From the Research
The primary treatment for bilateral mild mastoiditis in adults typically involves a course of oral antibiotics for 10-14 days, with the recommended first-line antibiotic being amoxicillin-clavulanate (875 mg/125 mg twice daily) or cefuroxime (500 mg twice daily) 1. In addition to antibiotics, the following measures are recommended:
- Pain management with over-the-counter analgesics like acetaminophen or ibuprofen
- Nasal decongestants (oral or topical) to improve eustachian tube function
- Warm compresses applied to the affected areas for comfort If symptoms do not improve within 48-72 hours of starting antibiotics, or if they worsen, the patient should be re-evaluated. In some cases, a switch to intravenous antibiotics or surgical intervention (myringotomy or mastoidectomy) may be necessary 2. This treatment approach aims to eradicate the bacterial infection, reduce inflammation, and prevent complications. Antibiotics target the causative bacteria, while decongestants help drain fluid from the middle ear and mastoid air cells. Pain management and warm compresses provide symptomatic relief during the healing process. It is essential to note that the diagnosis of acute mastoiditis can be made based on clinical presentation, but computed tomography of the temporal bone with contrast should be considered if there is concern for complicated mastoiditis 2. The most recent and highest quality study 1 suggests that conservative management with antibiotics is suitable for many patients, with surgery reserved for poor responders, and complications are rare in this setting. However, it is crucial to be aware of the possibility that noninfectious pathologies may present with a constellation of symptoms similar to mastoiditis, and further investigation may be necessary in atypical cases 3.