Materiały źródłowe

• #1 Mastoiditis

  https://www.nhs.uk/conditions/mastoiditis/

  Mastoiditis is a serious infection and should be diagnosed and treated quickly. […] If you have symptoms of mastoiditis, a GP will use a small magnifying lens called an otoscope to check for infection inside the ear. […] If the GP thinks you have mastoiditis, they’ll refer you to an ENT (ear, nose and throat) specialist at a hospital. […] Sometimes a scan may be needed to show the mastoid bone in more detail.

• #2 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  Despite the use of antibiotics, acute mastoiditis still remains a threat for patients with acute otitis media (AOM), especially for children younger than age 5 years. Great care is required on the part of clinicians to make an early diagnosis in order to promote adequate treatment and to prevent complications. […] Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available). Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process. […] A complete blood count (CBC) and sedimentation rate are obtained for baseline studies used to evaluate the efficacy of therapy. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

• #3 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  Despite the use of antibiotics, acute mastoiditis still remains a threat for patients with acute otitis media (AOM), especially for children younger than age 5 years. Great care is required on the part of clinicians to make an early diagnosis in order to promote adequate treatment and to prevent complications. […] Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available). Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process. […] A complete blood count (CBC) and sedimentation rate are obtained for baseline studies used to evaluate the efficacy of therapy. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

• #4 Mastoiditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560877/

  Mastoiditis is a common complication of acute otitis media. […] Review the steps necessary for the evaluation of mastoiditis. […] Mastoiditis is a clinical diagnosis. Laboratory and imaging are used as an adjunct when you are unsure of the diagnosis or considering a complication of acute mastoiditis. […] CT imaging can reveal the disruption of the bony septation in the mastoid air cells and the potential extension of the infection. […] If mastoiditis does not improve in 48 hours, mastoidectomy is indicated. […] It is essential to have a thorough history and physical examination, as common mimics can be overlooked, resulting in missed diagnosis and delay in treatment. […] The majority of patients with uncomplicated acute mastoiditis have a resolution of symptoms with conservative measures, including antibiotics, steroids, and myringotomy, without the need for mastoidectomy. […] In cases where the patient’s clinical status does not change or deteriorates from admission, mastoidectomy is then indicated.

• #5 Mastoiditis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/middle-ear-and-tympanic-membrane-disorders/mastoiditis

  Mastoiditis is a bacterial infection of the mastoid air cells, which typically occurs after acute otitis media. […] Diagnosis is clinical. […] Diagnosis of mastoiditis is clinical. CT is usually done, especially if an intratemporal or intracranial complication is suspected, to confirm the diagnosis and show the extent of the infection. […] Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) may be abnormal but are neither sensitive nor specific and add little to the diagnosis.

• #6 Mastoid – symptoms, diagnosis, treatment and disease prevention

  https://www.k31.ru/en/baza-statey/mastoidit/

  Mastoiditis is an inflammation in the mucous membrane and hard tissue of the temporal bone. […] In typical clinical situations, mastoiditis is not difficult to diagnose. The disease is detected by external examination, palpation and endoscopy of the auricle. However, with atypical development of the disease, additional studies are needed: CT, MRI, X-ray. […] The MRI method for mastoiditis determines the localization of purulent foci, the outflow of which is impaired. Imaging methods show the degree of intensity of inflammatory processes and detect destructive changes in bone tissue. […] If doctors do not know the causative agents of the disease, a bacterial culture of purulent discharge from the ear is performed. Determination of the exact type of pathogenic microflora is necessary for the appointment of targeted drug therapy.

• #7 Mastoiditis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24469-mastoiditis

  Mastoiditis is an infection of part of your temporal bone, the large bone behind your ear. […] Symptoms include ear pain, drainage and trouble hearing. […] Healthcare providers treat mastoiditis with antibiotics and by draining the infected middle ear fluid. […] A healthcare provider will use an otoscope to look inside your ear. […] They may also do the following tests: Blood tests. They may check your blood for signs of an infection or inflammation. […] Ear culture. Your provider will test the drainage coming from your ear for signs of the bacteria. […] Computed tomography (CT) scan. This test creates detailed images of the inside of your skull so providers can see where the infection is. […] Magnetic resonance imaging (MRI). Providers sometimes use this test to check the area between your ear and your brain.

• #8 Mastoiditis

  https://www.nhs.uk/conditions/mastoiditis/

  Mastoiditis is a serious infection and should be diagnosed and treated quickly. […] If you have symptoms of mastoiditis, a GP will use a small magnifying lens called an otoscope to check for infection inside the ear. […] If the GP thinks you have mastoiditis, they’ll refer you to an ENT (ear, nose and throat) specialist at a hospital. […] Sometimes a scan may be needed to show the mastoid bone in more detail.

• #9 Mastoiditis Differential Diagnoses

  https://emedicine.medscape.com/article/2056657-differential

  A high index of suspicion, judicious use of diagnostic modalities, and close follow-up care are recommended to make a diagnosis in a timely manner. […] Conditions to consider in the differential diagnosis of mastoiditis include the following: […] Differentiation from acute surgical mastoiditis (ASM) is relatively easy with preservation of the skin crease and presence of a normal middle ear. […] Lateral sinus thrombosis causes mastoid air sinus abnormalities; this is due to venous congestion as a consequence of this condition.

• #10 Diagnosing acute mastoiditis in a pediatric emergency department: a retrospective review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10210568/

  In univariable analysis, the clinical variables of otalgia, protrusion of the auricle and hyperemia of the mastoid were found to be strongly associated with the probability of AM diagnosis when compared to obliteration of the mastoid on CT scan. In a multivariable model, considering the most frequent clinical features, protrusion, otalgia and hyperemia were strongly and independently associated with AM diagnosis probability. […] Our analysis shows that clinical signs and symptoms could be enough to diagnose AM, start IV treatment and monitor for signs of ICC, which would warrant further imaging.

• #11 Mastoiditis – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/imaging/mastoiditis/

  Acute mastoiditis is diagnosed by pain and tenderness over the mastoid bone. Signs of acute otitis media (AOM) including fever, ear pain, and hearing loss are usually present or have preceded infection of the mastoid. […] Signs of acute mastoiditis include postauricular swelling, erythema, and tenderness over the mastoid bone. Protrusion of the pinna is most evident by viewing the patient from the front and comparing the position of the diseased versus the normal side in unilateral disease. A purulent discharge may be evident in the external canal following perforation of the tympanic membrane. […] Nonspecific tests of response to infection including peripheral white blood cell count, sedimentation rate, or C-reactive protein level do not assist in the diagnosis of acute mastoiditis. […] Cultures of purulent exudate in the external ear canal reflect the pus from the mastoid and middle ear. Cultures of pus may also be obtained by tympanocentesis, needle aspiration of the middle ear through the tympanic membrane.

• #12

  https://journals.lww.com/otology-neurotology/fulltext/2008/09000/A_Systematic_Review_of_Diagnostic_Criteria_for.5.aspx?generateEpub=Article%7Cotology-neurotology:2008:09000:00005%7C10.1097/mao.0b013e31817f736b%7C

  To review systematically the literature for the current criteria and strategies used to diagnose acute mastoiditis in children. […] Only 26 of 65 articles reported the criteria upon which the diagnosis of acute mastoiditis in children was based. The criteria most frequently used were the clinical signs of postauricular swelling, erythema, tenderness, and protrusion of the auricle. […] There is a lack of consensus regarding the criteria and strategies for diagnosing acute mastoiditis in the pediatric population. It is crucial that such criteria are established, and consensus is achieved so that prognostic and controlled studies can be initiated to identify risk factors and establish the most effective management of this condition in children.

• #13 Diagnosing acute mastoiditis in a pediatric emergency department: a retrospective review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10210568/

  In univariable analysis, the clinical variables of otalgia, protrusion of the auricle and hyperemia of the mastoid were found to be strongly associated with the probability of AM diagnosis when compared to obliteration of the mastoid on CT scan. In a multivariable model, considering the most frequent clinical features, protrusion, otalgia and hyperemia were strongly and independently associated with AM diagnosis probability. […] Our analysis shows that clinical signs and symptoms could be enough to diagnose AM, start IV treatment and monitor for signs of ICC, which would warrant further imaging.

• #14 Mastoiditis | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/mastoiditis

  How is mastoiditis diagnosed? […] In addition to a complete medical history and physical examination, your child’s doctor will inspect the outer ear(s) and eardrum(s) using an otoscope. […] Tympanometry, a test that can be performed in most doctors’ offices to help determine how the middle ear is functioning. […] Your child’s doctor may also order the following tests to help confirm the diagnosis: […] If your child has symptoms of a brain abscess or other intracranial complication, your child’s doctor may order the following: […] If your child has symptoms of meningitis, your child’s doctor may order a:

• #15 Mastoiditis | Children’s Wisconsin

  https://childrenswi.org/medical-care/ear-nose-and-throat/conditions/mastoiditis

  How is mastoiditis diagnosed? In addition to a complete medical history and physical examination, your child’s physician will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside of the ear. Your doctor may use an otoscope to blow a puff of air into the ear to test eardrum movement. […] Tympanometry, a test that can be performed in most physician offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to sit very still and not be crying, talking or moving. […] Your child’s physician may also order the following tests to help confirm the diagnosis: Blood work, X-rays or CT scan of the head, Culture from the infected ear.

• #16 Mastoiditis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/middle-ear-and-tympanic-membrane-disorders/mastoiditis

  Mastoiditis is a bacterial infection of the mastoid air cells, which typically occurs after acute otitis media. […] Diagnosis is clinical. […] Diagnosis of mastoiditis is clinical. CT is usually done, especially if an intratemporal or intracranial complication is suspected, to confirm the diagnosis and show the extent of the infection. […] Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) may be abnormal but are neither sensitive nor specific and add little to the diagnosis.

• #17 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  Despite the use of antibiotics, acute mastoiditis still remains a threat for patients with acute otitis media (AOM), especially for children younger than age 5 years. Great care is required on the part of clinicians to make an early diagnosis in order to promote adequate treatment and to prevent complications. […] Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available). Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process. […] A complete blood count (CBC) and sedimentation rate are obtained for baseline studies used to evaluate the efficacy of therapy. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

• #18 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  Despite the use of antibiotics, acute mastoiditis still remains a threat for patients with acute otitis media (AOM), especially for children younger than age 5 years. Great care is required on the part of clinicians to make an early diagnosis in order to promote adequate treatment and to prevent complications. […] Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available). Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process. […] A complete blood count (CBC) and sedimentation rate are obtained for baseline studies used to evaluate the efficacy of therapy. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

• #19 Mastoiditis: risky consequence of middle ear inflammation – USZ

  https://www.usz.ch/en/disease/mastoiditis/

  If you visit us with a long-standing or recurring middle ear infection, we will probably examine you or your child for mastoiditis. […] We carry out an ear examination using a microscope, known as ear microscopy. We can recognize signs of middle ear inflammation and see whether the posterior auditory wall is swollen and reddened due to mastoiditis. […] If there is a suspicion of complications, for example that pus has penetrated into surrounding areas such as the inner ear, a computer tomography scan can clarify this. […] A blood test may show whether inflammation levels are elevated. The following values, among others, are measured: White blood cell count, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR). […] Other examination methods include hearing tests or a swab to define the pathogens or imaging procedures such as computer tomography (CT) or magnetic resonance imaging (MRI).

• #20 Mastoiditis – Causes Symptoms Diagnosis Complications and Treatment

  https://www.medindia.net/health/conditions/mastoiditis.htm

  How to Diagnose Mastoiditis? Clinical diagnosis of mastoiditis includes: Medical history of ear infections. Patient symptom presentations like headaches and ear discharge. Physical examination to look for redness, tenderness and swelling behind the ear. […] Blood tests show: Excessive leukocytes. Elevation of erythrocyte sedimentation rate (ESR). […] Computerized tomography (CT scan) reveals: Opacity of the mastoid air cells – air cells appear clear with there is no infection. Erosion of the mastoid bone. […] Magnetic resonance imaging (MRI) is helpful in confirming: Opacity of the mastoid air cells. Presence of fluid in mastoid air cells. […] Culture tests: Culture testing of the ear discharge reveals the type of bacteria present.

• #21 Investigations – Primary Care Notebook

  https://primarycarenotebook.com/pages/ear-nose-and-throat/acute-mastoiditis/investigations

  Investigations in acute mastoiditis may reveal: a raised white cell count, especially neutrophils […] opacity and air coalescence seen on mastoid radiograph […] Other possible features of acute mastoiditis that may be found are: a subperiosteal abscess over the mastoid process […] an abscess formed in the neck – Bezold’s abscess […] extension of infection to the zygoma, causing a zygomatic mastoiditis.

• #22 Mastoiditis

  https://fpnotebook.com/ENT/Ear/Mstdts.htm

  Mastoiditis is a clinical diagnosis. […] Normal white count and normal inflammatory markers (e.g. CRP) does NOT exclude diagnosis. […] Lack of mastoid air cell destruction on imaging does not exclude diagnosis.

• #23 Mastoiditis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/middle-ear-and-tympanic-membrane-disorders/mastoiditis

  Mastoiditis is a bacterial infection of the mastoid air cells, which typically occurs after acute otitis media. […] Diagnosis is clinical. […] Diagnosis of mastoiditis is clinical. CT is usually done, especially if an intratemporal or intracranial complication is suspected, to confirm the diagnosis and show the extent of the infection. […] Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) may be abnormal but are neither sensitive nor specific and add little to the diagnosis.

• #24 Mastoiditis – Ear, Nose, and Throat Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/ear-nose-and-throat-disorders/middle-ear-disorders/mastoiditis

  Mastoiditis usually occurs when untreated or inadequately treated acute otitis media spreads from the middle ear into the surrounding bone the mastoid process (part of the temporal bone the skull bone that contains part of the ear canal, the middle ear, and the inner ear). […] Doctors typically base the diagnosis on the person’s symptoms. Doctors usually do computed tomography (CT) to confirm the diagnosis. […] To identify the bacteria causing the infection, doctors take samples of the discharge from the ear so that the bacteria in the discharge can be grown in a laboratory (cultured). […] If people do not have a discharge, doctors use a needle or make an incision in the eardrum and take a sample of the fluid from the middle ear.

• #25 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  Despite the use of antibiotics, acute mastoiditis still remains a threat for patients with acute otitis media (AOM), especially for children younger than age 5 years. Great care is required on the part of clinicians to make an early diagnosis in order to promote adequate treatment and to prevent complications. […] Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available). Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process. […] A complete blood count (CBC) and sedimentation rate are obtained for baseline studies used to evaluate the efficacy of therapy. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

• #26 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  Despite the use of antibiotics, acute mastoiditis still remains a threat for patients with acute otitis media (AOM), especially for children younger than age 5 years. Great care is required on the part of clinicians to make an early diagnosis in order to promote adequate treatment and to prevent complications. […] Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available). Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process. […] A complete blood count (CBC) and sedimentation rate are obtained for baseline studies used to evaluate the efficacy of therapy. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

• #27 Mastoiditis – Ear, Nose, and Throat Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/ear-nose-and-throat-disorders/middle-ear-disorders/mastoiditis

  Mastoiditis usually occurs when untreated or inadequately treated acute otitis media spreads from the middle ear into the surrounding bone the mastoid process (part of the temporal bone the skull bone that contains part of the ear canal, the middle ear, and the inner ear). […] Doctors typically base the diagnosis on the person’s symptoms. Doctors usually do computed tomography (CT) to confirm the diagnosis. […] To identify the bacteria causing the infection, doctors take samples of the discharge from the ear so that the bacteria in the discharge can be grown in a laboratory (cultured). […] If people do not have a discharge, doctors use a needle or make an incision in the eardrum and take a sample of the fluid from the middle ear.

• #28 Mastoiditis (Acute & Chronic): Symptoms, Causes, Treatment

  https://www.webmd.com/cold-and-flu/ear-infection/mastoiditis-symptoms-causes-treatments

  Any earache with fever or posterior ear tenderness, redness or swelling should be evaluated by a doctor. […] Mastoiditis is uncommon without a coinciding ear infection. A sample of the infected ear fluid should be collected for culture. […] If complicated, severe or chronic mastoiditis is suspected, you will be referred for a CT scan to image the mastoid area. If a pocket of fluid or pus is found anywhere (in your ear, neck, mastoid, spine) it will need to be drained and then cultured so antibiotics can be tailored to the bug found.

• #29 Acute Mastoiditis: Pearls and Pitfalls – emDocs

  https://www.emdocs.net/acute-mastoiditis-pearls-and-pitfalls/

  Acute mastoiditis is the most common, and usually the initial, complication of AOM. […] The diagnosis can be confusing due to differing uses of the term “mastoiditis”. […] A clinical diagnosis of acute mastoiditis necessitates treatment with IV antibiotics with a consideration for tympanostomy and mastoidectomy. […] Any patient who is suspected of having complications of AOM should receive imaging and laboratory testing. […] Computed Tomography (CT) is the imaging study of choice. […] The most common causative agents of acute mastoiditis include staphylococcus, streptococcus, and pseudomonas species. […] Acute mastoiditis usually presents 2-6 days after the onset of symptoms of AOM. […] A full history and physical exam is always important when evaluating these patients.

• #30 Mastoid – symptoms, diagnosis, treatment and disease prevention

  https://www.k31.ru/en/baza-statey/mastoidit/

  Mastoiditis is an inflammation in the mucous membrane and hard tissue of the temporal bone. […] In typical clinical situations, mastoiditis is not difficult to diagnose. The disease is detected by external examination, palpation and endoscopy of the auricle. However, with atypical development of the disease, additional studies are needed: CT, MRI, X-ray. […] The MRI method for mastoiditis determines the localization of purulent foci, the outflow of which is impaired. Imaging methods show the degree of intensity of inflammatory processes and detect destructive changes in bone tissue. […] If doctors do not know the causative agents of the disease, a bacterial culture of purulent discharge from the ear is performed. Determination of the exact type of pathogenic microflora is necessary for the appointment of targeted drug therapy.

• #31 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  CT scanning of the temporal bone is the standard for evaluation of mastoiditis, with published sensitivities ranging from 87-100%. Some argue that all suspected cases of mastoiditis warrant CT scan evaluation. […] It is this authors belief that in the presence of clear clinical indications of acute surgical mastoiditis, CT scanning may be omitted prior to surgical intervention, avoiding unnecessary radiation exposure as recommended by the US National Institutes of Health. […] Magnetic resonance imaging (MRI) is not typically the radiographic study of choice; however, it is helpful in showing inflammatory processes and differentiating certain tumors. Do not use MRI as a method of evaluating the mastoid, although it is the standard for evaluation of contiguous soft tissue, particularly the intracranial structures.

• #32 Acute mastoiditis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-mastoiditis?lang=us

  Acute mastoiditis refers to a suppurative infection of the mastoid air cells. It is the most common complication of acute otitis media. […] When there is clinical evidence of acute mastoiditis, the initial stage is referred to as „acute mastoiditis with periostitis”, „incipient mastoiditis”, or „mild mastoiditis”. […] Coalescent mastoiditis is a radiological diagnosis. […] CT is the initial investigation of choice. Post-contrast imaging is helpful in assessing for associated soft tissue or intracranial complications. […] Erosion of mastoid air cell bony septa establishes the diagnosis of coalescent mastoiditis. […] Fluid signal intensity in the mastoid should not be interpreted as mastoiditis without other evidence, such as mucosal contrast enhancement and/or diffusion restriction.

• #33 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  CT scanning of the temporal bone is the standard for evaluation of mastoiditis, with published sensitivities ranging from 87-100%. Some argue that all suspected cases of mastoiditis warrant CT scan evaluation. […] It is this authors belief that in the presence of clear clinical indications of acute surgical mastoiditis, CT scanning may be omitted prior to surgical intervention, avoiding unnecessary radiation exposure as recommended by the US National Institutes of Health. […] Magnetic resonance imaging (MRI) is not typically the radiographic study of choice; however, it is helpful in showing inflammatory processes and differentiating certain tumors. Do not use MRI as a method of evaluating the mastoid, although it is the standard for evaluation of contiguous soft tissue, particularly the intracranial structures.

• #34 Mastoiditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560877/

  Mastoiditis is a common complication of acute otitis media. […] Review the steps necessary for the evaluation of mastoiditis. […] Mastoiditis is a clinical diagnosis. Laboratory and imaging are used as an adjunct when you are unsure of the diagnosis or considering a complication of acute mastoiditis. […] CT imaging can reveal the disruption of the bony septation in the mastoid air cells and the potential extension of the infection. […] If mastoiditis does not improve in 48 hours, mastoidectomy is indicated. […] It is essential to have a thorough history and physical examination, as common mimics can be overlooked, resulting in missed diagnosis and delay in treatment. […] The majority of patients with uncomplicated acute mastoiditis have a resolution of symptoms with conservative measures, including antibiotics, steroids, and myringotomy, without the need for mastoidectomy. […] In cases where the patient’s clinical status does not change or deteriorates from admission, mastoidectomy is then indicated.

• #35 Acute mastoiditis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-mastoiditis?lang=us

  Acute mastoiditis refers to a suppurative infection of the mastoid air cells. It is the most common complication of acute otitis media. […] When there is clinical evidence of acute mastoiditis, the initial stage is referred to as „acute mastoiditis with periostitis”, „incipient mastoiditis”, or „mild mastoiditis”. […] Coalescent mastoiditis is a radiological diagnosis. […] CT is the initial investigation of choice. Post-contrast imaging is helpful in assessing for associated soft tissue or intracranial complications. […] Erosion of mastoid air cell bony septa establishes the diagnosis of coalescent mastoiditis. […] Fluid signal intensity in the mastoid should not be interpreted as mastoiditis without other evidence, such as mucosal contrast enhancement and/or diffusion restriction.

• #36 Mastoiditis – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/imaging/mastoiditis/

  Radiologic studies of the mastoid show a loss of the integrity of the cell walls of the mastoid. Computed tomography may demonstrate the extent of the disease in the mastoid and surrounding structures. […] Most important in management of acute mastoiditis is early diagnosis, appropriate antimicrobial therapy, and, when necessary, incision and drainage of the mastoid abscess. […] The prognosis is excellent if the disease is diagnosed and managed before complications develop.

• #37 Acute mastoiditis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-mastoiditis?lang=us

  Acute mastoiditis refers to a suppurative infection of the mastoid air cells. It is the most common complication of acute otitis media. […] When there is clinical evidence of acute mastoiditis, the initial stage is referred to as „acute mastoiditis with periostitis”, „incipient mastoiditis”, or „mild mastoiditis”. […] Coalescent mastoiditis is a radiological diagnosis. […] CT is the initial investigation of choice. Post-contrast imaging is helpful in assessing for associated soft tissue or intracranial complications. […] Erosion of mastoid air cell bony septa establishes the diagnosis of coalescent mastoiditis. […] Fluid signal intensity in the mastoid should not be interpreted as mastoiditis without other evidence, such as mucosal contrast enhancement and/or diffusion restriction.

• #38 Acute mastoiditis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-mastoiditis?lang=us

  Acute mastoiditis refers to a suppurative infection of the mastoid air cells. It is the most common complication of acute otitis media. […] When there is clinical evidence of acute mastoiditis, the initial stage is referred to as „acute mastoiditis with periostitis”, „incipient mastoiditis”, or „mild mastoiditis”. […] Coalescent mastoiditis is a radiological diagnosis. […] CT is the initial investigation of choice. Post-contrast imaging is helpful in assessing for associated soft tissue or intracranial complications. […] Erosion of mastoid air cell bony septa establishes the diagnosis of coalescent mastoiditis. […] Fluid signal intensity in the mastoid should not be interpreted as mastoiditis without other evidence, such as mucosal contrast enhancement and/or diffusion restriction.

• #39 Is mastoiditis being over-diagnosed on computed tomography imaging? —radiological versus clinical findings – Pastuszek – Australian Journal of Otolaryngology

  https://www.theajo.com/article/view/4325/html

  Non-contrast computed tomography (CT) of the mastoid air cells in the temporal bone is a standard investigation for patients with suspected coalescent mastoiditis. […] This analysis aims to determine the relationship between a radiological reporting of mastoiditis and the clinical diagnosis of acute mastoiditis. […] Mastoiditis determined on CT imaging has a poor correlation with the clinical diagnosis and is seen in many incidental patients or alternative pathologies. […] It is suggested that without evidence of bony erosion that this finding may preferentially reported as mastoid opacification only, for further clinical correlation. […] The aim of this study was to evaluate the importance of the presence of mastoid opacification on CT imaging and its the relationship with the clinical picture.

• #40 Is mastoiditis being over-diagnosed on computed tomography imaging? —radiological versus clinical findings – Pastuszek – Australian Journal of Otolaryngology

  https://www.theajo.com/article/view/4325/html

  It is hypothesized that opacification of the mastoid air cell system may not necessarily reflect coalescent changes or eventuate a diagnosis of AM. […] Overall, from the 1,946 CT scan reports and images reviewed, 52 scans (2.7%) had reported mastoiditis. Only 5.8% (3 of 52) ended up with a specialist diagnosis of AM. Therefore, 94.2% of CT reports with reported mastoiditis did not end up with a clinical diagnosis of AM. […] Radiological reporting of mastoiditis is not in keeping with the clinical entity of AM. […] Overall, 2.7% of CT scans showed mastoid opacification even in patients without acute middle ear symptoms. […] It is suggested from the analysis of available literature and the findings of this review that the radiological reporting of this finding would be better stated as mastoid opacification for clinical correlation if no bony erosion is seen.

• #41 Is mastoiditis being over-diagnosed on computed tomography imaging? —radiological versus clinical findings – Pastuszek – Australian Journal of Otolaryngology

  https://www.theajo.com/article/view/4325/html

  Non-contrast computed tomography (CT) of the mastoid air cells in the temporal bone is a standard investigation for patients with suspected coalescent mastoiditis. […] This analysis aims to determine the relationship between a radiological reporting of mastoiditis and the clinical diagnosis of acute mastoiditis. […] Mastoiditis determined on CT imaging has a poor correlation with the clinical diagnosis and is seen in many incidental patients or alternative pathologies. […] It is suggested that without evidence of bony erosion that this finding may preferentially reported as mastoid opacification only, for further clinical correlation. […] The aim of this study was to evaluate the importance of the presence of mastoid opacification on CT imaging and its the relationship with the clinical picture.

• #42 Mastoiditis | Radiology Case | Radiopaedia.org

  https://radiopaedia.org/cases/mastoiditis-4?lang=us

  Left ear pain and fever not improving on antibiotics. […] The presence of fluid in the mastoid air cells does not automatically make the diagnosis of mastoiditis. If there is absence of bony destruction on CT (or other complications), the diagnosis is impossible to make. On MRI, the presence of fluid in the mastoid air cells should be accompanied by mucosal enhancement and/or diffusion restriction is required. The presence of extramastoid change (in this case the soft tissue enhancement at the tip of the mastoid process) is also a helpful adjunct in making the diagnosis.

• #43 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  CT scanning of the temporal bone is the standard for evaluation of mastoiditis, with published sensitivities ranging from 87-100%. Some argue that all suspected cases of mastoiditis warrant CT scan evaluation. […] It is this authors belief that in the presence of clear clinical indications of acute surgical mastoiditis, CT scanning may be omitted prior to surgical intervention, avoiding unnecessary radiation exposure as recommended by the US National Institutes of Health. […] Magnetic resonance imaging (MRI) is not typically the radiographic study of choice; however, it is helpful in showing inflammatory processes and differentiating certain tumors. Do not use MRI as a method of evaluating the mastoid, although it is the standard for evaluation of contiguous soft tissue, particularly the intracranial structures.

• #44 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  CT scanning of the temporal bone is the standard for evaluation of mastoiditis, with published sensitivities ranging from 87-100%. Some argue that all suspected cases of mastoiditis warrant CT scan evaluation. […] It is this authors belief that in the presence of clear clinical indications of acute surgical mastoiditis, CT scanning may be omitted prior to surgical intervention, avoiding unnecessary radiation exposure as recommended by the US National Institutes of Health. […] Magnetic resonance imaging (MRI) is not typically the radiographic study of choice; however, it is helpful in showing inflammatory processes and differentiating certain tumors. Do not use MRI as a method of evaluating the mastoid, although it is the standard for evaluation of contiguous soft tissue, particularly the intracranial structures.

• #45 Diagnosing acute mastoiditis in a pediatric emergency department: a retrospective review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10210568/

  Acute mastoiditis (AM) is a common complication of acute otitis media in children. There is currently no consensus on criteria for diagnosis. Head CT is the most frequent diagnostic tool used in the ED although the increasing awareness on the use of ionized radiations in children has questioned the use of CT imaging versus solely using clinical criteria. Our research aimed to understand if CT imaging was essential in making a diagnosis of AM. […] Identifying specific criteria for diagnosing AM remains a matter of debate, mostly due to the fact that there is no definitive consensus regarding the role of imaging in the diagnosis of AM and of its complications. Gold standard in the diagnosis of AM is Magnetic Resonance Imaging (MRI) enhanced with gadolinium, which is not an exam you would perform in an Emergency Department (ED) due to its length and to the fact it usually requires pediatric patients to be sedated. Head Computed tomography (CT) on the other hand is a quick exam, and is considered very sensitive, although its specificity is not well assessed.

• #46 Acute mastoiditis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-mastoiditis?lang=us

  Acute mastoiditis refers to a suppurative infection of the mastoid air cells. It is the most common complication of acute otitis media. […] When there is clinical evidence of acute mastoiditis, the initial stage is referred to as „acute mastoiditis with periostitis”, „incipient mastoiditis”, or „mild mastoiditis”. […] Coalescent mastoiditis is a radiological diagnosis. […] CT is the initial investigation of choice. Post-contrast imaging is helpful in assessing for associated soft tissue or intracranial complications. […] Erosion of mastoid air cell bony septa establishes the diagnosis of coalescent mastoiditis. […] Fluid signal intensity in the mastoid should not be interpreted as mastoiditis without other evidence, such as mucosal contrast enhancement and/or diffusion restriction.

• #47 Mastoiditis | Radiology Case | Radiopaedia.org

  https://radiopaedia.org/cases/mastoiditis-4?lang=us

  Left ear pain and fever not improving on antibiotics. […] The presence of fluid in the mastoid air cells does not automatically make the diagnosis of mastoiditis. If there is absence of bony destruction on CT (or other complications), the diagnosis is impossible to make. On MRI, the presence of fluid in the mastoid air cells should be accompanied by mucosal enhancement and/or diffusion restriction is required. The presence of extramastoid change (in this case the soft tissue enhancement at the tip of the mastoid process) is also a helpful adjunct in making the diagnosis.

• #48 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  In areas of the world where CT scanning is not immediately available, plain radiographs of the mastoids demonstrate clouding of the air cells with bone destruction in ASM. In the vast majority of cases, radiographs suffice to establish the diagnosis but lack the sensitivity to differentiate the stages of the disease and fail to show the petrous apex in any great detail.

• #49 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  In areas of the world where CT scanning is not immediately available, plain radiographs of the mastoids demonstrate clouding of the air cells with bone destruction in ASM. In the vast majority of cases, radiographs suffice to establish the diagnosis but lack the sensitivity to differentiate the stages of the disease and fail to show the petrous apex in any great detail.

• #50 Mastoiditis Differential Diagnoses

  https://emedicine.medscape.com/article/2056657-differential

  A high index of suspicion, judicious use of diagnostic modalities, and close follow-up care are recommended to make a diagnosis in a timely manner. […] Conditions to consider in the differential diagnosis of mastoiditis include the following: […] Differentiation from acute surgical mastoiditis (ASM) is relatively easy with preservation of the skin crease and presence of a normal middle ear. […] Lateral sinus thrombosis causes mastoid air sinus abnormalities; this is due to venous congestion as a consequence of this condition.

• #51 Mastoiditis Differential Diagnoses

  https://emedicine.medscape.com/article/2056657-differential

  A high index of suspicion, judicious use of diagnostic modalities, and close follow-up care are recommended to make a diagnosis in a timely manner. […] Conditions to consider in the differential diagnosis of mastoiditis include the following: […] Differentiation from acute surgical mastoiditis (ASM) is relatively easy with preservation of the skin crease and presence of a normal middle ear. […] Lateral sinus thrombosis causes mastoid air sinus abnormalities; this is due to venous congestion as a consequence of this condition.

• #52 Mastoiditis Differential Diagnoses

  https://emedicine.medscape.com/article/2056657-differential

  A high index of suspicion, judicious use of diagnostic modalities, and close follow-up care are recommended to make a diagnosis in a timely manner. […] Conditions to consider in the differential diagnosis of mastoiditis include the following: […] Differentiation from acute surgical mastoiditis (ASM) is relatively easy with preservation of the skin crease and presence of a normal middle ear. […] Lateral sinus thrombosis causes mastoid air sinus abnormalities; this is due to venous congestion as a consequence of this condition.

• #53 Chronic Otitis Media, Cholesteatoma and Mastoiditis – Harvard Health

  https://www.health.harvard.edu/a_to_z/chronic-otitis-media-cholesteatoma-and-mastoiditis-a-to-z

  Sometimes a middle-ear infection causes a hole (perforation) in the eardrum. […] When a chronic ear infection spreads beyond the middle ear to the mastoid bone (the portion of bone behind the middle ear), a serious infection called mastoiditis can occur. […] If the otolaryngologist suspects mastoiditis or a cholesteatoma, additional tests may be needed. […] Swelling, tenderness, and redness behind the ear, which may indicate spread of infection to the mastoid bone (mastoiditis). […] Antibiotics given intravenously (into a vein) often can clear up this infection, but surgery may be necessary.

• #54 Mastoiditis Differential Diagnoses

  https://emedicine.medscape.com/article/2056657-differential

  A high index of suspicion, judicious use of diagnostic modalities, and close follow-up care are recommended to make a diagnosis in a timely manner. […] Conditions to consider in the differential diagnosis of mastoiditis include the following: […] Differentiation from acute surgical mastoiditis (ASM) is relatively easy with preservation of the skin crease and presence of a normal middle ear. […] Lateral sinus thrombosis causes mastoid air sinus abnormalities; this is due to venous congestion as a consequence of this condition.

• #55 Mastoiditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560877/

  Mastoiditis is a common complication of acute otitis media. […] Review the steps necessary for the evaluation of mastoiditis. […] Mastoiditis is a clinical diagnosis. Laboratory and imaging are used as an adjunct when you are unsure of the diagnosis or considering a complication of acute mastoiditis. […] CT imaging can reveal the disruption of the bony septation in the mastoid air cells and the potential extension of the infection. […] If mastoiditis does not improve in 48 hours, mastoidectomy is indicated. […] It is essential to have a thorough history and physical examination, as common mimics can be overlooked, resulting in missed diagnosis and delay in treatment. […] The majority of patients with uncomplicated acute mastoiditis have a resolution of symptoms with conservative measures, including antibiotics, steroids, and myringotomy, without the need for mastoidectomy. […] In cases where the patient’s clinical status does not change or deteriorates from admission, mastoidectomy is then indicated.

• #56 Is mastoiditis being over-diagnosed on computed tomography imaging? —radiological versus clinical findings – Pastuszek – Australian Journal of Otolaryngology

  https://www.theajo.com/article/view/4325/html

  It is hypothesized that opacification of the mastoid air cell system may not necessarily reflect coalescent changes or eventuate a diagnosis of AM. […] Overall, from the 1,946 CT scan reports and images reviewed, 52 scans (2.7%) had reported mastoiditis. Only 5.8% (3 of 52) ended up with a specialist diagnosis of AM. Therefore, 94.2% of CT reports with reported mastoiditis did not end up with a clinical diagnosis of AM. […] Radiological reporting of mastoiditis is not in keeping with the clinical entity of AM. […] Overall, 2.7% of CT scans showed mastoid opacification even in patients without acute middle ear symptoms. […] It is suggested from the analysis of available literature and the findings of this review that the radiological reporting of this finding would be better stated as mastoid opacification for clinical correlation if no bony erosion is seen.

• #57 Diagnosing acute mastoiditis in a pediatric emergency department: a retrospective review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10210568/

  In univariable analysis, the clinical variables of otalgia, protrusion of the auricle and hyperemia of the mastoid were found to be strongly associated with the probability of AM diagnosis when compared to obliteration of the mastoid on CT scan. In a multivariable model, considering the most frequent clinical features, protrusion, otalgia and hyperemia were strongly and independently associated with AM diagnosis probability. […] Our analysis shows that clinical signs and symptoms could be enough to diagnose AM, start IV treatment and monitor for signs of ICC, which would warrant further imaging.

• #58 Mastoiditis

  https://www.nhs.uk/conditions/mastoiditis/

  Mastoiditis is a serious infection and should be diagnosed and treated quickly. […] If you have symptoms of mastoiditis, a GP will use a small magnifying lens called an otoscope to check for infection inside the ear. […] If the GP thinks you have mastoiditis, they’ll refer you to an ENT (ear, nose and throat) specialist at a hospital. […] Sometimes a scan may be needed to show the mastoid bone in more detail.

• #59 Acute Mastoiditis | Ento Key

  https://entokey.com/acute-mastoiditis/

  Acute mastoiditis remains a contemporary disease with significant morbidity and even mortality. The clinical diagnosis of this disorder is so entrenched within the fabric of otolaryngology that it almost symbolizes the specialty. […] With the development of newer antibiotics and modern imaging techniques, the diagnosis and treatment of acute mastoiditis and its complications is in constant evolution. […] The clinical diagnosis of acute mastoiditis is usually made when the infection spreads beyond the tympanomastoid space to the soft tissues of the postauricular region. […] Diagnosis, Signs, and Symptoms In its most classic presentation, acute mastoiditis is readily diagnosable. The clinical diagnosis is based heavily on history and physical examination. […] Acute mastoiditis occurs without obvious abnormalities of the tympanic membrane or middle ear in 10% to 20% of cases.

• #60 Mastoiditis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/middle-ear-and-tympanic-membrane-disorders/mastoiditis

  Mastoiditis is a bacterial infection of the mastoid air cells, which typically occurs after acute otitis media. […] Diagnosis is clinical. […] Diagnosis of mastoiditis is clinical. CT is usually done, especially if an intratemporal or intracranial complication is suspected, to confirm the diagnosis and show the extent of the infection. […] Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) may be abnormal but are neither sensitive nor specific and add little to the diagnosis.

• #61 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  Despite the use of antibiotics, acute mastoiditis still remains a threat for patients with acute otitis media (AOM), especially for children younger than age 5 years. Great care is required on the part of clinicians to make an early diagnosis in order to promote adequate treatment and to prevent complications. […] Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available). Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process. […] A complete blood count (CBC) and sedimentation rate are obtained for baseline studies used to evaluate the efficacy of therapy. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

• #62 Mastoiditis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/middle-ear-and-tympanic-membrane-disorders/mastoiditis

  Mastoiditis is a bacterial infection of the mastoid air cells, which typically occurs after acute otitis media. […] Diagnosis is clinical. […] Diagnosis of mastoiditis is clinical. CT is usually done, especially if an intratemporal or intracranial complication is suspected, to confirm the diagnosis and show the extent of the infection. […] Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) may be abnormal but are neither sensitive nor specific and add little to the diagnosis.

• #63 Mastoiditis – Clinical Features – Investigations – TeachMePaeds

  https://teachmepaediatrics.com/ent/ear/mastoiditis/

  The diagnosis of acute mastoiditis is based mainly on thorough history-taking and clinical examination. Supporting investigations may be undertaken. […] CT head and mastoid with contrast is indicated in all cases of mastoiditis apart from cases of simple uncomplicated mastoiditis. CT images will typically show coalescence of the mastoid air cells along with an opaque mastoid and middle ear. It is also helpful in excluding intracranial complications of mastoiditis. […] MRI head under sedation or anaesthesia is helpful in cases of suspected complicated mastoiditis due to its increased sensitivity in highlighting soft tissue collections or vascular problems. Magnetic resonance venogram (MRV) is best at identifying venous thrombosis, which can be a complication of mastoiditis.

• #64 Mastoiditis | Children’s Wisconsin

  https://childrenswi.org/medical-care/ear-nose-and-throat/conditions/mastoiditis

  If your child has symptoms of a brain abscess or other intracranial complication, your child’s physician may order the following: Computerized tomography scan (Also called a CT or CAT scan.)- a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce images (often called „slices”), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays. […] Magnetic resonance imaging (MRI)- a diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. […] If your child has symptoms of meningitis, your child’s physician may order a: Lumbar puncture- a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child’s brain and spinal cord.

• #65 Diagnosing acute mastoiditis in a pediatric emergency department: a retrospective review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10210568/

  Acute mastoiditis (AM) is a common complication of acute otitis media in children. There is currently no consensus on criteria for diagnosis. Head CT is the most frequent diagnostic tool used in the ED although the increasing awareness on the use of ionized radiations in children has questioned the use of CT imaging versus solely using clinical criteria. Our research aimed to understand if CT imaging was essential in making a diagnosis of AM. […] Identifying specific criteria for diagnosing AM remains a matter of debate, mostly due to the fact that there is no definitive consensus regarding the role of imaging in the diagnosis of AM and of its complications. Gold standard in the diagnosis of AM is Magnetic Resonance Imaging (MRI) enhanced with gadolinium, which is not an exam you would perform in an Emergency Department (ED) due to its length and to the fact it usually requires pediatric patients to be sedated. Head Computed tomography (CT) on the other hand is a quick exam, and is considered very sensitive, although its specificity is not well assessed.

• #66 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  CT scanning of the temporal bone is the standard for evaluation of mastoiditis, with published sensitivities ranging from 87-100%. Some argue that all suspected cases of mastoiditis warrant CT scan evaluation. […] It is this authors belief that in the presence of clear clinical indications of acute surgical mastoiditis, CT scanning may be omitted prior to surgical intervention, avoiding unnecessary radiation exposure as recommended by the US National Institutes of Health. […] Magnetic resonance imaging (MRI) is not typically the radiographic study of choice; however, it is helpful in showing inflammatory processes and differentiating certain tumors. Do not use MRI as a method of evaluating the mastoid, although it is the standard for evaluation of contiguous soft tissue, particularly the intracranial structures.

• #67 Mastoiditis – Clinical Features – Investigations – TeachMePaeds

  https://teachmepaediatrics.com/ent/ear/mastoiditis/

  The diagnosis of acute mastoiditis is based mainly on thorough history-taking and clinical examination. Supporting investigations may be undertaken. […] CT head and mastoid with contrast is indicated in all cases of mastoiditis apart from cases of simple uncomplicated mastoiditis. CT images will typically show coalescence of the mastoid air cells along with an opaque mastoid and middle ear. It is also helpful in excluding intracranial complications of mastoiditis. […] MRI head under sedation or anaesthesia is helpful in cases of suspected complicated mastoiditis due to its increased sensitivity in highlighting soft tissue collections or vascular problems. Magnetic resonance venogram (MRV) is best at identifying venous thrombosis, which can be a complication of mastoiditis.

• #68 Paediatric Pathways

  https://bsac.org.uk/paediatricpathways/otitis-media-mastoiditis.php

  Acute presentation of ear pain (otalgia), discharge (otorrhoea) +- fever. AOM diagnosis is strengthened by the presence of a bulging tympanic membrane, air-fluid level behind the tympanic membrane, tympanic membrane perforation and/or discharge in the ear canal (although discharge only occurs in AOM if there is a tympanic perforation). Presence of fluctuant post auricular swelling and/or protrusion of the pinna suggest possible mastoiditis. […] If mastoiditis, consider contrast CT of petrous bones or if intracranial complications suspected, consider MRI brain/petrous bones. […] If signs of intracranial infection or mastoiditis, consider urgent neuro-otological imaging (CT +/- MRI). […] Urgent ENT review and consideration of neuro-otological imaging (contrast CT or MRI). […] Acute mastoiditis – drainage of mastoid +/- grommet if clinical or radiological evidence of subperiosteal access or other red flags.

• #69 Acute Mastoiditis: Pearls and Pitfalls – emDocs

  https://www.emdocs.net/acute-mastoiditis-pearls-and-pitfalls/

  Acute mastoiditis is the most common, and usually the initial, complication of AOM. […] The diagnosis can be confusing due to differing uses of the term “mastoiditis”. […] A clinical diagnosis of acute mastoiditis necessitates treatment with IV antibiotics with a consideration for tympanostomy and mastoidectomy. […] Any patient who is suspected of having complications of AOM should receive imaging and laboratory testing. […] Computed Tomography (CT) is the imaging study of choice. […] The most common causative agents of acute mastoiditis include staphylococcus, streptococcus, and pseudomonas species. […] Acute mastoiditis usually presents 2-6 days after the onset of symptoms of AOM. […] A full history and physical exam is always important when evaluating these patients.

• #70 Mastoiditis – Clinical Features – Investigations – TeachMePaeds

  https://teachmepaediatrics.com/ent/ear/mastoiditis/

  The diagnosis of acute mastoiditis is based mainly on thorough history-taking and clinical examination. Supporting investigations may be undertaken. […] CT head and mastoid with contrast is indicated in all cases of mastoiditis apart from cases of simple uncomplicated mastoiditis. CT images will typically show coalescence of the mastoid air cells along with an opaque mastoid and middle ear. It is also helpful in excluding intracranial complications of mastoiditis. […] MRI head under sedation or anaesthesia is helpful in cases of suspected complicated mastoiditis due to its increased sensitivity in highlighting soft tissue collections or vascular problems. Magnetic resonance venogram (MRV) is best at identifying venous thrombosis, which can be a complication of mastoiditis.

• #71 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  CT scanning of the temporal bone is the standard for evaluation of mastoiditis, with published sensitivities ranging from 87-100%. Some argue that all suspected cases of mastoiditis warrant CT scan evaluation. […] It is this authors belief that in the presence of clear clinical indications of acute surgical mastoiditis, CT scanning may be omitted prior to surgical intervention, avoiding unnecessary radiation exposure as recommended by the US National Institutes of Health. […] Magnetic resonance imaging (MRI) is not typically the radiographic study of choice; however, it is helpful in showing inflammatory processes and differentiating certain tumors. Do not use MRI as a method of evaluating the mastoid, although it is the standard for evaluation of contiguous soft tissue, particularly the intracranial structures.

• #72 Mastoiditis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24469-mastoiditis

  Often, healthcare providers treat mastoiditis with antibiotics and steroids. […] If these treatments dont help or theres a pocket of pus (abscess) in part of your temporal bone, you may need surgery (mastoidectomy) to remove the infected bone. […] Usually, mastoiditis symptoms go away a few days after you or your child starts taking antibiotics. […] Its important to finish taking all antibiotics as prescribed so the infection doesnt come back. […] Contact a healthcare provider if you or your child has symptoms of an ear infection, like ear pain that doesnt improve.

• #73 Diagnosis and Management of Mastoiditis

  https://www.scitechnol.com/peer-review/diagnosis-and-management-of-mastoiditis-DzxV.php?article_id=24483

  Mastoiditis is an infection or inflammation of the mastoid process, which is located behind the ear. […] The diagnostic process typically begins with a thorough medical history. The healthcare provider will inquire about the patient’s symptoms and any recent upper respiratory or ear infections. […] To confirm the diagnosis and assess the extent of mastoid involvement, imaging studies may be necessary. Computed Tomography (CT) scans are the preferred imaging modality for mastoiditis. […] In some cases, laboratory tests may be performed to identify the causative pathogen and guide antibiotic treatment. […] Early recognition, prompt treatment, and appropriate use of antibiotics are essential in preventing severe complications associated with mastoiditis.

• #74 Mastoiditis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24469-mastoiditis

  Often, healthcare providers treat mastoiditis with antibiotics and steroids. […] If these treatments dont help or theres a pocket of pus (abscess) in part of your temporal bone, you may need surgery (mastoidectomy) to remove the infected bone. […] Usually, mastoiditis symptoms go away a few days after you or your child starts taking antibiotics. […] Its important to finish taking all antibiotics as prescribed so the infection doesnt come back. […] Contact a healthcare provider if you or your child has symptoms of an ear infection, like ear pain that doesnt improve.

• #75 Investigations – Primary Care Notebook

  https://primarycarenotebook.com/pages/ear-nose-and-throat/acute-mastoiditis/investigations

  Investigations in acute mastoiditis may reveal: a raised white cell count, especially neutrophils […] opacity and air coalescence seen on mastoid radiograph […] Other possible features of acute mastoiditis that may be found are: a subperiosteal abscess over the mastoid process […] an abscess formed in the neck – Bezold’s abscess […] extension of infection to the zygoma, causing a zygomatic mastoiditis.

• #76 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=p02048

  Mastoiditis is a bacterial infection of the mastoid bone with inflammation. […] Mastoiditis is a complication of a middle ear infection. […] Your child’s healthcare provider will ask questions about your child’s health history and current symptoms. […] Your child may need an X-ray and CT scan of the mastoid area. […] Treatment often includes antibiotic medicine and draining the middle ear. […] This condition is often treated by an ear, nose, and throat doctor (ENT or otorhinolaryngologist). […] Complications can include hearing loss, facial nerve damage, and meningitis. Go to all follow-up appointments to check for hearing problems and other complications. […] Prompt treatment of all ear infections can help prevent mastoiditis.

• #77 Mastoiditis | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/mastoiditis

  How is mastoiditis diagnosed? […] In addition to a complete medical history and physical examination, your child’s doctor will inspect the outer ear(s) and eardrum(s) using an otoscope. […] Tympanometry, a test that can be performed in most doctors’ offices to help determine how the middle ear is functioning. […] Your child’s doctor may also order the following tests to help confirm the diagnosis: […] If your child has symptoms of a brain abscess or other intracranial complication, your child’s doctor may order the following: […] If your child has symptoms of meningitis, your child’s doctor may order a:

• #78 Mastoiditis | Children’s Wisconsin

  https://childrenswi.org/medical-care/ear-nose-and-throat/conditions/mastoiditis

  If your child has symptoms of a brain abscess or other intracranial complication, your child’s physician may order the following: Computerized tomography scan (Also called a CT or CAT scan.)- a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce images (often called „slices”), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays. […] Magnetic resonance imaging (MRI)- a diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. […] If your child has symptoms of meningitis, your child’s physician may order a: Lumbar puncture- a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child’s brain and spinal cord.

• #79 Paediatric Pathways

  https://bsac.org.uk/paediatricpathways/otitis-media-mastoiditis.php

  Acute presentation of ear pain (otalgia), discharge (otorrhoea) +- fever. AOM diagnosis is strengthened by the presence of a bulging tympanic membrane, air-fluid level behind the tympanic membrane, tympanic membrane perforation and/or discharge in the ear canal (although discharge only occurs in AOM if there is a tympanic perforation). Presence of fluctuant post auricular swelling and/or protrusion of the pinna suggest possible mastoiditis. […] If mastoiditis, consider contrast CT of petrous bones or if intracranial complications suspected, consider MRI brain/petrous bones. […] If signs of intracranial infection or mastoiditis, consider urgent neuro-otological imaging (CT +/- MRI). […] Urgent ENT review and consideration of neuro-otological imaging (contrast CT or MRI). […] Acute mastoiditis – drainage of mastoid +/- grommet if clinical or radiological evidence of subperiosteal access or other red flags.

• #80 Acute Mastoiditis: Pearls and Pitfalls – emDocs

  https://www.emdocs.net/acute-mastoiditis-pearls-and-pitfalls/

  Acute mastoiditis is the most common, and usually the initial, complication of AOM. […] The diagnosis can be confusing due to differing uses of the term “mastoiditis”. […] A clinical diagnosis of acute mastoiditis necessitates treatment with IV antibiotics with a consideration for tympanostomy and mastoidectomy. […] Any patient who is suspected of having complications of AOM should receive imaging and laboratory testing. […] Computed Tomography (CT) is the imaging study of choice. […] The most common causative agents of acute mastoiditis include staphylococcus, streptococcus, and pseudomonas species. […] Acute mastoiditis usually presents 2-6 days after the onset of symptoms of AOM. […] A full history and physical exam is always important when evaluating these patients.

• #81 Mastoiditis | Children’s Wisconsin

  https://childrenswi.org/medical-care/ear-nose-and-throat/conditions/mastoiditis

  If your child has symptoms of a brain abscess or other intracranial complication, your child’s physician may order the following: Computerized tomography scan (Also called a CT or CAT scan.)- a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce images (often called „slices”), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays. […] Magnetic resonance imaging (MRI)- a diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. […] If your child has symptoms of meningitis, your child’s physician may order a: Lumbar puncture- a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child’s brain and spinal cord.

• #82 Mastoiditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560877/

  Mastoiditis is a common complication of acute otitis media. […] Review the steps necessary for the evaluation of mastoiditis. […] Mastoiditis is a clinical diagnosis. Laboratory and imaging are used as an adjunct when you are unsure of the diagnosis or considering a complication of acute mastoiditis. […] CT imaging can reveal the disruption of the bony septation in the mastoid air cells and the potential extension of the infection. […] If mastoiditis does not improve in 48 hours, mastoidectomy is indicated. […] It is essential to have a thorough history and physical examination, as common mimics can be overlooked, resulting in missed diagnosis and delay in treatment. […] The majority of patients with uncomplicated acute mastoiditis have a resolution of symptoms with conservative measures, including antibiotics, steroids, and myringotomy, without the need for mastoidectomy. […] In cases where the patient’s clinical status does not change or deteriorates from admission, mastoidectomy is then indicated.

• #83 Acute Mastoiditis: Pearls and Pitfalls – emDocs

  https://www.emdocs.net/acute-mastoiditis-pearls-and-pitfalls/

  Acute mastoiditis is the most common, and usually the initial, complication of AOM. […] The diagnosis can be confusing due to differing uses of the term “mastoiditis”. […] A clinical diagnosis of acute mastoiditis necessitates treatment with IV antibiotics with a consideration for tympanostomy and mastoidectomy. […] Any patient who is suspected of having complications of AOM should receive imaging and laboratory testing. […] Computed Tomography (CT) is the imaging study of choice. […] The most common causative agents of acute mastoiditis include staphylococcus, streptococcus, and pseudomonas species. […] Acute mastoiditis usually presents 2-6 days after the onset of symptoms of AOM. […] A full history and physical exam is always important when evaluating these patients.

• #84 Mastoiditis

  https://fpnotebook.com/ENT/Ear/Mstdts.htm

  Mastoiditis is a clinical diagnosis. […] Normal white count and normal inflammatory markers (e.g. CRP) does NOT exclude diagnosis. […] Lack of mastoid air cell destruction on imaging does not exclude diagnosis.

• #85 Mastoiditis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/middle-ear-and-tympanic-membrane-disorders/mastoiditis

  Mastoiditis is a bacterial infection of the mastoid air cells, which typically occurs after acute otitis media. […] Diagnosis is clinical. […] Diagnosis of mastoiditis is clinical. CT is usually done, especially if an intratemporal or intracranial complication is suspected, to confirm the diagnosis and show the extent of the infection. […] Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) may be abnormal but are neither sensitive nor specific and add little to the diagnosis.

• #86 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  Despite the use of antibiotics, acute mastoiditis still remains a threat for patients with acute otitis media (AOM), especially for children younger than age 5 years. Great care is required on the part of clinicians to make an early diagnosis in order to promote adequate treatment and to prevent complications. […] Material for culture and sensitivity should be obtained from the ear (via tympanocentesis or myringotomy), blood, any abscess, and mastoid tissue (if it becomes available). Obtain and evaluate spinal fluid if any suggestion exists of intracranial extension of the process. […] A complete blood count (CBC) and sedimentation rate are obtained for baseline studies used to evaluate the efficacy of therapy. A high white blood cell count on admission may serve as a predictive factor for complicated cases.

• #87 Mastoiditis Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/2056657-workup

  CT scanning of the temporal bone is the standard for evaluation of mastoiditis, with published sensitivities ranging from 87-100%. Some argue that all suspected cases of mastoiditis warrant CT scan evaluation. […] It is this authors belief that in the presence of clear clinical indications of acute surgical mastoiditis, CT scanning may be omitted prior to surgical intervention, avoiding unnecessary radiation exposure as recommended by the US National Institutes of Health. […] Magnetic resonance imaging (MRI) is not typically the radiographic study of choice; however, it is helpful in showing inflammatory processes and differentiating certain tumors. Do not use MRI as a method of evaluating the mastoid, although it is the standard for evaluation of contiguous soft tissue, particularly the intracranial structures.

• #88 Mastoiditis – Clinical Features – Investigations – TeachMePaeds

  https://teachmepaediatrics.com/ent/ear/mastoiditis/

  The diagnosis of acute mastoiditis is based mainly on thorough history-taking and clinical examination. Supporting investigations may be undertaken. […] CT head and mastoid with contrast is indicated in all cases of mastoiditis apart from cases of simple uncomplicated mastoiditis. CT images will typically show coalescence of the mastoid air cells along with an opaque mastoid and middle ear. It is also helpful in excluding intracranial complications of mastoiditis. […] MRI head under sedation or anaesthesia is helpful in cases of suspected complicated mastoiditis due to its increased sensitivity in highlighting soft tissue collections or vascular problems. Magnetic resonance venogram (MRV) is best at identifying venous thrombosis, which can be a complication of mastoiditis.

• #89 Mastoiditis

  https://fpnotebook.com/ENT/Ear/Mstdts.htm

  Mastoiditis is a clinical diagnosis. […] Normal white count and normal inflammatory markers (e.g. CRP) does NOT exclude diagnosis. […] Lack of mastoid air cell destruction on imaging does not exclude diagnosis.

• #90 Is mastoiditis being over-diagnosed on computed tomography imaging? —radiological versus clinical findings – Pastuszek – Australian Journal of Otolaryngology

  https://www.theajo.com/article/view/4325/html

  It is hypothesized that opacification of the mastoid air cell system may not necessarily reflect coalescent changes or eventuate a diagnosis of AM. […] Overall, from the 1,946 CT scan reports and images reviewed, 52 scans (2.7%) had reported mastoiditis. Only 5.8% (3 of 52) ended up with a specialist diagnosis of AM. Therefore, 94.2% of CT reports with reported mastoiditis did not end up with a clinical diagnosis of AM. […] Radiological reporting of mastoiditis is not in keeping with the clinical entity of AM. […] Overall, 2.7% of CT scans showed mastoid opacification even in patients without acute middle ear symptoms. […] It is suggested from the analysis of available literature and the findings of this review that the radiological reporting of this finding would be better stated as mastoid opacification for clinical correlation if no bony erosion is seen.

• #91 Mastoiditis: Symptoms, Causes, and Treatment

  https://patient.info/doctor/mastoiditis

  Mastoiditis occurs when suppurative infection extends from a middle ear affected by otitis media to the mastoid air cells. The infective process causes inflammation of the mastoid and surrounding tissues and may lead to bony destruction. […] Early diagnosis and prompt treatment are important to reduce the risk of complications. […] Patients with suspected mastoiditis should usually be managed in a hospital setting. […] Appropriate clinical suspicion and prompt diagnosis are important to reduce the likelihood of complications. […] The usual initial therapy is high-dose, broad-spectrum intravenous (IV) antibiotics, given for at least 1-2 days (eg, with a third-generation cephalosporin). […] CT and/or MRI scanning can be used to aid diagnosis and look for intracranial complications. […] Incision and drainage of a subperiosteal abscess is another procedure that may be required. […] The prognosis for the vast majority of cases that are diagnosed early is excellent with a low chance of complications or severe hearing loss.

• #92 Mastoiditis: Symptoms, Causes, and Treatment

  https://patient.info/doctor/mastoiditis

  Mastoiditis occurs when suppurative infection extends from a middle ear affected by otitis media to the mastoid air cells. The infective process causes inflammation of the mastoid and surrounding tissues and may lead to bony destruction. […] Early diagnosis and prompt treatment are important to reduce the risk of complications. […] Patients with suspected mastoiditis should usually be managed in a hospital setting. […] Appropriate clinical suspicion and prompt diagnosis are important to reduce the likelihood of complications. […] The usual initial therapy is high-dose, broad-spectrum intravenous (IV) antibiotics, given for at least 1-2 days (eg, with a third-generation cephalosporin). […] CT and/or MRI scanning can be used to aid diagnosis and look for intracranial complications. […] Incision and drainage of a subperiosteal abscess is another procedure that may be required. […] The prognosis for the vast majority of cases that are diagnosed early is excellent with a low chance of complications or severe hearing loss.

• #93 Mastoiditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560877/

  Mastoiditis is a common complication of acute otitis media. […] Review the steps necessary for the evaluation of mastoiditis. […] Mastoiditis is a clinical diagnosis. Laboratory and imaging are used as an adjunct when you are unsure of the diagnosis or considering a complication of acute mastoiditis. […] CT imaging can reveal the disruption of the bony septation in the mastoid air cells and the potential extension of the infection. […] If mastoiditis does not improve in 48 hours, mastoidectomy is indicated. […] It is essential to have a thorough history and physical examination, as common mimics can be overlooked, resulting in missed diagnosis and delay in treatment. […] The majority of patients with uncomplicated acute mastoiditis have a resolution of symptoms with conservative measures, including antibiotics, steroids, and myringotomy, without the need for mastoidectomy. […] In cases where the patient’s clinical status does not change or deteriorates from admission, mastoidectomy is then indicated.

• #94

  https://journals.lww.com/otology-neurotology/fulltext/2008/09000/A_Systematic_Review_of_Diagnostic_Criteria_for.5.aspx?generateEpub=Article%7Cotology-neurotology:2008:09000:00005%7C10.1097/mao.0b013e31817f736b%7C

  To review systematically the literature for the current criteria and strategies used to diagnose acute mastoiditis in children. […] Only 26 of 65 articles reported the criteria upon which the diagnosis of acute mastoiditis in children was based. The criteria most frequently used were the clinical signs of postauricular swelling, erythema, tenderness, and protrusion of the auricle. […] There is a lack of consensus regarding the criteria and strategies for diagnosing acute mastoiditis in the pediatric population. It is crucial that such criteria are established, and consensus is achieved so that prognostic and controlled studies can be initiated to identify risk factors and establish the most effective management of this condition in children.

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