From the Guidelines
Mastoiditis treatment should prioritize hospitalization for intravenous antibiotics and possible surgical intervention to prevent serious complications and improve outcomes. The treatment approach for mastoiditis is guided by the need to cover common pathogens such as Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus, with initial antibiotic regimens including ceftriaxone and vancomycin for 10-14 days 1. Key considerations in the management of mastoiditis include:
- Hospitalization for intravenous antibiotic therapy
- Possible surgical intervention, such as mastoidectomy, for abscess formation or failure to improve with antibiotics
- Pain management with acetaminophen or NSAIDs
- Transition to oral antibiotics to complete a 2-3 week course after acute treatment
- Follow-up to ensure complete resolution of the infection
It is crucial to note that mastoiditis can lead to serious complications if not aggressively treated, including meningitis, brain abscess, or facial nerve paralysis 1. The decision to proceed with surgical intervention, such as mastoidectomy, is based on factors like abscess formation, coalescent mastoiditis, or lack of improvement with antibiotic therapy. Additionally, myringotomy with tympanostomy tube placement may be necessary to drain middle ear fluid. The goal of treatment is to prevent these complications and improve patient outcomes, with a focus on morbidity, mortality, and quality of life.
From the Research
Treatment for Mastoiditis
The treatment for mastoiditis typically involves a combination of medical and surgical interventions.
- Antibiotic therapy is the main treatment for non-complicated forms of mastoiditis, with cephalosporins being the antibiotic of choice due to the prevalence of Streptococcus pneumoniae 2.
- In cases where multibacterial flora is present, combinations of antibiotics may be suggested 2.
- For complicated forms of acute mastoiditis, antibiotic treatment may be combined with other specific drugs, such as anticoagulants and/or corticosteroids 2.
- Surgical treatments, including incision of abscesses, mastoidectomy, and neurosurgical procedures, may be performed in combination with medical therapy for severe complications 2, 3, 4.
- Retroauricular puncture and grommet tube insertion associated with antibiotic therapy may be an effective alternative to mastoidectomy in the treatment of acute mastoiditis with subperiosteal abscess, especially in the absence of intracranial complications and suspicion of Fusobacterium necrophorum 4.
- The adequacy of the initial empiric antibiotic therapy with the susceptibility of the suspected bacteria germs is essential to avoid potentially serious complications 5.
Medical Therapy
- Intravenous antibiotics are systematic in the treatment of acute mastoiditis 4.
- The choice of antibiotic should be based on the suspected pathogen, with Streptococcus pneumoniae being the most common cause of acute mastoiditis 2, 4.
- Antibiotic therapy should be adjusted based on culture results and susceptibility testing 6, 4.
Surgical Therapy
- Mastoidectomy is the standard management for exteriorized mastoiditis, but it may be avoided in some cases with conservative management 4.
- Surgical indications include subperiosteal abscess, septic fever that does not respond to antimicrobial therapy, and signs of meningeal irritation 3.
- Mastoid radiographs may not play a role in the decision to operate, and unsuspected epidural abscess may be found during surgery 3.