What is the treatment for mastoiditis?

From the Guidelines

Mastoiditis treatment should initially involve intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, and surgical intervention such as mastoidectomy should be considered if there is no improvement after 48 hours or clinical deterioration. The treatment approach for mastoiditis has evolved, 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.

Key Considerations

• The use of antibiotics alone has been successful in 10% of patients with mastoiditis, while the combination of antibiotics and myringotomy has been effective in 68% of patients 1.
• The decision to perform mastoidectomy should be based on the severity of the disease and the patient's response to initial treatment, with some studies reporting mastoidectomy rates between 29% and 93% of patients with mastoiditis 1.
• A proposed algorithm for the treatment of uncomplicated mastoiditis involves initiating treatment with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess, and postponing computerized tomography (CT) scanning until after 48 hours or if clinical deterioration occurs 1.

Treatment Options

• Intravenous antibiotics such as ceftriaxone, vancomycin, or a combination of antibiotics covering both aerobic and anaerobic bacteria for 7-14 days.
• Oral antibiotics like amoxicillin-clavulanate or clindamycin for an additional 1-2 weeks after initial improvement.
• Surgical intervention, including myringotomy, mastoidectomy, or tympanoplasty, for complicated cases or those not responding to antibiotics within 48-72 hours.
• Pain management with acetaminophen or ibuprofen is also important to ensure patient comfort and reduce the risk of complications.

Complications and Risks

• Mastoiditis can lead to serious complications, including meningitis, brain abscess, facial nerve paralysis, or hearing loss if left untreated 1.
• The infection spreads from the middle ear to the mastoid air cells in the skull, causing inflammation and destruction of the mastoid bone structure, which necessitates prompt and aggressive treatment.

From the Research

Treatment Options for Mastoiditis

The treatment for mastoiditis typically involves a combination of medical and surgical interventions. The primary goal of treatment is to eliminate the infection and prevent further complications.

• Medical management:
  • Broad-spectrum intravenous antibiotics are commonly used to treat mastoiditis, as seen in studies 2, 3, 4, 5, 6.
  • Antibiotic therapy may be initiated as the first line of treatment, with the option to add surgical interventions if necessary 3, 5.
• Surgical management:
  • Myringotomy, which involves making a small incision in the eardrum to drain the middle ear, may be performed in conjunction with antibiotic therapy 2, 4.
  • Mastoidectomy, a surgical procedure to remove the infected mastoid air cells, may be necessary in more severe cases or if the infection does not respond to antibiotic therapy 2, 3, 5.
  • Simple mastoidectomy or more extensive surgical procedures may be required, depending on the severity of the infection and the presence of complications 3, 5.

Approach to Treatment

The approach to treatment may vary depending on the severity of the infection, the presence of complications, and the patient's overall health.

• Conservative approach:
  • Some studies suggest that a conservative approach, using antibiotic therapy alone or in combination with minor surgical procedures, may be effective in managing mastoiditis 4, 5.
  • This approach may be suitable for patients with less severe infections or those who are at low risk for complications.
• Surgical approach:
  • A more aggressive surgical approach, including mastoidectomy, may be necessary for patients with severe infections, complications, or those who do not respond to conservative management 2, 3, 5.
  • The decision to proceed with surgery should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.

Success Rates of Treatment Options

The success rates of different treatment options for mastoiditis vary.

• Antibiotic therapy alone:
  • The success rate of antibiotic therapy alone is reported to be around 24.6% 5.
• Minor surgical procedures:
  • The success rate of minor surgical procedures, excluding mastoidectomy, is reported to be around 87.7% 5.
• Mastoidectomy:
  • The success rate of mastoidectomy is reported to be around 97% 5.