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Suggest Treatment For A Bacterial Infection Of A Bone Behind The Ear

Posted on Tue, 5 May 2015

Question: Hello, how does my doctor know how bad mastoiditis is without doing a CT scan? My daughter had an ear infection that was diagnosed on March 31 and she was prescribed antibiotic drops. She has a low-grade fever throughout the week which I attributed to the ear infection. Six days later, April 6, I noticed that it was really red behind her ear. We went to the ER and the doctor said that she has mastoiditis and prescribed Amoxicillin 500mg, 3x/day for ten days (my daughter is 5.5 years old). He did not look inside the ear and only looked behind the ear. I have been reading up and it seems that a CT scan is recommended, although when I asked the doctor, he seemed very reluctant and said that he wouldn't do it now, during the treatment, and only after the treatment was finished...and even then, he would have to wait and see. He said that it was caught fast and when I asked how did he know that, he said because I brought her in immediately but it was only by chance I saw the red behind her ear because I have never heard of mastoiditis and never checked behind the ear. I have no idea how many days it was red. Should he being doing a CT scan to check for damage and/or how deep the infection is?

Answered by Dr. Hariom Sharma (1 hour later)

Brief Answer:
Acute mastoiditis can be diagnosed clinically

Detailed Answer:
Hi,
I have gone through your query; it suggests that your daughter may be suffering from the acute mastoiditis.

For your kind information signs of acute mastoiditis are
1. Erythema, tenderness and edema over the mastoid area.
2. Postauricular fluctuance.
3. Protrusion of the auricle.
4. Sagging of the postero-superior canal wall.

No need to CT scan in initial condition, only conservative management is suffices.

Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Hariom Sharma (17 minutes later)

When is a CT scan recommended? What symtoms would the doctor recognize in order to order a CT scan? How does he know that the infection is gone? I understand that this is diffucukt to treat so hiw does the doctor make these assessments?

Answered by Dr. Hariom Sharma (4 hours later)

Brief answer:
CT scan if pain persists

Detailed Answer:
Hi,

1. I have gone through your follow up query and for your kind information in acute mastoiditis CT scan is recommended when persistence of pain in the ear during conservative management. Persistent pain suggests a failure of therapeutic response, development of coalescent mastoiditis and a need for surgery.

Otherwise CT scanning may be omitted prior to surgical intervention; avoiding unnecessary radiation exposure as recommended by the US National Institutes of Health.

2. In above answer, I already mention the signs of acute mastoiditis in four points on this basis your doctor clinically decides that disease gone or not.

3. Doctor can make assessment of your daughter`s disease by the regular otoscopic examination with routine haematological examinations such as total leucocyte & differential count and ESR.

Thanks

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad