Acute mastoiditis is a suppurative infection of the mastoid air cells, usually a complication from preceding acute otitis media
- Clinical features include fever, otalgia, pain & erythema posterior to the ear, and forward displacement of the external ear
- Organisms: S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes
History and physical exam. Most cases of mastoiditis can be clinically diagnosed
- CT scan of the temporal bone with contrast is the imaging of choice for complicated mastoiditis or toxic-appearing patients
For simple mastoiditis, oral antibiotic treatment should cover the most common pathogens (strep pneumo, strep pyogenes, and staph aureus)
- Consider IV antibiotics and ENT referral in more serious cases or with patients with unreliable follow-up
- Drainage by procedures such as tympanocentesis or myringotomy may also be considered
Mastoidectomy is reserved for patients with mastoiditis who fail medical therapy.
IM steroids are not indicated in the treatment of mastoiditis.
Ventilating tube placement
Ventilating tube placement is indicated in patients with auditory tube dysfunction and chronic serous otitis media.