External drainage is necessary with a drain in the mastoid cavity to drain the antrum, and a pressure equalization tube inserted to ventilate the middle ear space. In conclusion, acute mastoiditis is a diagnosis based on clinical acumen. When acute mastoiditis is suspected a careful history and physical examination should be ascertained to evaluate for intratemporal or intracranial complications. The presence of acute mastoiditis does not exclude the presence of underlying chronic ear disease, and should be taken into account in the evaluation and treatment of the patient. The presence of subperiosteal abscess or progression of symptoms on the above therapy warrants surgical intervention.
Simple mastoidectomy is the surgery of choice.
Prospective controlled studies are necessary to firmly identify indications for medical versus surgical therapy. The headache was not associated with photophobia. Physical examination revealed a young, alert boy with a temperature of 102 F. Examination of his right ear revealed a thickened, but intact tympanic membrane and middle ear effusion. Postauricular edema, erythema, tenderness, and fluctuance was evident. The remainder of the physical examination, including a neurological exam, was normal.