From the Guidelines
Treatment for mastoid effusion detected on CTA should prioritize addressing the underlying cause, often with a course of oral antibiotics, and considering the most recent guidelines, high-dose amoxicillin (80-90 mg/kg/d) or amoxicillin-clavulanic acid is recommended as the first-line treatment. According to the guidelines from the United States, 2013, and other countries, the management of acute otitis media (AOM), which is often the underlying cause of mastoid effusion, involves watchful waiting or immediate antibiotic therapy depending on the severity and patient age 1.
For patients with mastoid effusion, the initial approach includes:
- Oral antibiotics such as high-dose amoxicillin or amoxicillin-clavulanic acid for 10-14 days
- Nasal decongestants to improve Eustachian tube function
- Nasal steroid sprays to reduce inflammation
It's crucial to monitor the patient's response to treatment, and if symptoms persist or worsen, or if there are signs of complications, referral to an otolaryngologist for further evaluation and possible surgical intervention, such as myringotomy with tympanostomy tube placement or mastoidectomy, is necessary. The recent trend towards nonsurgical management with intravenous antibiotics, either alone or combined with myringotomy and TT insertion and/or needle aspiration of the subperiosteal abscess, should be considered based on the severity of the case and the presence of complications 1.
Key considerations in management include:
- Patient age and severity of symptoms
- Presence of complications such as severe pain, hearing loss, vertigo, or facial weakness
- Response to initial antibiotic therapy
- Need for surgical intervention to prevent progression to more serious conditions like mastoiditis or intracranial complications.
From the Research
Treatment for Mastoid Effusion
- The treatment for mastoid effusion typically involves antibiotics that cover organisms commonly found in acute otitis media (AOM), including Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis 2.
- Empirical antibiotic treatment should be chosen based on the susceptibility of these organisms to various antibiotics, as reported in studies such as 3, which evaluated the susceptibility of these organisms to common pediatric antibiotics.
- The choice of antibiotic may depend on factors such as the severity of the infection, the patient's age and medical history, and the presence of any antibiotic-resistant organisms 3, 4.
- Some studies have compared the efficacy of different antibiotic regimens for the treatment of AOM, such as a single dose of ceftriaxone versus a 10-day course of amoxicillin/clavulanate 5.
- The antimicrobial susceptibility pattern of bacterial isolates from patients with otitis media with effusion (OME) has also been studied, with results showing that most isolates are sensitive to ampicillin, amoxicillin/clavulanate, and fluoroquinolones 6.
Antibiotic Options
- Amoxicillin/clavulanate is a commonly used antibiotic for the treatment of AOM and OME, with a broad spectrum of activity against Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis 2, 3, 6, 5, 4.
- Ceftriaxone is another option, which has been shown to be effective in the treatment of AOM, especially in areas with high rates of penicillin-resistant Streptococcus pneumoniae 5.
- Other antibiotics, such as cefuroxime axetil, cefixime, and trimethoprim/sulfamethoxazole, may also be considered as alternatives, although there may be less data available on their efficacy 3, 4.