Mastoiditis

Condition

A suppurative infection of the mastoid air cells within the temporal bone. In children, a rare complication of acute otitis media; in adults, it can complicate chronic suppurative otitis media or cholesteatoma. Can be acute (symptoms <1 month) or chronic (symptoms for months to years). Acute mastoiditis is most common in children younger than 2, but complications are more frequent in children 2 or older.

Complications: subperiosteal, subcutaneous, intratemporal, or intracranial collections; facial nerve palsy.

Management

Urgent referral to ENT for IV antibiotics and surgical management.

Standard empirical therapy (active against Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus): IV cefotaxime, or IV ceftriaxone, or IV vancomycin — then switch to oral augmentin, cefuroxime, or azithromycin.

Empirical antipseudomonal regimen (if indicated): IV tazocin, or IV ceftazidime, or IV meropenem — then switch to oral ciprofloxacin.