What is the recommended treatment for mastoiditis?

From the Guidelines

The recommended treatment for mastoiditis typically involves hospitalization for intravenous antibiotics and possible surgical intervention, with a recent trend toward nonsurgical management with intravenous antibiotics, either alone or combined with myringotomy and TT insertion and/or needle aspiration of the subperiosteal abscess 1.

Treatment Approach

The initial approach to treating mastoiditis should prioritize broad-spectrum antibiotic coverage against common pathogens like Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and anaerobes.

• A common regimen includes a third-generation cephalosporin (such as ceftriaxone) combined with vancomycin or clindamycin for 10-14 days.
• Surgical intervention, ranging from myringotomy with tympanostomy tube placement to mastoidectomy, is often necessary for more severe cases with complications.
• Pain management with acetaminophen or NSAIDs is also crucial.

Management Considerations

• The use of intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, is a viable initial treatment strategy for uncomplicated mastoiditis cases without neurologic deficits or sepsis 1.
• Failure to improve after 48 hours or clinical deterioration should prompt a CT scan to assess coexistent intracranial pathology, followed by mastoidectomy if necessary.
• Following IV antibiotics, patients typically transition to oral antibiotics to complete a 2-3 week course.
• Close follow-up is essential to monitor for resolution and potential complications such as hearing loss, facial nerve paralysis, or intracranial spread of infection.

From the Research

Treatment Options for Mastoiditis

• The recommended treatment for mastoiditis depends on the severity and complexity of the condition, with options ranging from medical management to surgical intervention 2, 3, 4, 5, 6.
• Medical management is often considered for uncomplicated cases, and may include:
  • Intravenous antibiotics with a broad spectrum of activity 3, 4, 5, 6.
  • Myringotomy, which involves making a small incision in the eardrum to drain fluid and relieve pressure 3, 4, 5.
  • Incision and drainage of subperiosteal abscesses, if present 3, 4.
• Surgical intervention, such as mastoidectomy, may be necessary for complicated cases, including those with:
  • Intracranial complications, such as abscesses or empyema 2, 4, 6.
  • Subperiosteal abscesses that are large or not responding to medical management 2, 4.
  • Bony erosion or coalescence, which can indicate a more severe infection 2.
• Outpatient management may be possible for some cases, particularly those with mild symptoms and no complications, using parenteral antibiotics and close monitoring by a healthcare team 5.

Factors Influencing Treatment Choice

• The presence of complications, such as intracranial involvement or subperiosteal abscesses, can influence the choice of treatment 2, 4, 6.
• The severity of symptoms, such as fever, pain, and swelling, can also guide treatment decisions 3, 4, 5.
• The results of diagnostic tests, including imaging studies and bacterial cultures, can help identify the causative organisms and guide antibiotic therapy 6.