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The diagnosis of acute mastoiditis (AM) has been disputed. Luntz and colleagues (1) described AM as: acute otitis media (AOM) on otoscopy with local mastoid inflammatory findings (pain, erythema, sagging of postero-superior wall of external auditory canal and auricular protrusion) or mastoid inflammatory changes with radiological or surgical findings of AM +/− evidence of AOM on otoscopy. Other authors (2,3) have suggested that diagnosis requires all of otoscopic findings of AOM, inflammatory changes over the mastoid process and radiological findings of AM. The clinically important distinction in AM compared to middle ear infections is the development of periostitis or osteitis (4), as patients with bony destruction have an increased risk of intra or extra cranial complications. Incipient mastoiditis involves periostitis without any bony Original Article

Is mastoiditis being over-diagnosed on computed tomography imaging? —radiological versus clinical findings