Mastoiditis vs Malignant OE

[pinipig523]

Question for you pros...

Otitis media causing mastoiditis vs malignant otitis externa - how do you differentiate the two?

My understanding is that OE that causes destruction of soft tissue into surround areas including mastoid air cells is Malignant OE by definition. Now, OM that extends into the mastoid air cells is Mastoiditis by definition.

The reason why I think it's key to differentiate between the two is that MOE is more aggressive than Mastoiditis and the treatment for each is different. MOE needs IV abx for 6 weeks while Mastoiditis (w/o periosteal abscess) can be treated w/ po abx.

I had a patient last week who presented w/ an exam consistent w/ OE and we got a CT temporal bone - it showed opacification of the mastoid air cells with some degeneration.

I had a discussion with the other senior resident and it was decided that the patient had OE and OM causing mild mastoiditis. The ENT resident also concurred.

I don't get it..... I thought that if you have OE and mastoid involvement - that was MOE by definition?

Is there something I'm missing? Do you need destruction of the surround temporal bone around the external canal + mastoid air cells to call it MOE?

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[name?]

Was the patient toxic? Diabetic? The only malignant OE I've seen was toxic, hyperglycemic and looked like they needed the good stuff. The smoldering AOM that ends up extending into mastoiditis usually isn't as sick, and in bad OE, you often can't see the TM to see if there is concomitant AOM. And, unless the mastoid is warm, tender and nasty, it may be opacified due to adjacent inflammatory changes instead of true infection.

 

[Nevis]

Can you treat Mastoiditis with PO meds? I was under the impression that it is IV abx initially with a switch to PO after a good response has been shown. If you know of a source that addresses when it is permissible to use PO over IV abx's can you please post it. I'm a FM doc and you guys may have read some EM journals that had articles addressing this issue that i haven't seen. Thanks.

 

[pinipig523]

Can you treat Mastoiditis with PO meds? I was under the impression that it is IV abx initially with a switch to PO after a good response has been shown. If you know of a source that addresses when it is permissible to use PO over IV abx's can you please post it. I'm a FM doc and you guys may have read some EM journals that had articles addressing this issue that i haven't seen. Thanks.

I have to search for the literature - but I'm going with what ENT told me. PO meds for mastoiditis but you can start with IV to ensure response then wean to PO and home.

 

[Rendar5]

I understood Malignant Otitis Externa to be an osteomyelitis by definition, not a soft tissue destruction

 

[pinipig523]

I understood Malignant Otitis Externa to be an osteomyelitis by definition, not a soft tissue destruction

Understood... and mastoiditis is also an inflammation/infection of the bone which can also lead to osteomyelitis of the bone.

Interestingly enough, I was redirected to this website which actually clarifies Mastoiditis vs MOE to great effect.