Table 1. Summary Description of Mild Mastoiditis and Acute Coalescent Mastoiditis
Mild MastoiditisAcute Coalescent Mastoiditis
Imaging findings
  • Fluid in mastoid cavity

  • No invasion of bony septa

  • Fluid in mastoid cavity

  • Invasion of bony septa

  • Possible elevation of bone due to subperiosteal abscess

Exam findings
  • Possible otitis media

  • May be asymptomatic

  • Generally healthy

  • Pain or mastoid tenderness

  • Discharge from the ear

  • Bulging tympanic membrane

  • Retroauricular fluctuance

  • Possible raised erythematous area in retroauricular space

  • May have meningeal symptoms, facial nerve paralysis, high fever, or sepsis

Additional tests needed
  • Otoscopy

  • Tympanometry

  • Audiometry

  • Cranial MRI if intracranial complications are suspected

Management
  • Consider antibiotics appropriate for treatment of otitis media

  • No referral necessary

  • Referral to otolaryngology for hospitalization and intravenous antibiotics or surgical intervention

  • MRI, magnetic resonance imaging.