Decisions regarding intracranial complications from acute mastoiditis in children.

PURPOSE OF REVIEW: To review the clinical findings and treatment algorithms for intracranial complications of acute mastoiditis, such as sigmoid sinus thrombosis, otitic hydrocephalus, intracranial abscess, and otitic meningitis. We also briefly discuss the clinical sequelae of these complications.

RECENT FINDINGS: Recent changes in the microbiology and treatment paradigms of otitis media have the potential to influence the rates of intracranial complications of mastoiditis; however, evidence supporting a resultant increase in the rates of these complications is lacking.

SUMMARY: Antibiotic therapy and myringotomy with ventilation tube placement, with or without mastoidectomy, are the mainstays of treatment for intracranial complications of acute mastoiditis. Adjunct treatment, such as anticoagulation for sigmoid sinus thrombosis, is often used; however, the rarity of these complications makes establishing appropriate levels of evidence to support their use difficult.