Which type of doctor treats acute mastoiditis in children?

Treatment of Acute Mastoiditis in Children

Acute mastoiditis in children should be treated by an otolaryngologist (ENT specialist), who is the primary specialist responsible for managing this serious complication of acute otitis media. 1

Specialist Involvement in Acute Mastoiditis

Acute mastoiditis is the most common complication of acute otitis media and requires specialized care due to its potential severity and risk of further complications. The management typically involves:

• Primary specialist: Otolaryngologist (ENT specialist)
• Supporting specialists that may be involved:
  • Pediatric infectious disease specialist (for complex antibiotic management) 2
  • Pediatrician (for overall child health management)
  • Neurosurgeon (in cases with intracranial complications) 3

Diagnostic and Treatment Approach

The diagnosis of acute mastoiditis is based on specific clinical findings:

• Otomicroscopic evidence of acute otitis media
• Displacement of the pinna
• Retroauricular swelling, erythema, and tenderness 2

Treatment Algorithm

1. Initial management:

   • Hospitalization for intravenous antibiotics (typically cephalosporins due to prevalence of Streptococcus pneumoniae) 3
   • Pain management
   • Close monitoring by an otolaryngologist

2. Medical treatment:

   • Intravenous broad-spectrum antibiotics (third-generation cephalosporins are commonly used) 4
   • Medical management alone may be sufficient in approximately 26% of cases with early, uncomplicated mastoiditis 5

3. Surgical interventions (performed by otolaryngologist):

   • Myringotomy (surgical incision in the eardrum) if no response to antibiotics within 48 hours 5
   • Cortical mastoidectomy for cases with:
     • Subperiosteal abscess
     • Post-auricular fistula
     • Intracranial complications
     • Failure to respond to myringotomy 5

Evidence on Treatment Outcomes

Studies show varying approaches to management:

• In one study, 87% of patients responded well to intravenous antibiotics and myringotomy, with only 11.4% requiring mastoidectomy 6
• Another study found that 36.2% of hospitalized children required surgical intervention 4
• A combined team approach of otolaryngologists and infectious disease specialists has shown a 96.8% clinical cure rate in selected cases 2

Complications and Special Considerations

Complications of acute mastoiditis can be serious and include:

• Extracranial: subperiosteal abscess, Bezold's abscess
• Intratemporal: facial nerve palsy, labyrinthitis
• Intracranial: subdural abscess, lateral sinus thrombosis (observed in 3.2% of cases) 4

Important Pitfalls to Avoid:

• Delaying specialist referral - acute mastoiditis can progress rapidly
• Inadequate antibiotic coverage - Streptococcus pneumoniae remains the most common pathogen 1
• Failure to consider surgical intervention when medical management is insufficient
• Insufficient follow-up - recurrences requiring rehospitalization occur in approximately 4.3% of cases 4

Proper and timely management by an otolaryngologist is essential to prevent serious complications that can affect morbidity, mortality, and quality of life in children with acute mastoiditis.