Mastoiditis Complications: Intracranial Spread, Facial Palsy & Sepsis

Pathophysiology

Mastoiditis = infection of mastoid air cells (usually from untreated acute otitis media). Thin bone septa allow spread to adjacent structures.

Major Complications

Diagnosis & Urgent Management

CT temporal bone (contrast) – gold standard.
IV antibiotics (ceftriaxone + metronidazole; vancomycin if MRSA risk).
Myringotomy + ventilation tube (drain middle ear).
Mastoidectomy (cortical/modified radical) if medical failure, complications.
Neurosurgery/IR consult for abscess/sinus thrombosis.

Key Point

Mastoiditis is a surgical emergency in the antibiotic era. Delay → irreversible neurologic injury or death. Pediatricians, ENTs, ER physicians must maintain high index of suspicion.

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Complication	Mechanism	Clinical Signs
Meningitis	Septal erosion → subdural/epidural spread	Fever, nuchal rigidity, photophobia, AMS
Brain Abscess	Direct extension or thrombophlebitis	Focal deficits, seizure, headache, fever
Sigmoid Sinus Thrombophlebitis	Inflammation → thrombus in sigmoid sinus	Picket-fence fever, headache, papilledema
Facial Nerve Palsy (CN VII)	Dehiscence in fallopian canal → edema/compression	Peripheral facial weakness (forehead spared? no – LMN)
Labyrinthitis	Erosion into otic capsule	Vertigo, SNHL, nystagmus
Subperiosteal Abscess	Periosteal elevation (postauricular)	Fluctuant swelling, ear protrusion, erythema
Sepsis	Bacteremia from venous thrombosis	SIRS/qSOFA criteria, hemodynamic instability