From the Research
The treatment for mastoiditis complicated by facial nerve paralysis requires immediate hospitalization for aggressive management, with a primary approach involving high-dose intravenous antibiotics and surgical intervention, including mastoidectomy and facial nerve decompression, as supported by the most recent and highest quality study 1.
Key Components of Treatment
- High-dose intravenous antibiotics, such as a combination of a third-generation cephalosporin (e.g., ceftriaxone 2g IV daily) and vancomycin (15-20 mg/kg IV every 12 hours), to cover common pathogens including Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and anaerobes.
- Surgical intervention, including mastoidectomy to remove infected bone and drain purulent material, with facial nerve decompression performed during the same procedure to relieve pressure on the nerve and improve chances of functional recovery.
- Corticosteroids, such as dexamethasone 10mg IV followed by 4mg every 6 hours for 7-10 days, to reduce inflammation and edema around the facial nerve.
Monitoring and Evaluation
- Close monitoring of facial nerve function using the House-Brackmann scale is necessary during treatment.
- Imaging studies (CT and MRI) should be performed to evaluate the extent of infection and rule out intracranial spread.
Importance of Early Intervention
- Early intervention is crucial as delays in treatment can lead to permanent facial nerve damage and other serious complications, as highlighted in studies such as 2 and 3.