From the Guidelines
Mastoiditis treatment should prioritize 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 initial antibiotic regimen should include broad-spectrum IV antibiotics such as ceftriaxone and vancomycin to cover common pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus 1. This approach is supported by recent trends in nonsurgical management of mastoiditis, with contemporary case series reporting mastoidectomy rates between 29% and 93% of patients with mastoiditis 1.
Key Considerations
- Initial treatment with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess
- Surgical intervention such as mastoidectomy should be considered if there is no improvement after 48 hours or clinical deterioration
- Pain management with acetaminophen or NSAIDs is also important
- The antibiotic regimen usually continues for 7-10 days, followed by oral antibiotics for an additional 1-2 weeks
Surgical Intervention
- Myringotomy (to drain middle ear fluid)
- Mastoidectomy (removal of infected mastoid air cells)
- Tympanostomy tube placement
- These procedures may be necessary if the patient doesn't respond to antibiotics within 48-72 hours or if complications develop 1.
Complications
- Meningitis
- Brain abscess
- Facial nerve paralysis
- Hearing loss
- These complications can occur if mastoiditis is left untreated, making prompt and appropriate treatment essential to prevent them 1.
From the Research
Mastoiditis Treatment Overview
- Mastoiditis is a complication of acute otitis media, and its treatment depends on the severity of the disease 2, 3, 4.
- The main pathogen of acute mastoiditis is Streptococcus pneumoniae, followed by other bacteria such as Streptococcus pyogenes, Haemophilus influenzae, and Staphylococcus aureus 2, 5, 6.
Medical Treatment
- Antibiotic therapy is the main treatment for non-complicated forms of acute mastoiditis, with cephalosporins being the antibiotic of choice due to the prevalence of Streptococcus pneumoniae 2.
- Broad-spectrum intravenous antibiotics are recommended, and combinations with other antibiotics may be suggested when multibacterial flora is present 2, 3, 4.
- Conservative treatment, including intravenous antibiotics, myringotomy, and incision and drainage of subperiosteal abscess when needed, may be effective in most cases of acute mastoiditis 4.
Surgical Treatment
- Surgical treatments, such as incision of abscesses, mastoidectomy, and neurosurgical procedures, may be necessary in complicated forms of acute mastoiditis or when medical treatment fails 2, 3.
- Mastoidectomy is recommended if the infection fails to be controlled after 48 hours of intravenous antibiotic therapy, as it may prevent serious complications 3.
Complications and Prevention
- Complications of acute mastoiditis can be extracranial, intratemporal, or intracranial, and may be life-threatening 2.
- Early myringotomy for acute otitis media may decrease the incidence of complications, and obtaining a sample for culture prior to antibiotic treatment is important to guide therapy 5.