10 y/o with ear pain worsening over the last 5 days (Watch video)
Patient will present as → a 10-year-old boy with otalgia, worsening over the last 5-days and associated with nasal congestion. The patient is afebrile with a temperature of 98 ° F. Examination reveals edema of the external auditory canal producing an anterior and inferior displacement of the auricle with percussion tenderness posteriorly.
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
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.