Acute
Mastoiditis and Mastoid Infections
Disease/Disorder Name:
Acute Mastoiditis
ICD-9 Description:
Acute
Mastoiditis and Other Complications
ICD-9 Code Family: 383.02
Description:
Various infections
and complications on the mastoid area including
Gradenigo's Syndrome.
Mastoid
Infection (Mastoiditis)
The mastoid is part of the skull
and is made up of spongy bone just
behind the ear.
Mastoiditis is an
infection of the bony air cells in the
mastoid bone. In fact the middle
ear and the inner ear (cochlea) are
embedded in the mastoid bone.
Indications of a mastoid infection
are itching, reddening and swelling behind the
ear. The cause is usually from an
untreated middle ear infection (See
Otitis Media), so otitis media
symptoms are often present. An untreated
middle ear infection can slowly spread
into the mastoid cells. When infection
expands into the mastoid bone area
it is
known as mastoiditis.
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Note the mastoid bone swelling
behind the ear |
Another example showing a child's
right ear being pushed forward by
the mastoid infection |
Symptoms of the mild form of
mastoiditis show a reddening behind the
ear and swelling and sensitivity to
touch. An acute case of mastoiditis
shows a pronounce bulbous swelling that
can push the ear forward.
Mastoiditis treatment:
Treatment for Mild Mastoiditis
Antibiotics are the normal treatment
for the mild form of mastoiditis. There
are a number of antibiotics available to
treat mastoiditis (and coincidentally,
any otitis media that is present). Because there are few
blood vessels permeating the mastoid
area, a normal 10 day protocol of
antibiotics may be extended to 14 days
to make sure the medicine penetrates the
bony mass. This protocol should also
clear up any
otitis media present .
Treatment for Acute Mastoiditis
Acute mastoiditis is quite visually
apparent - a large swelling behind the
ear accompanied by high fever, ear pain,
sensitivity to touch, and hearing loss.
In serious cases, the facial nerves may
become paralyzed.
Diagnostic Procedures to determine the
extent of the Mastoiditis
A hospital setting is usually the
only facility capable of performing some
of the diagnoses to understand the
extent of a mastoid infection. A CT/PET/ scan
and/or X-rays will be used to assess the
extent of the infection. If the
mastoiditis is readily apparent i.e. a
swelling behind the ear the size of a
hens egg,
antibiotics will be immediately administered,
usually by IV.
To assist with diagnostic procedures
and antibiotic therapy, and if the
eardrum has not burst, a small incision
will often be made in the eardrum
(myringotomy) to allow drainage of the
infection and to alleviate pain.
If, and that's a big "if"
it is seen that the antibiotics are seen
to kill the bacteria causing the
infection, then no surgery may be
performed. But this situation rarely
occurs, and usually if the swelling is
quite large, after the scanning
sessions, antibiotic administration will be
continued and surgery
will be performed as soon as possible.
Mastoid Surgery
(Mastoidectomy)
The
operation is usually performed by an ENT
(Ear Nose Throat) surgeon or a head and neck
surgeon and the mastoidectomy is done under general
surgery. It involves drilling away
and removing the infected bone.
Surgical
Procedures
An
incision is made behind the ear and the
flap is lifted forward.
Photo Courtesy of The Internet Journal of
Otorhinolaryngology
A circle is cut out of
the bone covering the the mastoid and
showing the infected area. The spongy
mass that is infected is then cut away
and removed (it looks like pieces of
coral or hard sponge, although when they
are infected, they feel like soft mush).
After the bone removal, the remaining
cavity is cleaned, coated with
antibiotics and if possible the bone cover is "sewn"
back to the rest of the skull, and the
flap of skin stitched back together. An
outer pressure dressing is then worn for
1-2 days after surgery.
If too
much mastoid material has been removed,
and it is not possible to reattach the
bone covering, the bone covering is left
off and the skin
flap is stitched back to the surrounding
tissue. After
healing, there will be a permanent depression
behind the ear.
Mastoid Surgery
Recovery
The stay
in the hospital is usually 1-3 days.
After discharged from the hospital, a
full regimen of antibiotics will be
continued (10-14 day regimen).
The
stitches will be removed after about 2
weeks. Full recovery will take 3-4 weeks
with possibly bouts of dizziness and
headaches during this time. Over time
the headaches and dizziness should
diminish.
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