Acute otomastoiditis

Acute otomastoiditis is largely a disease of childhood, most frequently due to bacterial infections, with Streptococcus pneumoniae and Haemophilus influenzae account for 65 - 80% of cases, with H. inf although less common, being the more aggressive agent, and more frequently resulting in complications, especially meningitis.

Usually antibiotics are all that is required for treatment, and imaging is usually not required. When mucoperiosteal involvement evolves into bony involvement, with resorption of bony septae between adjacent mastoid air cells, the condition should be referred to as coalescent mastoiditis (intramastoid empyema) , and complications become much more likely.

Agents

• Streptococcus pneumoniae - most common
• Haemophilus influenzae - common and more aggressive than pneumococcus
• Aspergillus - aggressive, seen in older patients. Frequently associated with facial nerve dysfunction.
• Tuberculous otomastoiditis - increasing frequency due to greater immunocompromised population.

Complications

• subperiosteal abscess (mastoid)
• labyrinthitis
• petrous apicitis
• intracranial extension
  • meningitis
  • subdural empyema
  • cerebral abscess
  • dural sinus occlusive disease (DSOD)
• facial nerve dysfunction
• thrombosis of mastoid emissary vein ("Griesinger's sign")