From the Guidelines
Bilateral mastoiditis requires prompt medical treatment with intravenous antibiotics and possible surgical intervention, with the recommended initial treatment being hospital admission for intravenous antibiotics, pain management, and ENT consultation for potential surgical intervention. The symptoms of bilateral mastoiditis include severe ear pain, fever, headache, and hearing loss, and can lead to serious complications such as meningitis, brain abscess, or permanent hearing loss if left untreated or inadequately treated. The treatment options for bilateral mastoiditis include:
- Hospital admission for intravenous antibiotics, such as ceftriaxone 2g IV every 24 hours, plus vancomycin 15-20 mg/kg IV every 12 hours, as recommended by 1
- Pain management with acetaminophen or ibuprofen as needed
- ENT consultation for potential surgical intervention (mastoidectomy) if no improvement within 24-48 hours
- CT scan of the temporal bones to assess the extent of infection and any complications
- Audiometry to evaluate hearing loss Treatment duration is typically 10-14 days, with a switch to oral antibiotics once clinical improvement is noted, and common oral options include amoxicillin-clavulanate or clindamycin, as supported by 1. It is essential to note that prompt treatment is crucial to prevent complications, and the aggressive antibiotic regimen targets common pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, as highlighted in 1. Surgical intervention may be necessary to drain the infection and prevent further spread if antibiotics alone are insufficient, and the decision to perform surgery should be made on a case-by-case basis, considering the severity of the infection and the patient's overall health, as discussed in 1.
From the Research
Symptoms of Bilateral Mastoiditis
- Post-auricular erythema and protrusion of the auricle are common signs of acute mastoiditis 2
- Other symptoms include otalgia, fever, poor feeding, and vomiting 3
- Tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness, external canal swelling, otorrhea, and malaise are also associated with acute mastoiditis 4
- Aural protrusion and otorrhoea are also common presentations 5
Treatment Options for Bilateral Mastoiditis
- Intravenous antibiotics, such as ampicillin-sulbactam or ceftriaxone, are commonly used to treat acute mastoiditis 4, 6
- Myringotomy is also a common treatment approach 2, 6
- Surgical intervention, such as mastoidectomy or abscess drainage, may be necessary in complicated cases or in cases where conservative treatment fails 2, 3, 6
- Conservative treatment, including intravenous antibiotics and myringotomy, is often effective in treating uncomplicated acute mastoiditis 6
- Subperiosteal abscess incision and drainage may also be necessary in some cases 6
Complications of Bilateral Mastoiditis
- Subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures are potential complications of acute mastoiditis 4
- Cholesteatoma is also a possible complication 3
- Subperiosteal abscess (SA) is a common complication, and patients with SA and acute mastoiditis tend to have a longer hospital stay compared to those with isolated acute mastoiditis 5