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. Initial antibiotic therapy should include broad-spectrum coverage against common pathogens like Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and anaerobes, as suggested by 1. A common regimen includes a third-generation cephalosporin (such as ceftriaxone) combined with vancomycin. This IV antibiotic treatment typically continues for 7-10 days, followed by oral antibiotics for an additional 1-3 weeks.
Key Considerations
- Surgical intervention is often necessary, particularly in cases with complications or those not responding to antibiotics within 48-72 hours, with mastoidectomy being the most common procedure to drain the infection and remove infected bone 1.
- Pain management with acetaminophen or NSAIDs is also important.
- Prompt treatment is crucial as untreated mastoiditis can lead to serious complications including meningitis, brain abscess, facial nerve paralysis, or hearing loss.
- Regular follow-up is essential to monitor treatment response and prevent recurrence.
Recent Trends
- There is 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, as reported by 1.
- Needle aspiration can be performed for confirmation of diagnosis, but the subperiosteal abscess will often recur with needle aspiration alone, as noted by 1.
Treatment Algorithm
- Chesney et al developed an algorithm whereby in uncomplicated AM cases (without neurologic deficits or sepsis), computerized tomography (CT) scanning is postponed and treatment is initiated with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, as described by 1.
- Failure to improve after 48 hours or clinical deterioration should prompt a CT scan to assess coexistent intracranial pathology, followed by mastoidectomy.
From the Research
Mastoiditis Treatment Overview
- The treatment of mastoiditis typically involves a combination of antibiotic therapy, myringotomy, and in some cases, surgical intervention 2, 3, 4, 5.
- Antibiotic treatment is often the first line of defense, with broad-spectrum antibiotics being used to target the causative organisms 2, 4, 5.
- Myringotomy, which involves making a small incision in the eardrum to drain the middle ear, is also a common treatment approach 3, 5.
Medical Management
- Studies have shown that many cases of acute mastoiditis can be managed successfully with conservative medical therapy, including intravenous antibiotics and myringotomy 3, 5.
- Outpatient management of acute mastoiditis with periosteitis in children has been shown to be effective and safe, with a high clinical cure rate 3.
- Medical management is often preferred for uncomplicated cases of mastoiditis, with surgical intervention reserved for more severe or complicated cases 6.
Surgical Intervention
- Surgical intervention, such as mastoidectomy, may be necessary in cases where there are complications, such as intracranial complications or subperiosteal abscess 2, 4, 5.
- However, studies have shown that many cases of acute mastoiditis can be managed without surgical intervention, and that medical management can be effective in treating the condition 3, 5, 6.
Treatment Guidelines
- The treatment of mastoiditis should be individualized based on the severity of the condition, the presence of complications, and the patient's overall health status 2, 3, 4, 5, 6.
- A multidisciplinary approach, involving otolaryngologists, pediatricians, and infectious disease specialists, is often necessary to ensure optimal management of the condition 3, 5.