Acute mastoiditis: a review of 69 cases.

Sixty-nine cases of acute mastoiditis were managed at the Kaplan Hospital in Israel during a 10-year period. About two thirds (68%) recovered with conservative therapy consisting of wide myringotomy and intravenous antimicrobial therapy, usually ampicillin and cloxacillin. One third (22 patients) were managed surgically by complete mastoidectomy. Indications for surgery were subperiosteal abscess, based on clinical findings in 20 patients; one had septic fever that did not respond to antimicrobial therapy, and one had signs of meningeal irritation. Mastoid radiographs played no role in the decision to operate. Four cases of unsuspected epidural abscess were found, two behind intact tegmental bone. Acute mastoiditis develops mostly in ears that have not been immune to previous infections; thus the mucosal barrier is broken easily and osteitis occurs. Although with the advent of antimicrobial therapy the presentation and course of the disease are milder, the disease is still serious and potentially lethal.