This is an infection of mastoid air cells and mastoid bone occurring as a complication of an acute otitis media or chronic suppurative otitis media.
Clinical Features
There is a painful swelling above the ear in children under 2 years of age. There is tenderness, oedema, and possible flatulence behind the ear in other children, often with preceding otitis media and mastoid tenderness. There is fever and sagging of the posterosuperior meatal wall. Complications include squint or facial nerve palsy on the same side as mastoiditis.
Management
- Admit.
- Give antibiotics as for otitis media. Intravenous co-amoxi clavulanate 1.2gm BD or cefuroxime sodium 750 mg TDS.
- If the swelling points and /or bursts to discharge pus, refer to higher centre as this condition requires a formal mastoidectomy to adequately clear all the pus and infected material. Inadequate incision and drainage will result in a chronic sinus.
- Manage appropriately if a child develops signs of meningitis (see meningitis) or brain abscess or other complications.