• Otomastoiditis is inflammation and infection involving both the middle ear (otitis media) and mastoid air cells.
• The mastoid process communicates with the middle ear through the aditus ad antrum, allowing spread of infection.

Etiopathogenesis

• Acute otitis media → spreads into mastoid air cells → acute mastoiditis.
• Chronic otitis media (with or without cholesteatoma) → causes chronic mastoiditis with sclerosis.
• Pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis (in children); Pseudomonas, Staphylococcus aureus in chronic disease.

Clinical Features

• Ear pain, fever, otorrhea, conductive hearing loss.
• Postauricular swelling, erythema, tenderness.
• Protruding auricle in acute mastoiditis.

Complications:

• Extracranial: subperiosteal abscess, Bezold’s abscess, petrositis, facial nerve palsy.
• Intracranial: sigmoid sinus thrombosis, meningitis, extradural/brain abscess.

Radiological Features

HRCT temporal bone:

| Acute otomastoiditis | • Opacification of middle ear + mastoid air cells. • Clouding of mastoid without bony sclerosis. • Possible coalescent mastoiditis: destruction of mastoid septae and cortex, abscess formation | | --- | --- | | Chronic otomastoiditis | • Sclerotic, poorly pneumatized mastoid (reactive bone). • Thickened mucosa, granulation tissue ± cholesteatoma. • Erosion of ossicles, scutum, tegmen, posterior canal wall in cholesteatomatous disease |

Management