Acute mastoiditis represents the most common complication of acute otitis media in childhood and, despite a declining incidence in the era of vaccine prevention, remains a clinically significant entity. Particularly in infants and immunocompromised patients, symptoms may be nonspecific, thereby complicating early diagnosis. The present review provides a structured overview of the etiology, pathophysiology, diagnostic workup, and therapeutic management of acute and chronic mastoiditis, with special emphasis on interdisciplinary aspects.The pathogen spectrum is age-dependent and subject to epidemiological shifts driven by vaccination programs and external factors such as the COVID-19 pandemic. In acute cases, Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes predominate, whereas chronic mastoiditis frequently exhibits a polymicrobial flora including Pseudomonas aeruginosa and anaerobic pathogens. Diagnosis remains primarily clinical and is supported by imaging modalities (CT, MRI).Treatment is stage-dependent and may be conservative (high-dose intravenous antibiotic therapy, with or without ventilation tube placement) or surgical (mastoidectomy). Interdisciplinary management involving otolaryngology, pediatrics, (pediatric) radiology, neuropediatrics, and infectious diseases is of crucial importance-particularly in complicated courses such as abscess formation, labyrinthitis, facial nerve palsy, Gradenigo's syndrome, or intracranial complications.Special consideration is given to high-risk populations, including infants, immunocompromised patients, and children with cochlear implants, in whom atypical clinical courses and biofilm formation necessitate tailored management strategies. Follow-up care includes structured audiological assessment, vaccination counseling, and parental education aimed at preventing recurrence. A coherent, stage-oriented interdisciplinary treatment algorithm combined with close clinical re-evaluation by the surgical team enables effective management while reducing the rate of operative interventions-consistent with current international standards.