there may be marked tenderness over the mastoid antrum
the pinna may be pushed down and forward due to a swelling in the post-auricular region. Examination from behind may be required to assess this.
the tympanic membrane is either red and bulging or perforated - N.B. a normal tympanic membrane that is not perforated is not seen in acute mastoiditis.
signs of conductive deafness, e.g. Rinne negative; Weber's test shows that sound is heard loudest in the deafer ear.
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