Advances in broad-spectrum antibiotics are enabling general physicians and pediatricians to treat acute middle-ear infection without otolaryngologists' intervention. Most such subjects also recover without serious complications. Middle-ear infection remains potentially life-threatening, however, due to potential infectious intracranial complications, requiring surgery by otolaryngologists. We report two cases of acute pediatric mastoiditis following acute otitis media. Both had been initially treated by pediatricians and administered several antibiotics. One subject had masked mastoiditis when first seen and the other serious complications involving intracranial infection thought due to comorbid congenital cholesteatoma. Both were treated successfully with mastoidectomies followed by intravenous antibiotic therapy.
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