Mastoiditis and Complications of Otitis Media

Acute mastoiditis is a clinical complication of middle-ear infection, with mastoid/postauricular inflammation and possible extension. Coalescent disease involves destruction of mastoid air-cell septa. Mastoid opacification alone on a scan is common in otitis media and does not establish clinical mastoiditis.

Once the findings support suspected mastoiditis, admit urgently for IV treatment and monitoring, with paediatric involvement in children. Do not await a definitive scan before treating a clinically significant infection. ^{ENT UK mastoiditis}

Neurological change, sepsis, severe headache, meningism, a fluctuant collection or deterioration requires prompt escalation and imaging.^{ENT UK mastoiditis}

ABCDE, observations, perfusion, hydration, pain and level of consciousness. Stabilise first, obtain IV access and involve the appropriate senior/critical-care team if unstable.

Clarify the history of illness, previous antibiotics/dose/adherence, otorrhoea, hearing, previous surgery/grommets, chronic discharge and possible cholesteatoma. Assess oral intake and urine output.

Ask specifically about worsening headache, vomiting, photophobia, neck stiffness, diplopia, facial weakness, imbalance, hearing deterioration and neck swelling. The absence of fever after antibiotics does not exclude a significant complication.

Review relevant comorbidity, craniofacial disease, immunocompromise, allergy and vaccination history. Do not substitute a routine uncomplicated-AOM antibiotic algorithm for the management of suspected mastoiditis. ^{ENT UK mastoiditis}