What is the treatment for mastoiditis?

From the Guidelines

Mastoiditis treatment typically involves hospitalization for intravenous antibiotics and possible surgical intervention, with initial antibiotic therapy including broad-spectrum antibiotics like ceftriaxone and vancomycin, and surgical management often including myringotomy and mastoidectomy in severe cases. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by preventing complications such as meningitis, brain abscess, or facial nerve paralysis. According to the most recent and highest quality study 1, the recommended antibiotic therapy for mastoiditis is cloxacillin/flucloxacillin IV at a dose of 50 mg/kg QDS for 10 days, with ceftriaxone IV as a second-line option.

Some key points to consider in the treatment of mastoiditis include:

• Hospitalization for intravenous antibiotics and possible surgical intervention
• Initial antibiotic therapy with broad-spectrum antibiotics like ceftriaxone (1-2g IV every 12-24 hours) combined with vancomycin (15-20 mg/kg IV every 8-12 hours)
• Surgical management including myringotomy (eardrum incision) to drain fluid from the middle ear, and in more severe cases, a mastoidectomy to remove infected mastoid bone tissue
• Pain management with acetaminophen or NSAIDs
• Follow-up care includes monitoring for symptom resolution and hearing assessment, as mastoiditis can lead to conductive hearing loss if not properly treated

It's worth noting that the treatment approach may vary depending on the severity of the disease and the presence of complications, and that the algorithm developed by Chesney et al 1 suggests postponing CT scanning and initiating treatment with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, and reserving mastoidectomy for cases with neurologic deficits, sepsis, or failure to improve after 48 hours.

From the Research

Treatment for Mastoiditis

The treatment for mastoiditis can be divided into two main categories: conservative therapy and surgical intervention.

• Conservative therapy typically involves:
  • Intravenous antibiotic therapy, often using broad-spectrum antibiotics 2, 3
  • Myringotomy, which is a surgical procedure to drain the middle ear 2, 3
  • Incision and drainage of subperiosteal abscess when needed 3
• Surgical intervention may be necessary in certain cases, such as:
  • Presence of a subperiosteal abscess 2
  • Septic fever that does not respond to antimicrobial therapy 2
  • Signs of meningeal irritation 2
  • Failure of conservative therapy 4

Outpatient Management

Outpatient management of acute mastoiditis with periosteitis in children is also possible, using parenteral antibiotic therapy and daily visits from a combined team of an otolaryngologist and pediatric infectious disease specialist 5.

Specific Considerations

In children with cochlear implants, a treatment algorithm emphasizing early but conservative operative intervention may be necessary to save the device 6. This approach includes early operative drainage in conjunction with aggressive antibiotic therapy.

Effectiveness of Treatment

The cure rates for medical treatment, conservative surgery, and mastoidectomy have been reported to be 95.9%, 96.3%, and 89.1%, respectively 4. These findings suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis.