Mastoiditis

Symptoms begin days to weeks after onset of acute otitis media and include fever and persistent, throbbing otalgia. Nearly all patients have signs of otitis media Symptoms and Signs Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include otalgia, often with systemic symptoms (eg, fever... read more and purulent otorrhea Otorrhea Ear discharge (otorrhea) is drainage exiting the ear. It may be serous, serosanguineous, or purulent. Associated symptoms may include ear pain, fever, pruritus, vertigo, tinnitus, and hearing... read more . Redness, swelling, tenderness, and fluctuation may develop over the mastoid process; the pinna is typically displaced laterally and inferiorly.

Diagnosis of mastoiditis is clinical. CT is usually done, especially if an intratemporal or intracranial complication is suspected, to confirm the diagnosis and show the extent of the infection. Any middle ear drainage is sent for culture and sensitivity. Tympanocentesis for culture purposes can be done if no spontaneous drainage occurs. Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) may be abnormal but are neither sensitive nor specific and add little to the diagnosis.

IV antibiotic treatment is initiated immediately with a drug that provides central nervous system penetration, such as ceftriaxone 1 to 2 g (children, 50 to 75 mg/kg) once a day continued for ≥ 2 weeks; vancomycin or linezolid are alternatives. Oral treatment with a quinolone may be acceptable. Subsequent antibiotic choice is guided by culture and sensitivity test results.

A subperiosteal abscess usually requires a simple mastoidectomy, in which the abscess is drained, the infected mastoid cells are removed, and drainage is established from the antrum of the mastoid to the middle ear cavity.