CT has contributed to an understanding of the phatologic process by which mastoiditis and its complications develop. The labyrinth of mastoid cells is opacified. This condition occurs because the mucosal lining is swollen and the cells are filled with mucus or mucopurulent secretions. Inflammation of the periosteum can induce abnormal new bone formation, but the mastoid trabeculae appear intact and no postauricular subperiosteal abscess can be demonstrated. The lack of a demonstrable subperiosteal abscess and the absence of roentgenographic evidence of osteitis in the mastoid cellular system establishes the diagnosis of acute mastoiditis with periosteitis.
Management consists of myringotomy and antibiotic treatment.
After myringotomy is performed, the middle ear fluid is aspirated an sent for microbiological studies. In addition to providing material for culture and staining, the myringotomy serves as part of the therapy because it reduces middle ear pressure. Parenteral antibiotics are needed. The use of parenteral antibiotics for ambulatory patients is feasible, as shown recently with ceftriaxone. However, such an approach can only be successful if the children are monitored on a daily basis by a combined team including an otolaryngologist and a pediatric infectious disease specialist.