What is the recommended treatment for an adult patient with sinus mastoid infection and no significant underlying medical conditions?

Treatment of Sinus Mastoid Infection in Adults

For an adult with sinus mastoid infection (acute mastoiditis), immediate intravenous antibiotic therapy is required, with surgical intervention (mastoidectomy) indicated if there is no clinical improvement within 48-72 hours or if complications are present. 1

Critical Initial Assessment

Distinguish this from uncomplicated sinusitis immediately, as mastoiditis represents a serious complication requiring aggressive management. 1

Key clinical features to confirm mastoiditis include:

• Postauricular swelling, erythema, or tenderness 1
• Protrusion of the auricle 1
• Otoscopic evidence of coexistent or recent otitis media 1
• Fever and radiological findings of mastoid involvement 1

Immediate Management Algorithm

Step 1: Assess for Complications (High Priority)

Screen for life-threatening complications that modify treatment urgency: 1

• Meningitis (occurs in 24% of adult mastoiditis cases) 1
• Facial nerve paralysis (occurs in 18% of cases) 1
• Lateral sinus thrombosis 1
• Labyrinthitis (occurs in 13% of cases) 1

If any complication is present or suspected, immediate hospitalization and specialist consultation (otolaryngology, infectious disease) is mandatory. 1

Step 2: Initiate Antibiotic Therapy

For uncomplicated mastoiditis without immediate surgical indication:

• Start broad-spectrum intravenous antibiotics immediately 1
• Conservative treatment (antibiotics ± ventilation tube) achieves complete cure in 69% of uncomplicated cases 1

However, in complicated cases (with meningitis or other intracranial involvement), conservative treatment succeeds in only 24% of patients, making surgical intervention more likely necessary. 1

Step 3: Reassessment Timeline

Reassess at 48-72 hours: 2

• If symptoms worsen or fail to improve, proceed to surgical intervention 2, 1
• Clinical deterioration can be rapid, particularly in elderly patients 1

Step 4: Surgical Intervention

Mastoidectomy or mastoido-tympanoplasty is indicated when: 1

• No improvement after 48-72 hours of appropriate antibiotic therapy 2, 1
• Presence of complications (meningitis, facial paralysis, labyrinthitis) 1
• Clinical deterioration despite medical management 1

Critical Pitfalls to Avoid

Do not treat mastoiditis as simple sinusitis - this is a surgical emergency that requires specialist involvement. 1

Do not delay imaging - radiological confirmation is essential for diagnosis and surgical planning. 1

Beware of atypical presentations - clinical features are frequently atypical in adults, with prolonged insidious development followed by rapid deterioration. 1

Elderly patients require heightened vigilance - incidence of meningitis and complications is particularly high in this population. 1

Do not rely on oral antibiotics alone - intravenous therapy is the standard of care for mastoiditis. 1

Prognosis

Facial nerve paralysis recovers completely in nearly all cases with appropriate treatment. 1

No mortality was observed in the reviewed series when appropriate treatment was provided, despite high complication rates. 1

Early diagnosis and adequate treatment are essential - the key to successful outcomes is recognizing this as a complication requiring more aggressive management than uncomplicated sinusitis. 1