10 y/o with ear pain worsening over the last 5 days (View on ReelDx)
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 and erythema posterior to the ear, and forward displacement of the external ear
- Organisms: S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes
IV antibiotic treatment is initiated immediately with a drug that provides central nervous system penetration, such as ceftriaxone 1 to 2 g once a day continued for ≥ 2 weeks
- Vancomycin or linezolid are alternatives
- Oral treatment with a quinolone may be acceptable in certain cases
- A subperiosteal abscess usually requires a simple mastoidectomy, in which the abscess is drained, the infected mastoid cells are removed
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.