and fever. [ABX Guide] Complications occur in about 18% of cases and include subperiosteal abscess (most common), meningitis, brain abscess, central venous sinus thrombosis, and osteomyelitis. [5MCC-2020] See "Otitis media.
DIAGNOSTIC
Clinical; Rarely CT is needed; Send drainage for culture; Tympanocentesis may be indicated if no spontaneous drainage; [Merck Manual, p. 830]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • H leukocytosis
  • N headache
  • S pustule
  • *brain abscess or lesion
  • *cranial neuropathy
  • *meningitis
  • *osteomyelitis
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Inhalation
SOURCE
Person-to-Person
RESERVOIR
Human
RISK FACTORS
TREATMENT
Mastoidectomy if complicated case or antibiotics fail. [Harrisons, p. 251]
DRUG LINK
Merck Manual: Mastoiditis
REFERENCES FOR CASES/YEAR
1. (US) 1.2-2.0 cases per 100,000 person-years in countries where antibiotics are readily available; [Harrison ID, p. 210] Calculate: 1.6/100,000 = 4800 cases/yr (US);
2. (Global) Assume 1/2 of global population has same rate as US and 1/2 has 5 X that rate; Then 10 x 4800 US cases/yr = 48,000 and 10 X 4800 X 5 = .240,000; 48,000 + 240,000 = 288,000;