Mastoiditis

Acute mastoiditis is the most common, and usually the initial, complication of AOM. The diagnosis can be confusing due to differing uses of the term “mastoiditis”. Radiographic mastoiditis simply refers to fluid in the mastoid air cells, which can occur with any AOM due to communication between the middle ear and the mastoid air cells. However, acute mastoiditis for the EP involves clinical evidence of mastoid inflammation such as erythema, tenderness to palpation, bogginess, and swelling over the mastoid bone. A clinical diagnosis of acute mastoiditis necessitates treatment with IV antibiotics with a consideration for tympanostomy and mastoidectomy. Occasionally, a CT scan with IV contrast should be considered to evaluate for additional complications such as abscess.