Synopsis
Recognise mastoid and intracranial extension of ear infection, initiate urgent hospital care and understand how imaging, intravenous antimicrobials and surgical source control work together.
- The middle-ear cleft communicates with mastoid air cells, allowing acute infection to extend into the mastoid.
- Clinical mastoiditis is suggested by painful postauricular inflammation and displacement of the pinna.
- Mastoid fluid on a scan alone does not establish acute mastoiditis or mandate surgery.
Key red flags
Tender postauricular swelling, fluctuance, loss of the ear crease or a pinna pushed outwards suggests infection involving the mastoid or a subperiosteal collection.
Investigation priorities
Assess inflammatory burden and guide antimicrobial treatment safely.
Management branches
Clinical findings suggest mastoiditis or a complication of middle-ear infection.
- Arrange urgent ENT and senior paediatric or adult medical assessment, with anaesthetic or critical-care help for threatened airway or physiological instability.
- Assess and treat airway, breathing and circulation, give appropriate analgesia and address dehydration using the age-appropriate acute-care pathway.
Key medicines
Intravenous co-amoxiclav for selected adult mastoiditisThe NHS Forth Valley adult hospital pathway uses co-amoxiclav 1.2 g intravenously every eight hours, adjusted for renal impairment. Its total treatment range is seven to fourteen days, with longer treatment for severe or extensive disease and an individually reviewed IV-to-oral switch.