From the Research
Mastoiditis with facial palsy and neuralgia requires urgent hospitalization for aggressive treatment, prioritizing intravenous antibiotics and surgical intervention to prevent serious intracranial complications and permanent nerve damage. The standard approach includes intravenous antibiotics (typically ceftriaxone 2g daily plus vancomycin 15-20mg/kg every 12 hours) for 2-3 weeks, followed by oral antibiotics for an additional 2-4 weeks, as supported by the most recent study 1. Surgical intervention with mastoidectomy is often necessary to drain the infection and remove infected bone. For facial palsy, corticosteroids (prednisolone 1mg/kg/day for 7-10 days with tapering) may be prescribed to reduce inflammation and improve nerve function, as suggested by 2. Pain management for neuralgia includes gabapentin (starting at 300mg three times daily and titrating up as needed) or carbamazepine (starting at 100mg twice daily and increasing gradually). Close monitoring of facial nerve function using the House-Brackmann scale is essential, and audiometric testing should be performed to assess hearing.
Key considerations in treatment include:
- Urgent hospitalization for aggressive treatment
- Intravenous antibiotics as the first line of treatment
- Surgical intervention with mastoidectomy for complicated cases
- Corticosteroids for facial palsy
- Pain management for neuralgia
- Close monitoring of facial nerve function and hearing
The most critical aspect of treatment is preventing serious intracranial complications and permanent nerve damage, which can occur if mastoiditis is inadequately treated, especially with facial nerve involvement indicating advanced disease 3, 4, 5.