Mastoiditis is a rare but possible complication of acute otitis media (AOM). It presents with similar symptoms and signs of AOM in addition to inflammation over the mastoid process (retro-auricular), pinna protrusion, and loss of post-auricular sulcus. Patients with mastoiditis are also likely to be more unwell, more likely to have a fever, and have prolonged pain even in cases of tympanic membrane rupture. Otoscopy would reveal either a bulging eardrum, as in AOM, or a perforation – otoscopy should not be normal.
In uncomplicated cases, IV antibiotics are the first-line management. However, if there is no improvement within 24-48 hours of treatment, or from initial presentation there are signs of intracranial complications or subperiosteal abscess, a CT Head should be performed. Surgery can then be planned and performed. Incision and drainage, myringotomy, tympanostomy tube insertion, and cortical mastoidectomy are some of the many options depending on the specific case.