Acute Mastoiditis
Acute mastoiditis *New*
General and supportive measures
ICD-10 code: H70.9
DESCRIPTION
A serious condition involving acute infections of mastoid antrum that could spread to the adjacent brain and could occur secondary to an ear infection. Usually due to bacterial infections but tuberculosis should also be considered.
DIAGNOSTIC CRITERIA
Clinical
- Fever, severe pain, hearing impairment, tenderness over mastoid antrum.
- Swelling in post-auricular area. Pinna is pushed down and forward.
- Tympanic membrane is often perforated with otorrhoea.
- Occasionally, pus breaks through the mastoid tip and forms an abscess in the neck.
- If seizures, headache, loss of consciousness or neck stiffness, do CT scan of brain.
Investigations
- CT brain scan to exclude intracranial spread.
- Collect blood and pus for Gram stain, microscopy, culture and sensitivity tests before initiation of antibiotic therapy.
GENERAL AND SUPPORTIVE MEASURES
- Dry mopping of the external auditory canal.
MEDICINE TREATMENT
Empiric antibiotic therapy
- Ceftriaxone, IV, 100 mg/kg once daily.
Note: Adjust antibiotic therapy based on culture results or if response to antibiotic therapy is unsatisfactory.
As soon as there is a response and patient can tolerate oral medication:
- Amoxicillin/clavulanic acid, oral, 45 mg/kg/dose of amoxicillin component, 12 hourly (amoxicillin/clavulanic acid in a ratio of 14:1).
- Maximum dose of amoxicillin component: 1.5 g 12 hourly.
Total duration of therapy: at least 14 days.
For pain and fever:
REFERRAL
Urgent
- To ENT surgeon after initiation of antibiotics.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 17: Ear Nose & Throat, 17.5 Acute Mastoiditis