Episode 137: Acute Mastoiditis

Acute mastoiditis represents a suppurative infection of the mastoid air cells, primarily occurring as a complication of acute otitis media. Pediatric patients, particularly those aged two to seven, face the highest risk due to anatomical factors and immature immune systems. Clinical presentation often includes otalgia, post-auricular tenderness, and pinna protrusion, though systemic symptoms like fever and malaise are common. While diagnosis is often clinical, CT imaging with IV contrast is essential when complications—such as subperiosteal abscesses or intracranial involvement—are suspected. Management requires prompt ENT consultation, admission for IV antibiotics, and frequently surgical intervention, such as myringotomy or mastoidectomy, to prevent severe sequelae like meningitis or venous sinus thrombosis. Given the rising incidence of MRSA and Pseudomonas, empiric antibiotic selection must account for patient history and local resistance patterns to ensure effective treatment.