mastoiditis

August 4, 2000

mastoiditis

Mastoiditis is a bacterial infection of the air cells in the bony skull in

the area behind the ear. The air chambers serve to lighten the skull; they

communicate with the outside air via small passages that lead to the inner

ear behind the eardrum. Mastoiditis almost always occurs as a complication

of untreated otitis media with chronic ear drainage. Once very common

(mastoidectomy was once the most common operation in the United States as

late as the 1940's), the infection has all but disappeared. I have seen two

cases in my career.

Parents will from time to time encounter articles in which it is stated that

in certain European countries, antibiotics are not given for ear infections

routinely. These articles usually fail to add that the incidence of

mastoiditis, with its attendant complications of painful illness, surgery

and hearing loss, are much higher in those countries. Now that the push is

on to cut back antibiotic treatment of otitis media, I suppose we will have

to learn about this disease again.

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May 16, 2012

Macey went through a type of infection like this but more in her sinuses

when she was 3 or 4. It helped us re-evaluate her dose (she was on IV at

the time) and we stepped up our vigilance about her deficiency. She

started maintenance antibiotics too.

Pseudomonas is known to grow in the ear even in immune competent people so

the culture is not a surprise but it can get out of hand in PID patients.

Infections in these areas make ENT's very nervous because it is so close

to the brain and can develop into meningitis. Macey had an ethmoid

infection once with orbital cellulitis that landed her in the hospital for

a couple of days and then home with a PICC line and 12 weeks of IV

antibiotics.

Hope things improve soon. If trough levels showed the dose was not

appropriate and he's had these break through infections then I would give

the new dose several infusions to catch up and see how he does before

thnking he needs more workup.

Ursula - mom to Macey (17,CVID) and wife to Les (CVID)

On Wed, May 16, 2012 at 9:54 PM, Liz Pence <pencesiding@...> wrote:

> **

>

> I haven't posted in a while. Things have been much better for us since we

> started subq hizentra. We did have one hospitalization for an asthma attack

> last month, but that has been the only biggie since Jan of this year.

> 1 week ago my 4yo got an ear infection. No big deal it happens to us a

> lot. We went and were giving zithromax on day one of pain. Within 2 days he

> was a screaming writhing fevered mass of hot mess. We went to children's er

> where he was looked at, labs drawn and ct scanned. Justus has mastoiditis.

> FYI: I should not have googled that one... We were admitted for iv

> antibiotics and his ear goo sent for culture. He grew pseudomonas.

> Our immunologist came, his igg needed to be higher so we got mega dose of

> ivig while in hospital. Lots of antibiotic. They seemed super concerned

> about the pseudomonas. Said it's opportunistic. I feel very afraid now. I

> am worried it won't go away or he'll get something worse. In middle of our

> hospital stay he had another bad asthma attack...

> Now his doctors are calling him fragile and we have appts every 2 days for

> the next 2 weeks with ENT, primary and immuno.

> Aside from whining I am looking for info on what we are dealing with.

> Anyone else delt with this kind of stuff? Is this an indication that I need

> to go to a bigger center for evaluation or just a fluke? It really seemed

> like everything was under control. I feel like I came close to losing him

> last week...

>

May 16, 2012