Acute mastoiditis is a characteristic complication of acute middle ear infection. The other mentioned complications (erosion, fistula, palsy due to erosion) are characteristic features of long-term chronic disease, especially cholesteatoma | Posterior wall erosion, fistula, facial palsy due to erosion, and ossicular sclerosis are all chronic complications | Otology consultation upon medical treatment failure for acute otitis media within 48-72 hours | Presence of persistent fever or postauricular swelling despite antibiotics mandates imaging and surgical consultation | Acute mastoiditis requires surgical intervention in 10-20% of cases | Scott Brown's Otorhinolaryngology 8th Ed Vol 1 — pp. 455-456; CUMMINGS Otolaryngology 7th Ed p1 — pp. 9-10