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Dull pain around ear and temples, jaws are stiff. CT suggests chronic mastoiditis. Middle ear had burst, grommet inserted. Mastoidectomy ?

Hi 6 months back I had a viral ear infection . I had blood filled blisters on my ear drum. Fluid (lot of blood + pus ) got accumulated in my middle ear after those bursted and for that a grommet was inserted after 20 days of the infection. My hearing returned to normal but since then I am having pain in my TMJ region. My grommet was taken out after 2 months of its insertion since my doctor found it unnecessary. My MRI /CT shows minimal fluid in my mastoid. I also had a bone scan and the last phase of it (SPECT) came to be positive. I have been put on IV antibiotics (Piptaz + Oflox) for 3 weeks and then had 3 weeks of oral ciprofloxcin. My MRI after antibiotic shows no fluid in mastoid. Only the last phase of bone scan is still positive. When I asked the nuclear medicine doctor about the report, he told me its just a osteoblastic response and no active infection. He explained that had it been active bone infection (osteomyelitis) it should have come in all the three phases of the scan. He told it takes time for the bone scan to be normal. I have a dull pain around my ear and sometimes this goes to my temple region. My preauricular jaw region is stiff and pains when pressed hard. However I don t have any pus coming out of my ear and my TM is fine according to my ENT. I had a CT scan yesterday which shows subtle soft tissue opacification in posterio-inferior mastoid air cells suggesting chronic mastoiditis. Now I don t have any pain on back of my ear. I wanted to know if I am healing or is there still infection. Also please advice is it time for me to go for mastoidectomy? Please let me know if you require any more information. Thanks, AAAAA
Asked On : Mon, 13 Aug 2012
Answers:  2 Views:  190
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Pulmonologist 's  Response
Hi Mithun,
thanks for your query.
i think as per your bone scan report your mastoid is in the healing stage i.e. why there is osteoblastic response
but what it requires is that serial follow up and continuation of oral antibiotic treatment
if in future it causes too much problem and if there is residual diseases even after medical management for a prolonged time then mastoidectomy may be required
right now its better to continue medical management
but serial follow up is really required
thank you
Answered: Mon, 13 Aug 2012
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Internal Medicine Specialist Dr. Ram Choudhary's  Response
Hi Mithun,
Welcome to healthcare magic!
Your problem is chronic, it is ironic that a trouble started by a virus taken over by bacteria and lastly has landed up in nonspecific inflammation.
But still I would advise you to have a CBC, CRP & Pro-Calcitonin levels done, just to have an idea about nature of inflammation.
You had aggressive treatment with antibiotics and had initial response as well, I would advise at present to give time, may be the condition will resolve. You can undergo Mastoidectomy later on safely.
Take tablet Lyser-D for 15 days twice a day after meals to suppress inflammation.
Get imaging about a month later only if you have symptoms.
I hope this advise would be helpful for you.

Wish you a great health!
Answered: Mon, 13 Aug 2012
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