From the Guidelines
The treatment for mastoid air cell disease should prioritize intravenous antibiotics, such as ceftriaxone or ampicillin-sulbactam, for 24-48 hours, followed by oral antibiotics like amoxicillin-clavulanate for 10-14 days, with surgical intervention considered for severe or unresponsive cases. When considering the management of mastoid air cell disease, it's essential to note that the condition can range from acute to chronic, with varying degrees of severity. According to the study by Chesney et al 1, an algorithmic approach can be taken, where uncomplicated cases are treated with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess. Some key points to consider in the treatment of mastoid air cell disease include:
- The use of high-dose amoxicillin or amoxicillin-clavulanic acid as first-line antibiotics, as suggested by guidelines from the United States, Japan, and South Korea 1
- The importance of pain management with acetaminophen or NSAIDs to ensure patient comfort and prevent complications
- The potential need for surgical intervention, including myringotomy with tympanostomy tube placement or mastoidectomy, in severe or unresponsive cases
- The role of follow-up care in ensuring complete resolution and preventing recurrence of the disease. It's also worth noting that, as reported in the study, 10% of patients were successfully treated with antibiotics alone, 68% with antibiotics and myringotomy, and 22% with antibiotics and mastoidectomy 1, highlighting the variability in treatment approaches and outcomes.
From the Research
Treatment for Mastoid Air Cell Disease
The treatment for mastoid air cell disease, also known as acute mastoiditis, typically involves antibiotics and may require surgical intervention.
- The choice of antibiotic may depend on the causative bacteria, with common pathogens including Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus 2, 3, 4, 5.
- Antibiotics such as ampicillin-sulbactam or ceftriaxone may be used to treat the infection 4.
- In some cases, otolaryngology consultation and surgical intervention, such as myringotomy or mastoidectomy, may be necessary 3, 4, 5.
- The treatment approach may vary depending on the severity of the disease and the presence of complications, such as intracranial abscess or venous sinus thrombosis 2, 4.
Diagnosis and Management
Diagnosis of acute mastoiditis is typically based on clinical presentation, including symptoms such as tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness, and fever 4.
- Laboratory analysis and imaging studies, such as computed tomography (CT) of the temporal bones, may be used to confirm the diagnosis and identify potential complications 4, 5.
- A high index of suspicion is necessary to diagnose acute mastoiditis, as the disease can be serious and potentially life-threatening if left untreated 4.