Management of Mastoiditis

Initial Management

The American Academy of Otolaryngology-Head and Neck Surgery recommends initial management of moderate fluid within the mastoid air cells without signs of acute infection or complications to consist of intravenous broad-spectrum antibiotics with close monitoring for clinical deterioration, followed by CT imaging if no improvement occurs within 48 hours 1
The American Academy of Otolaryngology-Head and Neck Surgery suggests starting intravenous broad-spectrum antibiotics immediately upon diagnosis, with recommended regimens including IV amoxicillin-clavulanate at 80-90 mg/kg/day for pediatric patients with serious infection 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends assessing pain severity using validated scales, and using acetaminophen or NSAIDs for mild-moderate pain, with opioid combinations considered for severe pain 2

The American Academy of Otolaryngology-Head and Neck Surgery suggests considering myringotomy with or without tympanostomy tube as part of initial management, with success rates of antibiotics alone achieving only 10% success, while antibiotics plus myringotomy achieve 68% success 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends obtaining CT temporal bone with IV contrast if the patient fails to improve after 48 hours of IV antibiotics, with clinical deterioration occurring at any point, and CT providing high spatial resolution for assessing bony erosion and intratemporal complications 1