From the Guidelines
The initial workup for suspected mastoiditis should include a thorough history and physical examination, complete blood count, blood cultures, and imaging studies, with a CT scan of the temporal bone being the preferred imaging modality 1. The diagnosis of mastoiditis is primarily clinical, but imaging studies are essential for confirming the diagnosis and evaluating the extent of the disease.
- A complete blood count (CBC) and blood cultures should be obtained to evaluate for signs of infection and bacteremia.
- Imaging studies, particularly a CT scan of the temporal bone, are crucial for evaluating the extent of the disease and identifying potential complications such as abscess formation or intracranial extension 1.
- The treatment of mastoiditis typically involves hospital admission for intravenous antibiotics, with a combination of a third-generation cephalosporin and vancomycin being a common choice 1.
- Antibiotic therapy should be continued for 10-14 days, with transition to oral antibiotics once clinical improvement occurs, and pain management with acetaminophen or NSAIDs is important.
- Surgical intervention with mastoidectomy may be necessary for patients who fail to respond to medical therapy within 48-72 hours, have complications, or have recurrent mastoiditis.
- ENT consultation should be obtained early in the course of treatment to evaluate the need for surgical intervention.
- Prompt treatment is essential as mastoiditis can lead to serious complications, including meningitis, brain abscess, and sigmoid sinus thrombosis, if left untreated 1.
From the Research
Initial Workup for Mastoiditis
- The initial workup for a patient suspected of having mastoiditis includes a thorough clinical evaluation, with attention to symptoms such as mastoid area erythema, proptosis of the auricle, and fever 2, 3.
- Laboratory findings, including white blood cell count, absolute neutrophil count, and C-reactive protein, can also be helpful in diagnosing mastoiditis 2.
- Imaging studies, such as computed tomography (CT) of the mastoid, may be necessary to confirm the diagnosis and identify any complications 3, 4.
Treatment of Mastoiditis
- Antibiotic therapy is the main treatment for mastoiditis, with cephalosporins being the antibiotic of choice due to the prevalence of Streptococcus pneumoniae 2.
- In cases of complicated mastoiditis, antibiotic treatment may be combined with other specific drugs, such as anticoagulants and/or corticosteroids 2.
- Surgical treatments, such as incision of abscesses, mastoidectomy, and neurosurgical procedures, may be necessary in severe cases or when complications are present 2, 5, 4.
Complications of Mastoiditis
- Complications of mastoiditis can be extracranial (subperiosteal abscess, Bezold's abscess), intratemporal (facial nerve palsy, labyrinthitis), or intracranial (subdural abscess) 2.
- These complications can have a serious clinical course and may be life-threatening, emphasizing the importance of prompt and effective treatment 2, 5.
Management Algorithm
- A practical, evidence-based algorithm for the diagnostic and therapeutic approach to mastoiditis has been proposed, emphasizing the importance of early diagnosis, close follow-up, and timely medical and surgical intervention 6, 4.
- Children with acute mastoiditis should be managed in centers where complete medical and surgical treatment is available, due to the potential for significant morbidity 4.