Pseudomonas organism. He was nursed in paediatric intensive care unit and was administered oral glycerol and high doses of intravenous antibiotics against gram positive, gram negative and anaerobic organisms. HRCT temporal bone (Fig 1) revealed right sided mastoiditis with an abscess under the temporalis muscle. There was cerebritis, transverse sinus thrombosis with empyema along the inferior border of the tentorium cerebelli on the right side (Fig 2). Neurosurgical consultation warned of considerable risk in draining a small subdural empyema and recommended continuation of conservative therapy. After a week of antibiotic cover child was taken up for a tympanomastoid exploration under general anaesthesia. By a postaural approach the mastoid was exposed. There was an abscess pocket below the temporalis muscle that was fully evacuated and granulation tissue debrided. The surface of the mastoid did not reveal any erosion. Some pus was seen to be draining from the region of the mastoid emissary vein. A canula was inserted in the foramina and suction applied. Mastoidectomy was performed