Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D 
Different surgical procedures may be performed to treat mastoiditis. Myringotomy is surgical perforation of the tympanic membrane. It should be considered the primary treatment in all cases of infectious mastoiditis following otitis media, particularly when there is an unperforated tympanic membrane or inadequate drainage. Tympanocentesis should be performed in all mastoiditis patients to obtain middle ear fluid for culture and susceptibility testing. Myringotomy accompanied by the additional insertion of a tympanostomy tube is indicated in some cases, such as Eustachian tube dysfunction, suppurative complications requiring additional drainage, and when tympanic membrane must be repaired from Eustachian tube dysfunction. Definitive surgery is mastoidectomy, which is the surgical removal of the mastoid cortical bone and underlying air cells. Indications for mastoidectomy may include subperiosteal abscess such as postauricular fluctuance or mass, chronic suppurative otitis media or cholesteatoma, progression of postauricular swelling or fluctuance, fever, and other clinical findings or continuous drainage despite parenteral antimicrobial therapy and myringotomy.
Surgical procedures and indications
Different surgical procedures may be performed to treat mastoiditis:
Incision and drainage of the mastoid abscess:
When fluctuation presents, drainage must be done immediately to achieve complete drainage of the pus.
Myringotomy is the surgical perforation of the tympanic membrane.
- It should be considered a primary treatment in all cases of infectious mastoiditis when there is an unperforated tympanic membrane or inadequate drainage.
- Myringotomy may be done with or without tympanostomy tube placement.
Tympanocentesis should be done in all mastoiditis patients to obtain middle ear fluid for culture and susceptibility testing.
Myringotomy accompanied by the additional insertion of a tympanostomy tube is indicated in the following:
- Eustachian tube dysfunction
- Suppurative complications requiring additional drainage via the tympanostomy tube
- Necessity to repair the tympanic membrane from Eustachian tube dysfunction
Otorrhea is a possible complication of performing a myringotomy with a tympanostomy tube, affecting up to 17% of infected ears.
Definitive surgery is mastoidectomy, which is the surgical removal of the mastoid cortical bone and underlying air cells.
- Cortical mastoidectomy is the best choice of therapy.
- Open mastoidectomy should be performed if cholesteatoma is present.
- Simple mastoidectomy is performed to clean out the mastoid infection and provide external drainage
- Radical mastoidectomy is performed only when there is no clinical response to simple mastoidectomy, as evidenced by continued otorrhea or pain.
Indications for mastoidectomy may include:
- Subperiosteal abscess such as postauricular fluctuance or mass
- Coalescent mastoiditis in CT scan (regardless of other clinical features)
- Chronic suppurative otitis media or cholesteatoma
- Progression of postauricular swelling or fluctuance, fever, and other clinical findings or continuous drainage despite parenteral antimicrobial therapy and myringotomy
The following video presents surgical procedures for mastoiditis:
- ↑ Zanetti D, Nassif N (2006). "Indications for surgery in acute mastoiditis and their complications in children". Int. J. Pediatr. Otorhinolaryngol. 70 (7): 1175–82. doi:10.1016/j.ijporl.2005.12.002. PMID 16413617.
- ↑ "Pediatric Guidelines: Head and Neck Infections - Mastoiditis | Infectious Diseases Management Program at UCSF".
- ↑ Lin HW, Shargorodsky J, Gopen Q (2010). "Clinical strategies for the management of acute mastoiditis in the pediatric population". Clin Pediatr (Phila). 49 (2): 110–5. doi:10.1177/0009922809344349. PMID 19734439.
- ↑ Pang LH, Barakate MS, Havas TE (2009). "Mastoiditis in a paediatric population: a review of 11 years experience in management". Int. J. Pediatr. Otorhinolaryngol. 73 (11): 1520–4. doi:10.1016/j.ijporl.2009.07.003. PMID 19758711.