Doctors Revision

IMCI · Age: 2 months - 5 years

Mastoiditis

Classification for a child with ear problem presenting with tender swelling behind the ear. This is a serious bacterial infection of the mastoid bone requiring immediate antibiotic treatment and urgent referral.

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Care priority and warning signs

Care priority

Refer URGENTLY

Red flags

  • Tender swelling behind the ear
  • High fever
  • Signs of systemic illness (lethargy, poor feeding)
  • Facial nerve palsy
  • Signs of meningitis (stiff neck, altered consciousness)

Assessment

  • Ask: Does the child have an ear problem?
  • Ask: Is there ear pain?
  • Ask: Is there ear discharge? If yes, for how long?
  • Look/Feel: Feel for tender swelling behind the ear.

Classification

  • Tender swelling behind the ear -> MASTOIDITIS

Key features

  • Presence of Tender Swelling Behind the Ear.
  • Indicates spread of infection from the middle ear to the mastoid bone.
  • Requires urgent hospital management to prevent serious complications.

Management

Non-pharmacological management

  • Keep child comfortable.
  • Quickly complete assessment for other pre-referral needs.

Pre-referral treatment

  • Give first dose of an appropriate IM antibiotic (e.g., Ampicillin + Gentamicin or Ceftriaxone - see page 12 for doses).
  • Give first dose of Paracetamol for pain/fever (10-15 mg/kg). Dose (500mg tablet): 2-3m (<6kg): 1/4 tab. 4m-3y (6-<14kg): 1/2 tab. 4-5y (14-19kg): 3/4 tab (or 1/2 of 500mg tab from p15).
  • Treat for low blood sugar if needed (see page 12).
  • Give other relevant pre-referral treatments if other severe classifications present.

Follow-up

  • To be managed at referral hospital facility (typically requires IV antibiotics, possibly surgery).

Counselling points

  • Explain that the swelling behind the ear is a serious infection requiring urgent hospital treatment.
  • Explain treatments given (antibiotic, pain relief).
  • Advise on keeping child comfortable during transport.
  • Write a detailed referral note indicating mastoiditis and treatments given.

Differential diagnosis

  • Postauricular lymphadenopathy (swollen lymph node, may be tender but usually more mobile)
  • Acute Otitis Media (without mastoid involvement)
  • Otitis Externa (infection of ear canal)
  • Cellulitis over mastoid area

Complications

  • Meningitis
  • Brain abscess
  • Facial nerve paralysis
  • Hearing loss (conductive or sensorineural)
  • Labyrinthitis
  • Sepsis
  • Venous sinus thrombosis

Prevention

  • Prompt and appropriate treatment of Acute Otitis Media.
  • Pneumococcal vaccination (PCV).
  • Hib vaccination.

References

IMCI Chart Booklet - Page 5, Page 12 (Antibiotic), Page 15 (Paracetamol)

For learning and professional reference. Use current local guidance and clinical judgement.

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