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Mastoiditis, Emergency Medicine

Reviewed 06/2017



  • Inflammation of the mastoid air cells of the temporal bone, generally caused by direct extension of acute purulent otitis media

  • Middle ear and mastoid air cells are contiguous via the...


Signs and Symptoms


  • Ear pain

  • Otorrhea

  • Mild to severe hearing loss

  • Fever

  • Headache

  • History of irritability in a child

  • History of recurrent otitis media

Physical Exam

  • Tenderness, edema, and erythe...


Initial Stabilization/Therapy

  • ABCs

  • Airway management for signs of airway compromise

  • 0.9% NS IV fluid bolus for hypotension/volume depletion

Ed Treatment/Procedures

  • Initiate IV antibiotics

  • Otolaryn...



Admission Criteria

  • Clinical suspicion of acute or coalescent mastoiditis

  • Subperiosteal abscess

  • Toxic appearing

Discharge Criteria

Patients with acute or coalescent mastoiditis should n...

Pearls and Pitfalls

  • It is important to maintain a high index of suspicion for mastoiditis in setting of persistent or untreated acute otitis media.

  • Failure to recognize meningitis or intracranial invol...

Additional Reading

  • Anderson  KJ. Mastoiditis. Pediatr Rev.  2009;30:233–234.

  • Anthonsen  K, Høstmark  K, Hansen  S, et al. Acute mastoiditis in children. A 10-year retrospective and validated multi...



  • 383.00 Acute mastoiditis without complications

  • 383.01 Subperiosteal abscess of mastoid

  • 383.9 Unspecified mastoiditis

  • 383.1 Chronic mastoiditis

  • 383.02 Acute mastoiditis with other complications

  • 38...

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