The species of bacteria responsible for mastoiditis are the same as those that cause acute otitis media. Patients who fail to respond to antibiotic therapy within 48 hours and those with CNS complications should be considered for early mastoidectomy. Other suppurative complications of acute otitis media are rare, including purulent labyrinthitis, meningitis, lateral sinus thrombosis, and brain abscess. Pain and fever are usually absent but can occur during sporadic flare-ups. Diminished hearing and foul otorrhea are major symptoms.
Physical examination discloses perforation of the tympanic membrane.
Central perforations of the pars tensa are associated with benign disease, but peripheral perforations may occur with invasive cholesteatomas. X-rays reveal sclerosis of the mastoid air cells and bone destruction. Antibiotics are generally of little benefit, and surgery is required in advanced cases. Without therapy, chronic otitis media can cause the same intracranial suppurative complications seen in acute otitis media. Patients have pruritus or pain, or both, that may be severe.