Acute otomastoiditis occurs as a complication of acute otitis media and is most often encountered in young children. In most children with uncomplicated otitis media, there is no role for imaging. However, imaging plays an important role in the detection of complications related to otomastoiditis because clinical symptoms may be nonspecific in young children and, at times, masked by the use of antibiotics. In addition, intracranial complications may impart a higher risk of mortality and warrant urgent surgical therapy. Although the frequency of serious complications has substantially decreased in the antibiotic era, early recognition of serious, life-threatening complications related to this common disease may become increasingly important in the future as a result of antibiotic-resistant microorganisms. Complications of otomastoiditis include coalescent otomastoiditis, subperiosteal abscess, Bezold abscess, meningitis, cerebritis, parenchymal abscess, dural venous sinus thrombosis, epidural abscess, subdural empyema, petrous apicitis, and the Gradenigo syndrome. Patients may benefit from prompt radiologist recognition of these intra- and extracranial complications, which can guide appropriate medical and/or surgical therapy. Learning Objective: Describe the imaging evaluation of intracranial and extracranial complications related to acute otomastoiditis.
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