Acute mastoiditis (AM) is characterized by an inflammation of the mastoid air cells of the temporal bone and is likely a consequence of acute otitis media. Most common infections involve Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis. The surgical treatment option usually provides the best recovery perspectives, if broad-spectrum antibiotics haven't alleviated symptoms.
Acute mastoiditis (AM) is the most probable complication of acute otitis media . In more than fifty percent of diagnosed patients, it is the first evident manifestation of acute otitis media   . AM is caused by bacterial infection and can overshadow other conditions or develop into a chronic form.
AM typically presents with mastoid area erythema, proptosis of the auricle, fever, otorrhea, lethargy and pain. Fever may be quite high. Pain is located deep in or behind the ear and is usually worse at night. Persisting pain is an indication of a more serious condition of the mastoid. Hearing loss is frequently reported in AM and should recover back to normal after the infection has worn off .
The infection of the mastoid bone is most likely caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, less probably by group A Streptococci, Staphylococcus aureus, and the Pseudomonas species. The mean gap time between infection and onset of AM is 4.5 days .
AM is more likely in children than in adults. Risk factors include a recent untreated bacterial infection of the middle ear and cholesteatoma. In infants, it is advisable to look out for general symptoms that may be consistent with infections like diarrhea, irritability, or malnutrition .
The diagnosis of AM is based on patient history and clinical examination. There is no well-defined consensus which symptoms are crucial in diagnosing AM.
It is usually not necessary to go beyond the clinical diagnosis but it may be advisable to consider computed tomography (CT) or magnetic resonance imaging (MRI) of the temporal bone as a possibility to better assess the extent of the infection and screen for other possible reasons of the inflammation. Some experts consider CT scan a necessary procedure in AM diagnosis . Both in CT and MRI, AM presents with a partial to total opacification of the mastoid air cells.
If ear drainage occurs, it is highly advisable to analyze the material for cultures, Gram stain, and acid-fast stain. If there is no spontaneous drainage, ear fluid could be obtained within a tympanocentesis and/or myringotomy procedure. The tympanic membrane will recover fast and extraction of excess ear fluid will likely ease acute symptoms. It is often possible to carry out both procedures in one session without additional discomfort for the patient. Tympanostomy tube insertion is often performed to allow for continued drainage and easier administration of antimicrobial agents .
An audiometric test should be scheduled after complete recovery.