Section 2

Describe the abnormality and likely diagnosis shown in the photograph.

Acute mastoiditis (left) 

What might you expect to see on otoscopy?

  • Bulging erythematous tympanic membrane
  • Possibly purulent discharge

List three presenting symptoms.

  • Pyrexia
  • Otalgia
  • Otorrhea

What is the most common aetiology?

Acute otitis media

Describe two management options.

  • IV antibiotics
  • Cortical mastoidectomy

List three complications that may result from this condition?

  • Intracranial
    • Extratemporal
      • Meningitis
      • Brain abscess
      • Subdural abscess
      • Epidural empyema
      • Sigmoid sinus thrombosis
    • Intratemporal
      • Labyrinthitis
      • Facial palsy
      • Petrositis
  • Extracranial
    • Subperiosteal abscess
    • Bezold abscess
    • Citelli abscess
  • Luc abscess

Supporting information


Acute otitis media– infection of the middle ear. 

  • Common in children
  • Often bilateral
  • Bacterial/viral
  • Strep pneumonia and H influenza most common then moraxella catarrhalis, strep pyogenes and staph aureus. 

Symptoms; severe otalgia, hearing loss, pyrexia, bulging eardrum, perforation of TM with relief. 

Treatment; systemic or oral abx- penicillin, swab, surgical myringotomy if very severe and if abx haven’t worked. 


  • Mastoiditis- mastoid air cells close to the middle ear. Tender postauricular swelling with opaque mastoid on CT – mastoiditis. If no response in 24 hrs of IV antibiotics for cortical mastoidectomy with all air cells drilled and drain left in may require grommets.
    • Can mimic postauricular lymphadenopathy differentiated by coryzal symptoms, red bulging tympanic membrane, fever, pain and loss of postauricular skin crease
    • Also mimic sebaceous cyst/epidermoid cyst etc
    • pinna pushed down and out
    • Rubella can give kids postauricular lymphadenopathy as well as scalp infection
    • Strep pneumoniae, haemophilus influenzae and moraxella catarrhalis
    • Co-amoxiclav (H influenzae resistant to amoxicillin)
  • Meningitis
  • Extradural abscess- extension around the lateral sinus or above the tegmen tympani (thin plate of bone forming the roof of the tympanic cavity)
  • Subdural abscess
  • Brain abscess- temporal lobe or cerebellum
  • Facial palsy- in presence of dehiscent facial nerve canal
  • Petrositis- spread to petrous apex of temporal bone- weakness of V and VI- gradenigo’s syndrome
  • Citelli’s abscess- posterior to mastoid involving/abutting occipital bone and anterior inferior to mastoid tip involving digastric muscle 
  • Bezold’s abscess- sheath of sternocleidomastoid forming an anterior border mass. 
  • Luc abscess- under temporal muscle
  • Sigmoid sinus thrombosis
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