This review article was based on mastoiditis, which was relevant to one of the cases that I had presented during my site visit. It was an emphasis on the overall clinical picture of the disease process and how to manage it in the emergency room as a provider. It mentioned that mastoiditis is a suppurative infection of the mastoid air cells that often complicates otitis media. Studies show that approximately 40% of patients have a history of otitis media 2–8 weeks prior to diagnosis, and 50% had received antibiotics before developing mastoiditis. Common pathogens include Streptococcus pneumoniae and pyogenes, while Pseudomonas is more frequent in patients with diabetes, recent antibiotic use, recurrent otitis media, or tympanic membrane perforation.

Clinical presentation typically includes ear pain, auricular protrusion, and postauricular or mastoid tenderness, redness, swelling, or fluctuance, often accompanied by fever, irritability, poor feeding, and malaise. Diagnosis is primarily clinical, supported by nonspecific laboratory findings such as elevated WBC, CRP, and ESR, and imaging in severe or refractory cases. Temporal bone CT with IV contrast is the imaging modality of choice, particularly in cases with suspected complications. Management in the ED involves IV antibiotics, such as ampicillin-sulbactam or ceftriaxone, and otolaryngology consultation for drainage via myringotomy or mastoidectomy if necessary.