What is Right (RT) mastoiditis?

From the Guidelines

RT mastoiditis refers to right-sided mastoiditis, which is an infection of the mastoid bone located behind the ear, typically occurring as a complication of acute otitis media (middle ear infection). This condition is a serious complication that requires prompt treatment to prevent further complications. According to a study published in 2017 in the journal Otolaryngology--head and neck surgery 1, acute mastoiditis is a significant complication of otitis media, with varying trends in incidence reported in recent studies.

Key Points to Consider

• RT mastoiditis is an infection of the mastoid bone, which can lead to serious complications if left untreated or inadequately treated.
• The treatment approach typically involves a combination of intravenous antibiotics, pain management, and close monitoring, with surgical intervention considered if symptoms persist or worsen.
• The choice of antibiotics, such as ceftriaxone or ampicillin/sulbactam, is crucial in managing the infection effectively.
• Completing the full course of antibiotics is essential to prevent recurrence and antibiotic resistance.

Treatment Approach

1. Intravenous antibiotics: Initiate treatment with broad-spectrum antibiotics, such as ceftriaxone 1-2g IV every 24 hours or ampicillin/sulbactam 3g IV every 6 hours for 7-10 days.
2. Pain management: Use acetaminophen 650mg orally every 6 hours or ibuprofen 400mg orally every 6 hours as needed to manage pain and discomfort.
3. Surgical intervention: Consider a mastoidectomy if symptoms persist or worsen after 24-48 hours of antibiotic therapy to drain the infection and remove infected bone.
4. Close monitoring: Regular follow-up is necessary to assess improvement and potential complications, ensuring prompt intervention if needed.

Importance of Prompt Treatment

Prompt treatment of RT mastoiditis is crucial to prevent serious complications such as meningitis, brain abscess, or facial nerve paralysis, as the mastoid bone's structure allows infections to spread quickly 1. Patients should be advised to complete the full course of antibiotics even if symptoms improve to prevent recurrence and antibiotic resistance.

From the Research

Definition and Overview of Mastoiditis

• Mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality 2
• It is a suppurative infection of the mastoid air cells, often associated with otitis media 2
• Common bacteria include Streptococcus and Staphylococcus 2

Clinical Presentation

• History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise 2
• The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms 2

Diagnosis and Management

• Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis 2
• Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis 2
• Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation 2

Complications

• Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures 2
• A high white blood cell count on admission may serve as a predictive factor of complicated cases 3

Right (RT) Mastoiditis

• There is no specific information available on Right (RT) mastoiditis, as the provided studies do not differentiate between right and left mastoiditis
• However, the information provided on mastoiditis in general can be applied to Right (RT) mastoiditis, as the condition is not typically specified as being specific to one side 4, 3, 2, 5, 6