MRI (Magnetic Resonance Imaging) scans
may detect a fluid signal in the mastoid sinus on T2 studies. This
is often described as "mastoiditis" by the radiologist.
However, in the absence of pain, fever and an abnormal ear exam this
finding should not considered diagnostic of mastoiditis and is usually
considered a normal variant.
The case presented below is a child which developed acute coalescent mastoiditis with a sub-periosteal abscess. Almost all cases develop from patient non-compliance or an untreated acute otitis media . The child had been treated with multiple antibiotics including Augmentin ( Amoxcillin / Clavulanate ), none of which eradicated the infection . Bacterial resistance was suspected and it was elected to perform complete surgical drainage by performing a mastoidectomy .
Preoperative Appearance of the Child. Note the protrusion of the auricle from a sub-periosteal abscess. The abscess at the time of surgery was found to contain 6 cc of pus and had direct communication with the mastoid air cells through a small bony dehiscence. He cultured Streptococcal Pneumonia resistant to penicillin, trimethoprim/sulfamethoxazole, erythromycin and intermediate susceptible to Ceftriaxone. Examination of the child's ear showed an acute otitis media . The posterior -superior canal was not collapsed, as is sometimes seen in this disease.
Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery , American Academy of Otolaryngology-Head and Neck Surgery , American Head and Neck Society
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;Preacute Population Health Management;The Physicians Edge<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Rxblockchain;Bridge Health.
The doctor will ask you to describe your dizziness and answer questions about your general health. Along with these questions, your doctor will examine your ears, nose, and throat. Some routine tests will be performed to check your blood pressure, nerve and balance function, and hearing. Possible additional tests may include a CT or MRI scan of your head, special tests of eye motion after warm or cold water or air is used to stimulate the inner ear (ENGelectronystagmography or VNGvideonystagmography), and in some cases, blood tests or a cardiology (heart) evaluation. Balance testing may also include rotational chair testing and posturography. Your doctor will determine the best treatment based on your symptoms and the cause of them. Treatments may include medications and balance exercises.