Mastoidit

Mastoidit, or mastoiditis, is an infectious or inflammatory condition characterized by inflammation of the mastoid air cells in the temporal bone. It most often follows acute otitis media and is caused by bacterial spread from the middle ear; pathogens include Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and Haemophilus influenzae, with variations depending on vaccination status.

Clinical features include fever, retroauricular pain and tenderness, swelling and erythema behind the ear, and protrusion of the auricle. Children may have irritability, ear tugging, and poor feeding. Otorrhea, hearing loss, and vertigo may occur. On examination, postauricular edema and a limited range of motion of the head may be observed.

Diagnosis is based on clinical presentation and imaging when needed. Otoscopy may show middle-ear infection. Computed tomography of the temporal bone is the preferred imaging test to assess mastoid air cell involvement and bony erosion. MRI can be used to evaluate intracranial complications. Laboratory tests are supportive.

Treatment requires prompt antibiotic therapy; initial management often includes intravenous antibiotics tuned to cover common pathogens. Surgical intervention, such as drainage of a subperiosteal abscess or mastoidectomy, is considered for abscess formation, coalescent mastoiditis, or failure to respond to medical therapy.

Complications can be serious and include intracranial spread (meningitis, brain abscess), venous sinus thrombosis, facial nerve palsy, and Bezold or Bezold's abscess. With timely treatment, prognosis is generally favorable, but delays increase the risk of sequelae. Prevention relies on proper management of otitis media and vaccination against pneumococcus.