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Mastoiditis

What is Mastoiditis?

Mastoiditis is an inflammation or infection of the mastoid bone (bone behind the ear), which is a portion of the temporal bone. The mastoid consists of air cells that connect to the middle ear. Mastoiditis can be a mild infection or can develop into life-threatening complications.

What Causes Mastoiditis?

Mastoiditis is usually a result of an extension of the inflammation of a middle ear infection (otitis media) into and beyond the mastoid air cells. A child with mastoiditis usually has a history of having a recent ear infection or has middle ear infections that continue to reoccur. The risk of mastoiditis may be reduced with the use of antibiotics for ear infections. The presence of a skin cyst (cholesteatoma) in the middle ear or mastoid may block drainage of the ear leading to an infection and mastoiditis.

What are the Symptoms of Mastoiditis?

The following are the most common symptoms for mastoiditis. However, each child may experience symptoms differently. Symptoms may include:

  • Pain behind the ear
  • Lethargy 
  • Change in mental status
  • Fever
  • Irritability
  • Redness or swelling of the skin behind the ear
  • Drainage from an ear infection

The symptoms of mastoiditis may resemble other medical conditions or problems. Always consult your child's physician for a diagnosis.

How is Mastoiditis Diagnosed?

In addition to a complete medical history and physical examination, your child's physician will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see the ear canal and eardrum. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

Tympanometry is a test that can be performed in most physician offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to sit very still and not be crying, talking or moving.

Your child's physician may also order the following tests to help confirm the diagnosis:

  • Blood work
  • Culture from the infected ear

If your child has symptoms of a brain abscess or other intracranial complication, your child's physician may also order the following:

  • Computed tomography scan (Also called a CT scan)—a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Radiographic dye is generally used to detect an abscess under the skin or determine if the infection has spread to the brain.
  • Magnetic resonance imaging (MRI)—a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

If your child has symptoms of meningitis, your child's physician may order a:

  • Lumbar puncture—a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord. This is usually not done until a CT scan or MRI is completed.

Treatment for Mastoiditis:

Specific treatment for mastoiditis will be determined by your child's physician based on:

  • Your child's age, overall health and medical history
  • Extent of the disease
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment of mastoiditis usually requires hospitalization and a complete evaluation by a physician that specializes in the ear, nose, and throat disorders (otolaryngologist). Your child, in most cases, will receive antibiotics through an intravenous (IV) catheter. Surgery is sometimes needed to help drain the fluid from the middle ear.

If the infection is not severe, your child's physician may suggest a myringotomy and placement of a ventilation tube. This surgical procedure involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A sample of the fluid is obtained to try and identify the causative bacteria. A small tube may be placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The child's hearing is usually restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months.

If the infection is severe, your physician may perform a mastoidectomy which involves removing the infected bone behind the ear. Hearing loss may occur with a severe infection, especially if a cholesteatoma is present.

What are the Effects of Mastoiditis?

If the infection continues to spread, despite antibiotic therapy, the following complications may occur:

  • Sigmoid sinus thrombosis—a clot in the large vein next to the mastoid that drains blood from that side of the brain.
  • Meningitis—an infection of the outside of the brain.
  • Brain abscess—a pocket of pus and infection that may develop in the brain.

Early and proper treatment of mastoiditis is necessary to prevent the development of these life-threatening complications.