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Thursday, July 31, 2014
Ear, Nose, and Throat Disorders
Mastoid air cell disease
I have had 3 CAT-scans and 2 MRIs trying to find out the source of frequent fevers, headaches, unexplained weight gain, among many other very odd symptoms. From all of these tests, the only thing that seemed to explain the fevers was a diagnosis of "bilateral mastoid air cell disease". I frequently feel a little "yucky" and can`t quite kick it. I have been on antibiotics for about 6 weeks, the most current being doxycycline. The MRI was done during the 5th week of antibiotic treatment.
Does this mean that antibiotic therapy most likely will not treat this type of problem? Any advise or information (other than seeing an ENT, which I will be doing soon) would be helpful. Thanks
From the information that you've provided, it certainly sounds reasonable to pursue an evaluation with an otolaryngologist (ENT doctor).
One of the cautions to consider is that "mastoid air cell disease" as noted on MRI scans and to a lesser extent, on CT scans, can sometimes be "over-interpreted" or "over-diagnosed". What this means is that scans can sometimes detect subtle abnormalities (e.g. fluid in the mastoid air cells) that cause no real problems for the patient and might not require treatment.
If the clinical picture was that of someone who had acute ear pain, drainage out of the ear, swelling and redness behind the ear, then findings of mastoid air cell disease on MRI would take on a much more prominent importance and relevance. But if someone has no real symptoms that localize specifically to the ears or the mastoid area, then the importance and relevance of the MRI findings need to be weighed in the context of the clinical picture.
As a general guideline, isolated mastoid air cell disease or fluid (as noted on a scan) would be a weak explanation for the constellation of symptoms that you describe in your summary. Its difficult for ear problems to cause an overall (whole body) feeling of fatigue, weakness or malaise.
Regardless, starting with your ENT physician is a good first step. Scans alone don't necessarily answer every problem. Integrating the scan information with a patient's clinical history and physical exam are essential.
Daniel Choo, MD
Associate Professor and Director, Division of Otology/Neurotology
College of Medicine
University of Cincinnati