ear, nose, and throat disorders
Mastoiditis
Treatment of Mastoiditis
IVceftriaxone IV antibiotic treatment is initiated immediately with an antibiotic that provides central nervous system penetration, such asceftriaxone1 to 2 g (children, 50 to 75 mg/kg) once a day continued for≥2 weeks;vancomycinorlinezolidare alternatives. Oral treatment with a quinolone may be acceptable. Subsequent antibiotic choice is guided by culture and sensitivity test results. A subperiosteal abscess usually requires a simple mastoidectomy, in which the abscess is drained, the infected mastoid cells are removed, and drainage is established from the antrum of the mastoid to the middle ear cavity. If the tympanic membrane does not spontaneously perforate, a tympanostomy tube is placed to allow fluid to drain. Then patients are treated with fluoroquinolone ear drops for 2 to 3 weeks and dry ear precautions. Dry ear precautions include occluding the external canal (eg, using a cotton ball lathered with petroleum jelly) during bathing and showers and avoiding swimming. Ear drops that contain aminoglycosides (eg,neomycin,tobramycin) or polymyxin should not be prescribed for patients with a perforated tympanic membrane or a tympanostomy tube because of potential ototoxicity. 