Acute mastoiditis (AM) is an uncommon but potentially serious sequelae of acute otitis media (AOM). In the preantibiotic era it complicated up to 20% of cases of AOM. Currently, the incidence of AM has fallen to 1.2 to 4.2 cases per 100,000 children per year. The peak age of incidence of AM is in the first 1 to 2 years of life.

Mastoid air cells have a direct physical connection to the middle ear space through the aditus ad antrum. Inflammation of the middle ear typically affects the mastoid mucosa in a similar manner. In this way, virtually all cases of AOM are associated with some degree of mastoid inflammation.

If this initial mastoid inflammation results in blockage of the aditus ad antrum, pus and edema may accumulate, leading to periostitis. If the destruction affects the delicate trabecular system it will create a type of empyema called a coalescent mastoiditis....

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