If there is any suspicion of intracranial extension, a CT scan is immediately warranted. 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 acute otitis media will have a component of mastoid inflammation. Myringotomy initially is the standard of care.
Mastoidectomy is performed if conservative treatment fails.
In order 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. If there is mastoid osteitis, a subperiosteal abscess, intracranial involvement, or no improvement after 24-48 hours of treatment, a mastoidectomy is performed. If patient does not respond to standard treatment, or if the patient has chronic mastoiditis, an infectious disease consult may be helpful. ENT consultation is imperative, as they will perform surgery if medical management fails.