Treatment of Mastoiditis
The treatment of Mastoiditis typically involves a combination of aggressive medical and surgical interventions due to the potentially serious nature of this middle ear infection. Treatment of Mastoiditis depends on the severity, underlying cause, and whether complications have developed, but it is always considered a condition requiring prompt and comprehensive care. Early and effective treatment is vital to prevent the spread of infection to nearby structures like the brain or facial nerves. This section outlines medical therapies, surgical procedures, hospitalisation protocols, and the ongoing management of mastoiditis, providing an in-depth look into the clinical approach used to resolve the infection and preserve hearing and overall health.
Medical Management
The first step in treatment of mastoiditis is usually medical. Doctors start with strong intravenous (IV) antibiotics in hospital. This ensures enough medicine reaches the blood and infected tissue. Common antibiotics include ceftriaxone, cefotaxime, or vancomycin. Doctors adjust the choice based on culture results from ear fluid or mastoid samples.
In simple acute cases, patients usually receive IV antibiotics for 7–14 days. After that, they may take oral antibiotics for another 1–2 weeks. If the patient does not improve in 24–48 hours, or symptoms get worse, doctors move to surgery. Even so, in many early cases, antibiotics alone control the infection and stop the spread.
Myringotomy and Tympanostomy
A myringotomy is a small cut made in the eardrum. It drains pus or fluid, reduces pressure, eases pain, and allows accurate cultures. Sometimes, doctors place a tympanostomy tube in the ear to keep it ventilated and stop more fluid build-up.
Children usually need general anaesthesia for these procedures. Adults may have them with local anaesthesia if they can stay calm. These methods work best when mastoiditis occurs together with a middle ear infection.
Mastoidectomy in Treatment of Mastoiditis
If infection spreads into the mastoid bone and does not improve with medicine, surgery is needed. A mastoidectomy removes infected air cells from the bone. Surgeons drill into the mastoid to clear infection and support healing.
There are several types:
- Simple mastoidectomy: only infected cells are removed.
- Radical mastoidectomy: more bone and ear parts are removed, but this is rare today.
- Modified radical mastoidectomy: balances infection control with preserving hearing.
This surgery is vital in the treatment of mastoiditis when abscesses or bone erosion appear. It prevents dangerous problems like meningitis or brain abscess.
Hospitalisation and Monitoring
Most people with acute mastoiditis need hospital care, especially children. Doctors check for:
- Fever and swelling changes
- Hearing changes
- Signs of brain problems like confusion or seizures
If problems such as subperiosteal abscess, facial nerve weakness, or brain spread appear, doctors speed up surgery. Hospital stays may last from a few days to several weeks depending on recovery. Outpatient care is only safe in very mild cases with close specialist follow-up.
Follow-Up and Long-Term Care
After acute treatment of mastoiditis, follow-up is important. Doctors check hearing recovery and look for leftover infection. Hearing tests are repeated after a few weeks. In severe cases, scans confirm full healing.
If a tube was inserted, it may stay in place for 6–12 months. Patients then need regular ENT visits. In some, repeated infections or chronic mastoiditis develop, needing further surgery or long-term antibiotics.
Supportive Therapies
Supportive treatments add to medicine and surgery. These include:
- Pain relievers like paracetamol or ibuprofen
- Nasal decongestants or antihistamines to ease Eustachian tube blockage
- Good hydration and nutrition, especially in children
Parents and caregivers should watch for warning signs of infection coming back. Completing all prescribed antibiotics is key. Patients should also avoid water in the ear during healing.
Special Considerations in Children
Children get mastoiditis more often. For them, treatment of mastoiditis must suit their age, immune health, and ability to explain symptoms. ENT surgeons usually get involved early. A team approach works best when problems arise.
Doctors often choose surgery faster for children, since their narrow ear spaces make infection spread quicker. In chronic mastoiditis or cholesteatoma, children may need larger surgeries. Sometimes, staged procedures are used to clear infection first and then restore hearing later.
