Chronic Mastoiditis/Something Else

27 YO female

I had an MRI of my brain done in Nov of 2005.  At that time the report stated "increased fluid signal to the left mastoid suggesting mastoiditis" I didn't remember this but my Dr did confirm to me that I was treated with antibiotics at the time (2 weeks worth).

On April 22nd (this year) I had another brain MRI done. (this was for my migraines)  I requested a copy of the MRI images.  I could still see a big white area in the left mastoid, even though the MRI report had no mention of it.  At my follow up appointment with my doctor to discuss the MRI findings I brought this up to her.  I think she thought I was crazy but to satisfy me, she requested they do a comparison study between the two MRIs.  Here are the results

"Dependent mucosal thickening in the left mastoid sinus is unchanged between the two studies consisten with the sequela of chronic mastoiditis.  No new mastoid or paranasal sinus abnormalities."

I have not heard back from my Dr on these findings yet.  I had called the clinic and asked if it was completed and asked if I could get a copy of the report.  So I'm not sure if my doctor is still trying to figure it out or maybe she has been out of the office, and that's why she hasn't gotten back to me on the findings.  OR she may be ignoring it, I'm not really sure.  She had mentioned leaving the findings for when I meet with the neurologist on the 13th, so maybe that is what she is doing.

I am curious if something OTHER than mastoiditis could be seen here.  I have read online that an MRI is not accurate in diagnosing mastoiditis, and that a CT is more accurate. At no point in time, neither now nor back in 05, have I had the symptoms I have read about with mastoiditis.  I have no ringing in my ears, no ear pain, no drainage from the ears, no fever.  I DO have intermittent dizziness and balance issues which I have been having for the 5 years since the last MRI (actually dizziness is why they did that MRI) and I do have migraines.  I haven't had an ear infection (to my knowledge) for YEARS, and in asking my mother, she doesn't remember be having very many when I was younger either.  All I ever get told by Drs is what beautiful ears I have :0) The only other thing that may be of importance to mention would be intermittent tingling of the tongue without a migraine coming.

Also, if it IS mastoiditis, the only "treatment" I have had for it would be the two weeks of antibiotics back in 05.  Is this sufficient enough?

[venkatasu]

Dear Madam,
I saw your post. It's indeed reports the conditions and feeling which i have been experiencing off late. I don't know for what purpose you have done the MRI but based on my experience recently I want to share it with you and the forum readers. I have mild to moderate hearing loss in the right ear which turned into moderate to severe hearing loss in the right ear. My left ear is fine. I took Pure Tone Audiometry (every two years once for the past 10 years) and Tymponometry (which revealed type "B" in the right ear). I have the same balance problems like a feeling of jerk or falling down sensation when comming out of lifts, buses etc., and occasional tinnitus. Other than that I have no ear pain, discharge or the so called room spinning vertigo. My ENT who was observing me for the past 10 years didn't see any problem in my ear like perforated ear drum or inflammed ear drum etc. But due to my concern about my dizziness he refered to another ENT hospital where they took CT scan of the Temporal bone and Para nasal sinuses. The CT scan of the temporal bone revealed a white or cloudy or opacified or what ever way you mention it in the mastoid area of the right ear and my left ear is fine. The report said "sclerosed mastoid air cells with soft tissue density in the typanic cavity suggestive of chronic mastoiditis".
           So far I haven't had any ear problem other than the hearing loss and dizziness. No symptoms of mastoiditis like post auricler inflammation, redness, pain, discharge etc. in my life. It is an accidental findings. The two doctors (ENT) who I have visited is supposed to be the genius in their field in our city never seemed to be concerned about the report and they never uttered a word about the scan report. They diagnosed my condition as otosclerosis because of the air bone gap in the audiometry and the so called history. They even ignored the tymponogram report which had a persistent type "B" suggestion of fluid etc as they are very much satisfied with the movement of the ear drum through physcial examination with a pneumatic otoscope where air with pressure is delivered in the external ear canal and movement is observed through the otoscope.
For you taking a CT will reaveal the same condition of chronic mastoiditis as the air cells may have been sclerosed which gives a cloudy picture. If you don't have any other condition in the CT (provided if you undergo the test) you can ignore this after checking with your ENT specialist  Check your hearing and if there is any problem please do an Audiometry and Tymponogram. Check for any neurological problems or Mitral Valve Prolapse which is common among women and may cause dizziness, pressure, tingling and myriad symtoms (symptoms). Tell us what your doctors have disscussed with you about this.

[cjmiller]

Thank you so much for your response.  (and fair warning, this post could get long)

It is SO funny that you mention the "falling" sensation because that's EXACTLY what it is that I have.  They keep wanting to label it "vertigo" but when they explain that to me they say it's the spinning sensation.  (like if you drank too much and laid down and have the room spins) When I tell them NO it's like a falling sensation..like when an elevator starts to go down, or when you are in an airplane during turbulence, they look at me like I have a 3rd eye or something. They want to either label it vertigo (spinning) or lightheaded (like I am going to black out) and don't seem to grasp the concept of it not being either of those.  Maybe it doesn't matter, but it's frustrating when I feel like that don't know what I mean.

I don't think it will matter, but I do have pictures of my MRI in my photo album on here in my profile.  The "fluid" doesn't appear to be close to where all my inner ear  is and the report confirms that as well. "There is increased signal in the left mastoids suggesting fluid.  This is present posteriorly and inferiorly rather than close to the inner ear structures", so this is probably why it doesn't seem to be having any effect on my hearing. Maybe??

Like I said I did NOT remember being put on those antibiotics. (but it was 5 years ago)  I remember her calling me and telling me everything on the MRI looked ok, BUT, she did go back in her reports and it did show she put me on antibiotics at the time. I don't think she ever told me why though. Maybe she did and I just don't remember.  I really don't know.  

05 MRI was done because of the dizziness.  I have had tests over the years on different things trying to figure this all out.  I wore a heart monitor two times, once for a month, and once for 2 weeks. I saw a neurologist right after the 05 MRI and he didn't say anything.  I had a table tilt test, and hearing test after hearing test, and a test (which I can't remember the name of) where they shot warm water in my ears, and cold water in my ears while I laid in a dark room.  Is this one of the tests you mentioned?

The recent MRI was done because I had been developing new symptoms with my migraines, inability to speak, inability to form words together either speaking or reading.

I'm hoping my doctor will refer me to an ENT.  I would feel much better dealing with an ENT on this one I think.  Even if the answer is the same and everything is fine and nothing has to be done, I would feel better seeing an ENT.

I am seeing a neurologist on the 13th of this month as well for my migraines.  She felt they were taking a different direction than they have been for so many years of HER treating them that maybe it was time to take a second look by a neurologist and get his suggestion on whether I need preventative meds for them or not.

If it isn't one thing with me it's the other, let me tell ya.  It gets very frustrating and it is so hard for me to tell the difference between what is what. I think part of me wants a
"cure all" answer which I know isn't going to happen.  I want to lump everything together as being related, but dr's want to deal with each thing separately. They very well may be right.  I have a damaged long thoracic nerve with no explanation as to how it may have happened causing a winged scapula. At the time doing x-rays and MRI on the shoulder they also said I have some extra bone growth on my scapula, which they said was probably just a calcium deposit.  Some mild disk degeneration of the c-3 and c-4 level of my spine and minor narrowing (I can't find my MRI report from that so I could be off on my levels) which I was told COULD be contributing to the dizziness.  I also just got told I have TMJD, which I have an appt to see an oral surgeon in June.  I was told this too COULD be causing the dizziness. My jaw has popped the way it does and move to the side when biting for as long as I can remember but it became painful recently.

Here's what both MRI reports said
MRI findings Nov 2005

There is increased signal in the left mastoids suggesting fluid.  This is present posteriorly and inferiorly rather than close to the inner ear structures.  There is no evidence of intracranial hemorrhage, mass, or edema.  There are no foci of abnormal restricted diffusion to suggest recent stroke. There are only a few tiny foci of increased signal in deep white matter in each frontal lobe which are nonspecific and not uncommon.  No brainstem or cerebellar lesions are demonstrated. Ventricles are normal in size and shape.

Impression: Findings suggesting mastoiditis on the left. The examination is otherwise unremarkable.

MRI findings April 2010

There are no abnormal extraaxial fluid collections.  No mass lesions are identified and there is no shift in midline structures.  There are a few small foci of T2 lengthening deep in the deep white matter of both hemispheres. These are nonspecific but can be seen in association with migraine syndrome.  There are no abnormal areas of restricted diffusion.

Impression: There are a few small nonspecific foci of T2 lengthening in the deep white matter of both hemispheres which can be seen in association with migraine syndrome. Otherwise unremarkable MRI of the brain.

Addendum

Findings: Dependent mucosal thickening in the the left mastoid sinus is unchanged between the two studies consistent with the sequela of chronic mastoiditis. No new mastoid or paranasal sinus abnormalities

Slight progression of the small bilateral frontal white matter changed which are nonspecific. No new cortical abnormalities. No other interval changes"

[venkatasu]

Dear Madam,

                  Have you taken a heart echo ever. Has it showed any thing like mitral valve prolapse syndrome. Mitral valve prolapse is found more in women a benign condition not a heart disease which has myriad symptoms. Some are:

heart palps, breathing difficulty or inability to take deep breaths, dizziness (feeling of falling down), migraine headaches, TMJ disorders, tinnitus, IBS, Extreme fatigue/tiredness, allergy, Irregular menstural cycles, tremor or body shaking which is not perceived by other, anxiety or panic attacks, depression, mood swings etc.,

   Not all experience all the symptoms, Some experience one or two, others most of them and some no symptoms at all. It was thought all these symptoms were in the patient's head but now research shows that there is a imbalance in the hormones or dysautonomia which is yet to be confirmed.

  If you haven't undergone an echo cardiogram check out whether it has a role to play in your dizziness, migraine etc.

[cjmiller]

Yes I had an echo back when they were thinking it may be heart related.  They did the echo, and a thallium stress test.  Everything came back looking good.  I think they started thinking it was heart related since I mentioned that when I would get dizzy my heart would start to race.  I thought it was because I would get nervous about the dizziness, especially when I was driving and it would happen, but they thought it was worth looking into.  For me it was more of a shock like "oh I'm going to fall" and get a little scared so my heart would beat fast. In any event, it all came back normal.

I received a call this morning from the clinic about some blood tests they had run and everything there looked good too.  I asked about the comparison MRI, and they nurse said they had not received it yet.  I told her that was odd because I already had a copy, I got mine on Friday.  She looked at where it was, printed it out, and said she would bring it to the Dr to look at since she didn't even know they had it back yet.  I'm wondering what she was talking about though because she said that there was a request put in for my 05 MRI on the 30th.  The comparison was done on the 28th and the report I have was dated the 28th.  So maybe they asked for them back to look again? I'm not really sure.  She said she would call me back as soon as she heard anything about it.

I'm thinking no matter what I will probably be referred to someone else as the Dr. dealing with this is just my regular family practice doctor.

[venkatasu]

Dear Madam,
           I too have the feelling of fall when comming out from a moving bus or train, lifts or long walks or running. Its almost like a feeling of jerk in the head which gives us the sensation of falling or losing balance (but actually not. Its purely subjective no one would have noticed us objectively). I have been visiting ENT for past 10 years of no significant use other than the latest CT which revealed Chronic mastoiditis. For me the ENT said to ignore the report and they haven't given any serious view to it unless there is any symptoms of it. So

      1.       If you are 100% sure by going through the echo cardiogram that mitral valve prolapse is ruled out then may be one of causes for dizzy may be eliminated. Ensure it by going through the report once again.
      2.       You can ignore the Mastoiditis after getting opinion from the ENT if there is an unlikely change for any complication regarding that.
      3.       Try some exercises for the dizziness by visiting (Pls go through the contents throughly)                     http://www.pneuro.com/publications/dizzy/
      4.        Pls read an article :   Mastoiditis on MRI: fact or artifact?
http://www.thefreelibrary.com/Mastoiditis+on+MRI:+fact+or+artifact%3F-a0186320441
an excellent article about MRI and mastoiditis
       Pls get back after going through the links mentioned above

[cjmiller]

Thanks for all your help.

The MRI: Fact or Artifact article I had read before posting this, and yes there was a lot of good information in there.

Took me a while to read through the dizziness one, and I will probably read through it several more times.  There is so much information on there! Thank you so much.  I think I will find this to be very helpful!

My doctor got back in touch with me. (well, her nurse did) She didn't say much about the MRI saying chronic mastoiditis.  She said that she read the report and plans on leaving it up to the neurologist to do something with it.  I feel he will probably then refer me to an ENT (at least I hope this is his plan)

I think even if it's nothing to worry about, it is something that needs to be checked into by an ENT like you say.  It was kind of discouraging to hear she was just leaving it for the neurologist to decide what to do with it, but I guess that's why she's the doctor and I'm not. *shrugs*

[venkatasu]

Dear Madam,

               I hope you have attained much more confidence now. Seeing a neuologist or to be specific a neuro-otologist will help you to diagnose the cause of your symptom. Some times even when all the tests reports negatively but we have the symptoms the right thing would be how to modify our life style by which the frequency, insensity of the symptoms gets reduced.
                  As I told earlier I have the sensation of falling down while walking after a considerable distance or a feeling of jolt in the head for a sec which seems like I would fell down (but actually not happens so). I have even when i rotate in the bed from one side to the other (not always but on and off). The doctors simply ignored and even refused a ct of the head and put me on a ct of the temporal bone which revealed chronic mastoiditis which also they totally ignored and for them it seemed to be non-specific. What to do? That's it.

[Cat2cad]

This is exactly what I have been experiencing!!  Four years ago I felt really ill for several months but couldn't figure out what was wrong until I had an MRI and then a CT scan showing chronic mastoiditis.  My regular doctor took it seriously and sent me to an ENT.  The ENT initially said it was nothing but I kept feeling more and more ill.  I finally got tubes put in ears and several months of antibiotics and felt much better.  This past October I started to feel dizzy especially when riding or driving in cars, etc. and I often having feelings of "dropping".  The past few weeks have been so bad it is difficult to leave the house.  I asked my ENT for a CT scan of mastoids as I felt it was back.  Again, the left mastoid is inflamed and has some fluid in it.  I am going to be getting ear tubes this week and I'm hoping this will help with the dizziness. Did your dizziness ever get resolved?  Did you receive another diagnosis?  Thanks.

[anomale]

Hi! Iwas on this site because I was curious that my own chroinic mastoiditis had become complicated. I have ALL of the symptoms you speak of with the mitral valve prolapse. I have had 2 echos, a bubble study and A TEE test. Wouldnt that show up on one of those?

[anomale]

I was diagnosed by my ENT with chronic mastoidits about 2 years ago. He immediately reffered me to a more experienced ENT and Surgeon in VA. I went to see and he looked at my CT and said "Huh". Then he explained he was not sure what was there and that he must do exploratory surgery by doing  opening the bone behind my ear. Also at the same time he would fix my life long hearing loss in my left ear as it is conductive and not neurological. I have been feeling like the back side of a donkey's a** for about 2 years. I didn't go through with the surgery because I was terrified to have my skull opened. My then neurologist told me that an ENT shouldnt be doing craniotomies anyway and I kinda just left it at that. I have had every freaking lab test, diagnostic procedure and you name it , under the sun. I feel like Pure Sh*t! Has anyone had an ENT want to do this kind of surgery and neurologist disagree with it? The ENT is highly regarded in his feild. Dr. Hashisaki of Charlottesville VA who was also referred to me by one of the best ENTs in my area (Dr. Mikus of Shenandoah Head and neck) I feel like I should just go get the surgery. Any thoughts?