Acute and chronic mastoiditis and chronic suppurative otitis media

Abstract

The objectives of this article are to enhance the clinician's ability to (1) diagnose mastoiditis and chronic suppurative otitis media, (2) effectively treat these infections, and (3) appropriately refer patients to an otolaryngologist for possible surgical intervention. When inflammation of the mastoid is diagnosed by computed tomography or magnetic resonance imaging as an incidental finding in which there is no evidence of mastoid osteitis or signs or symptoms of acute mastoiditis, the disease is most likely a natural extension of otitis media (ie, acute mastoiditis-otitis media) and should be managed as any other episode of otitis media. When there are clinical signs of acute mastoiditis (eg, protrusion of the pinna and postauricular erythema) but no radiographic evidence of mastoid osteitis (ie, acute mastoiditis with periostitis), the child should have a tympanocentesis and myringotomy and receive parenteral antimicrobial therapy: referral for possible mastoidectomy is indicated if the child does not rapidly improve with this management. Presence of a subperiosteal abscess or radiographic evidence of mastoid osteitis, or both (ie, acute mastoid osteitis), also calls for mastoid surgery. Likewise, referral is indicated whenever acute mastoiditis is associated with another suppurative complication of otitis media-mastoiditis and when acute mastoiditis develops in a child who has chronic suppurative otitis media (CSOM) or cholesteatoma, or both. Treatment of CSOM with appropriate ototopical antimicrobial medications or oral antibiotics, or both, is frequently effective. If the child does not respond to these measures, he or she requires parenteral administration of an antimicrobial agent. Referral to an otolaryngologist may be necessary.