Any suspicion of intracranial extension warrants a CT scan immediately. CT scan of the mastoids may demonstrate a fluid-filled middle ear and mastoid and demineralization of the mastoid trabeculae. CT scan may detect the presence of any intracranial complications. CT scanning may be overly sensitive since any AOM has a component of mastoid inflammation. Myringotomy initially is the standard of care.
Mastoidectomy is performed if conservative treatment fails.
To treat the disease properly, clinical suspicion and prompt diagnosis are very important. The most common surgical treatment for uncomplicated mastoiditis is myringotomy or tympanostomy tube insertion. A mastoidectomy is performed in the presence of mastoid osteitis, a subperiosteal abscess, intracranial involvement, or if no improvement occurs after 24-48 hours of treatment. If the patient does not respond to standard treatment or if the patient has chronic mastoiditis, an infectious disease consult may be helpful, especially in patients with chronic mastoiditis when the causative organism may be difficult to identify due to antibiotic pretreatment. A mastoidectomy should be performed if no improvement occurs or if the disease progresses.