What is the treatment for mastoiditis?

From the Guidelines

The treatment for mastoiditis typically involves hospitalization for intravenous antibiotics and possible surgical intervention, with initial antibiotic therapy often including broad-spectrum agents like ceftriaxone (1-2g IV every 12-24 hours) combined with vancomycin (15-20mg/kg IV every 8-12 hours) to cover common pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus 1.

Key Considerations

• The choice of antibiotics should be guided by local resistance patterns and the severity of the infection.
• Surgical management, including mastoidectomy, may be necessary in cases of abscess formation, persistent fever despite antibiotics, or complications like facial nerve paralysis.
• Pain management with acetaminophen or NSAIDs is also important to ensure patient comfort and reduce the risk of complications.

Treatment Approach

• Initial antibiotic therapy usually continues for 7-10 days, followed by oral antibiotics for an additional 1-3 weeks.
• The use of needle aspiration for subperiosteal abscesses may be considered, but most published literature reports surgical management 1.
• The algorithm developed by Chesney et al, which involves postponing CT scanning and initiating treatment with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, may be a useful guide for treatment decisions 1.

Important Considerations

• Prompt treatment is essential to prevent serious complications, including meningitis, brain abscess, hearing loss, or facial nerve damage.
• The aggressive approach to treatment reflects the serious nature of this infection, which develops when middle ear infections spread to the mastoid bone's air cells.
• The treatment approach should be individualized based on the patient's specific needs and circumstances, taking into account factors such as age, underlying health status, and the presence of any complications.

From the Research

Treatment for Mastoiditis

The treatment for mastoiditis can vary depending on the severity and complexity of the condition.

• Medical treatment is often the first line of treatment, with a cure rate of 95.9% 2.
• Conservative surgery, such as myringotomy and incision and drainage of subperiosteal abscess, can also be effective, with a cure rate of 96.3% 2.
• Mastoidectomy may be necessary in some cases, particularly those with complications or severe disease, with a cure rate of 89.1% 2.

Conservative Treatment

Conservative treatment typically involves:

• Intravenous antibiotic therapy using a broad-spectrum antibiotic 3.
• Myringotomy to drain the middle ear 3.
• Incision and drainage of subperiosteal abscess if needed 3.
• Outpatient parenteral antibiotic therapy, such as once daily i.m. ceftriaxone, can be effective in treating acute mastoiditis with periosteitis in children, with a clinical cure rate of 96.8% 4.

Management of Complicated Cases

In cases of complicated mastoiditis, such as those with intracranial complications or subperiosteal abscess, surgical intervention may be necessary.

• A treatment algorithm emphasizing early but conservative operative intervention can be effective in managing acute mastoiditis in children with cochlear implants, with a focus on saving the device 5.
• Uncomplicated acute mastoiditis can be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess, and these patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics 6.