Incidental mastoid effusion diagnosed on imaging: Are we doing right by our patients?

Abstract

Objectives/Hypothesis To investigate whether radiologist‐produced imaging reports containing the terms mastoiditis or mastoid opacification clinically correlate with physical examination findings of mastoiditis. Additionally, to investigate whether and how often otolaryngology was unnecessarily consulted and inappropriate antibiotic therapy was initiated. Study Design Retrospective chart review within a large community hospital setting. Methods A retrospective review of 160 patients who had imaging tests performed for nonotolaryngology indications from January 2011 to March 2017 at our facility. Indications, patient demographics, otolaryngology consultations, and new antibiotics started were recorded. Physical examinations were documented. Results Physical examination revealed that only 14 of 160 patients (8.8%) had clinical evidence of otologic disease. However, of the 160 patients meeting the inclusion criteria, 18 (11.3%) received an otolaryngology consultation, and 18 (11.3%) had antibiotics started. Eleven of the 18 patients in each group (61.1%) had a normal physical examination, two (11.1%) had serous otitis media, one (5.6%) had chronic otitis media, and four (22.2%) had acute otitis media. No patients were found to have clinical mastoiditis. χ2 analysis revealed no significance in the radiologic diagnosis of mastoiditis versus mastoid opacification in relation to physicians requesting otolaryngology consultations (P = .241) or starting patients on antibiotics (P = .951). Conclusions This study highlights the prevalence of incidental but clinically insignificant opacification of the mastoid cavity. We believe that nonotolaryngology physicians are, overall, competent to correlate such radiologic findings clinically and to prevent unnecessary consultations and inappropriate treatment, which add significant costs to our overstretched healthcare system. Level of Evidence 4 Laryngoscope, 129:852–857, 2019

The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta‐Analysis

“…Although exclusion of these studies caused an insignificant change to the pooled prevalence (9.3%, 95% CI 4.3–16.0), this analysis served to highlight potential study characteristics that may be of interest in our moderator analysis. Sayal et al 12 and Polat et al 21 both reported the smallest IMO rates out of all the studies, 0.1% and 1.4%, respectively. The factors that both studies had in common were that they contained the largest sample sizes, n = 205,792 and n = 29,850, respectively, and both inspected radiology reports to detect IMO.…”

“…There was a large difference in prevalence between studies that measured IMO by screening radiology reports 11,12,21–23,25,31 (3.5%, 95% CI 1.3–6.6) and directly evaluating radiological images 10,20,24,26–30 (14.5%, 95% CI 9.9–19.8), as shown in Figure 7. This difference was highly significant (QM (1) = 16.0, P < .0001) and contributed to the observed heterogeneity ( R 2 = 28.0%).…”

“…Sample size. Dividing the studies into sample sizes of less than 11,20,22,24,26,[28][29][30][31] or greater than 1000 10,12,21,23,25,27 demonstrated a small negative regression coefficient (À0.2; Z (13) = À2.9, P = .003), as shown in supplementary file 6. The pooled prevalence in smaller studies was 12.4% (95% CI 8.1-17.3), compared to 4.1% (95% CI 1.5-7.8) in larger studies, as shown in Figure 6.…”

“…Sensitivity analysis identified that three studies 12,20,21 exerted a considerable influence on the summary effect size, as shown in supplementary files 2 and 3. Although exclusion of these studies caused an insignificant change to the pooled prevalence (9.3%, 95% CI 4.3-16.0), this analysis served to highlight potential study characteristics that may be of interest in our moderator analysis.…”

Relationship between Increased Intracranial Pressure and Mastoid Effusion

“…On MR images, high signal intensity of T2 or T2 fluid-attenuated inversion recovery (FLAIR) imaging in the mastoid air cell cavity indicated ME (Fig. 1) 12,22) . Two independent reviewers confirmed these diagnoses.…”