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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suffering from chronic mastoiditis. CT scan showed subtle soft tissue opacification in the mastoid. Is it dangerous?

Answered by
Dr.
Dr. Sadiq Mughal

Critical Care Specialist

Practicing since :1992

Answered : 1661 Questions

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Posted on Thu, 18 Oct 2012 in Ear, Nose and Throat Problems
Question: Hi
I had been suffering from chronic mastoiditis (as my doctor said). My CT scan report showed subtle soft tissue opacification in the mastoid. I also had bone scan which showed increased activity in the mastoid bone. I never had any discharge from my ear.
I had cortical mastoidectomy a month ago. In the surgery doctors found glue in the mastoid which was sent for culture. But culture report did not find anything. Mild granulation was found which was send for Histo-pathology Exam. The report says - mildly inflammed fibrocollagenous tissues. My surgery report says - "Disease cleared from all accessible air cells". I got some relief but still I have a dull pain in my temple region of my head and in the neck.
I am taking ciprofloxcin 750 mg twice a day for 7 days. Please let me know why is the dull pain still there after surgery. My doctor said my mastoid had bone sclerosis. What is that and is it dangerous?
Thanks,
XXXXXX
doctor
Answered by Dr. Sadiq Mughal 4 hours later
Hello XXXXXX,

Thanks for your question.

You have got done cortical mastoidectomy for chronic mastoiditis and you want to know cause of dull pain after surgery and what is bone sclerosis and finally if it is XXXXXX

Let me answer your question in reverse direction. First of all I address last part of your question that bone sclerosis is not a XXXXXX entity and you have got rid of it by cortical mastoidectomy. So relax in this regard.

The second part of your question, what is bone sclerosis, sclerosis primarily means thickening or hardening. In Bone sclerosis, due to inflammation there is wear and tear of bone. The body makes the bony area stronger by depositing new bone and calcium into the area there is also fibrous thickening, the area appear whiter than rest of bone more due to deposition of calcium.

And final cause of dull pain - To know the cause of pain you should know what mastoiditis is and what cortical mastoidectomy is. In mastoiditis there is inflammation of the mucosal lining of the mastoid antrum with mastoid air cell system inside from infection of the middle ear that is Otitis media, and in mastoidectomy a portion of bone is removed to drain the infection, so the dull pain which your experiencing could be due to removal of that part of bone which was infected.

The pain could also be due to some left over infected air cell or could be due to post operative wound infection or inadequately treated primary surgical pain. You are advised to consult your operating surgeon for management of pain.

I hope I answered your question, for any further query you are welcome to write back.

Get well soon.

Regards,

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Sadiq Mughal 12 hours later
Thanks for the reply.

I asked the surgeon about the pain. He told maybe its a neurological pain.

1. Can a neurological pain be there without infection? I am having the pain in my temple region of the affected ear. No pain at the back of the ear.
2. Since the culture did not reveal any pathogen, my surgeon is reluctant in giving antibiotics. He just gave me ciprofloxin 750mg for 7 days. Please suggest if I should continue this or any other better antibiotic for a long time.
3. I got my ear examined and ENT says my eardrum looks normal. Can there be infection even when the ear drum is normal?

Regards,
XXXXXX
doctor
Answered by Dr. Sadiq Mughal 10 hours later
Hi XXXXXX,

Thanks for follow up.

Yes, I know your culture was sterile; the material sent for culture was mastoid air cell and mastoid bone at the time of surgery. What I meant was any post operative infection after the surgery, which could give you pain, if your wound is healthy, means there is no post operative infection, so no need of any antibiotic anymore.

In mastoidectomy, your operation site is posterior to your ear, and if infection occurs it will occur at operation site. Before mastoidectomy, the source of infection to mastoid, come from middle ear that is posterior to your ear drum. Since your ear drum is normal your wound is healthy ( I presume that), so infection is ruled out.

Yes, there can be neurological pain, and as I mentioned in my answer in mastoidectomy, the mastoid air cell and sclerosed bone is removed, it may have injured small nerve twigs which may be giving you neurological pain, you can take analgesics that is pain killer, it will subside even if it is neurological pain.

Hope I addressed your follow up, for any further query; you are welcome to write back.

I wish you early recovery.

Regards,

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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