Although acute mastoiditis is a severe infection that may lead to subperiosteal abscesses and intracranial complications, the necessity and procedure of surgical treatment for acute mastoiditis remain controversial. In this study, we discuss the management of acute mastoiditis, including surgical treatment, based on our experiences in 5 cases and 6 ears, as well as a literature review.
All patients initiated receiving intravenous antibiotics on admission. Four of the 5 cases involved complications on admission: meningitis in two cases and a periauricular abscess or cellulitis in two cases. Although one patient had no complications, intravenous antibiotics were ineffective. Therefore, we performed middle ear surgery in all cases to control for the source of infection. Almost all patients underwent surgery within 3 days of admission. The procedures were intact canal wall tympanomastoidectomy in 4 cases and 4 ears and simple cortical mastoidectomy in 2 cases and 2 ears. In all cases, the attic and aditus ad antrum occupied granulous tissue, which blocked the root from the attic to the mesotympanum. Communication was created between the attic and mesotympanum due to the thorough removal of the granulous tissue. The postoperative courses were favorable in all cases without the recurrence of mastoiditis.
It is important to prevent the progression of mastoiditis due to middle ear surgery, including mastoidectomy at an early stage, in cases of acute mastoiditis with complications and cases without complications for which antibiotics are not effective.
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