ENT/Otology: Mastoiditis
High-Yield Revision for NEET PG
Acute Mastoiditis is an inflammatory process of the mastoid air cells, typically secondary to untreated or inadequately treated Acute Otitis Media (AOM). It is an emergency due to the risk of intracranial complications.
1. Clinical Presentation
- Post-auricular pain, swelling, and redness.
- Protrusion of the auricle (pinna) downwards and outwards.
- Sagging of the postero-superior meatal wall (the earliest diagnostic sign of mastoiditis).
- Otorrhea and persistent fever.
2. Complications (The “Dreaded Five”)
| Extracranial | Intracranial |
|---|---|
| Post-auricular abscess | Meningitis (most common) |
| Bezold’s abscess | Lateral sinus thrombophlebitis |
| Facial nerve palsy | Brain abscess |
3. NEET PG High-Yield Pearls
- Imaging: CT Temporal bone (with contrast) is the investigation of choice to assess bone destruction and abscess formation.
- Management: IV antibiotics (targeted to Streptococcus pneumoniae) + Myringotomy (drainage) + Mastoidectomy (if unresponsive/complicated).
- Bezold’s Abscess: Results from pus tracking into the neck via the tip of the mastoid process (digastric notch).
- Pathophysiology: The mastoid air cells are continuous with the middle ear cleft; inflammation leads to stasis, hypoxia, and eventual osteitis of the mastoid bone.