Diagnosis
Infection of the mastoid, often follows otitis media. Rubor, dolor, calor, and tumor behind the ear.
Epidemiologic Risks
If > age 2 you have a mastoid; infection often follows URIs.
Microbiology
Acute: S. pneumoniae, H. influenzae.
Chronic: S. aureus and gram-negative enteric bacilli.
It is nice to get cultures.
Atypical mycobacteria are not uncommon, presenting with refractory otorrhea and lots of granulation tissue and are best treated with surgery (PubMed)
Empiric Therapy
Acute: amoxicillin OR amoxicillin/clavulanate OR doxycycline OR tmp/sulfa OR second-generation cephalosporins such as cefuroxime.
In other words; damn near anything will work.
Chronic: it is best to let cultures be your guide; treating empirically is a path down which lies madness.
Pearls
Occasionally will be the source of a cerebellar abscess.
Curious Cases
Relevant links to my Medscape blog
Last Update: 11/06/18.