H70.9
DESCRIPTION
A serious condition involving acute infections of mastoid antrum that could spread to the adjacent brain and could occur secondary to an ear infection. Is usually due to bacterial infections but also consider tuberculosis in this condition.
DIAGNOSTIC CRITERIA
Clinical
- Fever, severe pain, hearing impairment, tenderness over mastoid antrum.
- Swelling in post-auricular area. Pinna is pushed down and forward.
- Tympanic membrane is often perforated with otorrhoea.
- Occasionally, pus breaks through the mastoid tip and forms an abscess in the neck.
- If seizures, headache, LOC and neck stiffness, do CT scan.
Investigations
- CT brain scan to exclude intracranial spread.
- Collect blood and pus for Gram stain, microscopy, culture and sensitivity tests before initiation of antibiotic therapy.
GENERAL AND SUPPORTIVE MEASURES
- Dry mopping of the external auditory canal.
MEDICINE TREATMENT
Antibiotic therapy
As soon as there is clinical improvement and patient can tolerate oral medication, change to oral antibiotics based on culture and sensitivity.
Total duration of therapy: at least 14 days.
- Ceftriaxone, IV, 80 mg/kg once daily.
Note:
Adjust antibiotic therapy based on culture results or if response to antibiotic therapy is unsatisfactory.
As soon as there is a response and patient can tolerate oral medication:
- Amoxicillin/clavulanic acid, oral, 30 mg/kg/dose of amoxicillin component, 8 hourly.
For pain:
- Refer to Chapter: Pain Control, Management of Pain .
REFERRAL
Urgent
- To ENT surgeon after initiation of antibiotics.