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Radiology of acute mastoiditis and its complications: a pictorial review and interpretation checklist

  • M W Mather (a1), P D Yates (a1), J Powell (a1) and I Zammit-Maempel (a2)



Mastoiditis is an otological emergency, and cross-sectional imaging has a role in the diagnosis of complications and surgical planning. Advances in imaging technology are becoming increasingly sophisticated and, by the same token, the ability to accurately interpret findings is essential.


This paper reviews common and rare complications of mastoiditis using case-led examples. A radiologist-derived systematic checklist is proposed, to assist the ENT surgeon with interpreting cross-sectional imaging in emergency mastoiditis cases when the opinion of a head and neck radiologist may be difficult to obtain.


A 16-point checklist (the ‘mastoid 16’) was used on a case-led basis to review the radiological features of both common and rare complications of mastoiditis; this is complemented with imaging examples.


Acute mastoiditis has a range of serious complications that may be amenable to treatment, once diagnosed using appropriate imaging. The proposed checklist provides a systematic approach to identifying complications of mastoiditis.


Corresponding author

Author for correspondence: Mr Michael W Mather, Institute of Cellular Medicine, 3rd Floor, Leech Building, Framlington Place, Newcastle University, Newcastle upon Tyne NE2 4HH, UK E-mail:


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Mr M W Mather takes responsibility for the integrity of the content of the paper



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1Psarommatis, IM, Voudouris, C, Douros, K, Giannakopoulos, P, Bairamis, T, Carabinos, C. Algorithmic management of pediatric acute mastoiditis. Int J Pediatr Otorhinolaryngol 2012;76:791–6
2Lemmerling, M, Smet, B, De Foer, B. Cross-sectional imaging anatomy of the temporal bone. In: Lemmerling, M, De Foer, B, eds. Temporal Bone Imaging. Berlin: Medical Radiology, Springer, 2014
3Juliano, AF, Ginat, DT, Moonis, G. Imaging review of the temporal bone: part I. Anatomy and inflammatory and neoplastic processes. Radiology 2013;269:1733
4Mirza, O, Varadarajan, V, Youshani, AS, Willatt, DJ. Escherichia coli positive infratentorial subdural empyema secondary to mastoiditis and underlying cholesteatoma. BMJ Case Rep 2014;2014:bcr2014204498
5Gradenigo, G. On paralysis of the abducens nerve in otitis [in German]. Arch Ohrenheilkunde 1907;774:149–87
6Allam, AF, Schuknecht, HF. Pathology of petrositis. Laryngoscope 1968;78:1813–32
7Jensen, PVF, Hansen, MS, Møller, MN, Saunte, JP. The forgotten syndrome? Four cases of Gradenigo's syndrome and a review of the literature. Strabismus 2016;24:21–7
8Zammit-Maempel, I. Imaging the temporal bone. Imaging 2014;23:20110070
9Platzek, I, Kitzler, HH, Gudziol, V, Laniado, M, Hahn, G. Magnetic resonance imaging in acute mastoiditis. Acta Radiol Short Rep 2014;3:2047981614523415
10Migirov, L, Duvdevani, S, Kronenberg, J. Otogenic intracranial complications: a review of 28 cases. Acta Otolaryngol 2005;125:819–22
11Duarte, MJ, Kozin, ED, Barshak, MB, Reinshagen, K, Knoll, RM, Abdullah, KG et al. Otogenic brain abscesses: a systematic review. Laryngoscope Investig Otolaryngol 2018;3:198208
12Abbati, SG, Torino, RR. Spontaneous intraparenchymal otogenic pneumocephalus: a case report and review of literature. Surg Neurol Int 2012;3:32
13Luscan, R, Belhous, K, Simon, F, Boddaert, N, Couloigner, V, Picard, A et al. TMJ arthritis is a frequent complication of otomastoiditis. J Craniomaxillofac Surg 2016;44:1984–7
14Gaffney, RJ, O'Dwyer, TP, Maguire, AJ. Bezold's abscess. J Laryngol Otol 1991;105:765–6
15Luc, H. The sub-periosteal temporal abscess of otic origin without intraosseous suppuration. Laryngoscope 1913;23:9991003
16Scrafton, DK, Qureishi, A, Nogueira, C, Mortimore, S. Luc's abscess as an unlucky complication of mastoiditis. Ann R Coll Surg Engl 2014;96:e2830
17Mather, M, Musgrave, K, Dawe, N. Is anticoagulation beneficial in acute mastoiditis complicated by sigmoid sinus thrombosis? Laryngoscope 2018;128:2435–6
18Redaelli de Zinis, LO, Gasparotti, R, Campovecchi, C, Annibale, G, Barezzani, MG. Internal jugular vein thrombosis associated with acute mastoiditis in a pediatric age. Otol Neurotol 2006;27:937–44
19Shon, AS, Berenson, CS. Pseudomonas aeruginosa intrapetrous internal carotid artery mycotic aneurysm--a complication of mastoiditis: first reported case. BMJ Case Rep 2013;2013:bcr2013200005
20Smith, CP, Jackson, C, Stewart, R. Subacute bacterial endocarditis secondary to mastoiditis: a rare complication. BMJ Case Rep 2012;2012:bcr2012007247


Radiology of acute mastoiditis and its complications: a pictorial review and interpretation checklist

  • M W Mather (a1), P D Yates (a1), J Powell (a1) and I Zammit-Maempel (a2)


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