Overview
Acute mastoiditis is an inflammatory condition of the mastoid process, often complicating acute otitis media, and can lead to serious complications including facial paralysis and intracranial involvement 1.Diagnosis
Clinical presentation includes otalgia, fever, otorrhea, and signs of systemic infection 1.
Imaging: CT or MRI may reveal mastoid opacification; however, incidental opacification does not necessarily indicate active infection 3.
Facial nerve function assessment crucial; facial paralysis suggests more severe involvement 1.
Laboratory tests: Elevated white blood cell count and erythrocyte sedimentation rate support the diagnosis 1.Management
First-line treatment: Intramuscular or intravenous antibiotics, typically high-dose amoxicillin-clavulanate or ceftriaxone 1.
Surgical intervention: Indicated for persistent fever, worsening symptoms, or signs of complications such as abscess formation or facial paralysis 14.
Conservative management: Decreased post-COVID-era, with a trend towards earlier surgical intervention 1.Special Populations
Pediatrics: Increased risk of intracranial complications post-COVID era; management may shift towards more aggressive surgical approaches 1.
Comorbidities: No specific guidance provided in abstracts; individualized care based on severity and complications is advised 1.Key Recommendations
Monitor for signs of intracranial complications closely, especially in pediatric patients post-COVID, given increased risk 1 (Evidence: Moderate).
Consider early surgical consultation for cases presenting with facial paralysis or other severe complications 14 (Evidence: Moderate).
Evaluate the necessity of surgical intervention earlier in the treatment course compared to pre-COVID practices due to changes in conservative management success rates 1 (Evidence: Moderate).References
1 Briggs EE, Chau IJ, Nguyen SA, Pelic JC, Harvey EA, Meyer TA. Acute mastoiditis in children during the Covid era: A systematic review and meta-analysis. International journal of pediatric otorhinolaryngology 2025. link
2 Leboulanger N, Celerier C, Parodi M, Denoyelle F, Thierry B. The Auxiliary Report Book: A glimpse of surgical activity in a pediatric ENT department in Paris in the 1920s. European annals of otorhinolaryngology, head and neck diseases 2025. link
3 Lafferty DJ, Cohn JE, McKinnon BJ. Incidental mastoid opacification on computed tomography in the pediatric population. International journal of pediatric otorhinolaryngology 2020. link
4 Milstein S. The history of mastoid surgery. The American journal of otology 1980. link