The diagnosis and management of mastoiditis in children.

Even though mastoiditis as a complication of AOM is uncommon, its recognition is imperative to institute timely therapy. Acute coalescent mastoiditis generally follows a severe bout of AOM. Intravenous antimicrobial therapy and myringotomy drainage are usually satisfactory measures. However, refractory cases may require a simple mastoidectomy. Chronic mastoiditis in children is treated initially with intravenous antimicrobial therapy and vigorous aural toilet, which is successful in most patients. Mastoidectomy may be required in selected patients. The clinician must be aware of the differential diagnosis of chronic otorrhea so that biopsies can be obtained whenever a neoplasm is suspected.