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Mastoiditis: Causes, Symptoms and Treatment

Mastoiditis is a bacterial infection of the mastoid bone located behind the ear. It most commonly develops as a complication of a middle ear infection and requires prompt medical treatment.

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Things worth knowing about "Mastoiditis"

Mastoiditis is a bacterial infection of the mastoid bone located behind the ear. It most commonly develops as a complication of a middle ear infection and requires prompt medical treatment.

What is Mastoiditis?

Mastoiditis is an inflammation of the mastoid bone, a spongy, air-filled bone located directly behind the ear as part of the temporal bone of the skull. The mastoid contains small air cells that are connected to the middle ear. When bacteria from a middle ear infection (otitis media) spread into these air cells, mastoiditis can develop. It is considered the most common serious complication of otitis media and predominantly affects young children, although it can occur at any age.

Causes

Mastoiditis is almost always caused by bacterial infection that spreads from the middle ear to the mastoid bone. The most common causative organisms include:

Streptococcus pneumoniae (pneumococcus)
Streptococcus pyogenes
Staphylococcus aureus (including methicillin-resistant strains)
Haemophilus influenzae
Pseudomonas aeruginosa (more common in chronic cases)

Risk factors include inadequately treated middle ear infections, a weakened immune system, and anatomical conditions that impair drainage from the middle ear.

Symptoms

Symptoms of mastoiditis typically appear days to weeks after the onset of a middle ear infection. Common signs and symptoms include:

Pain and tenderness behind the affected ear
Redness and swelling over the mastoid area
Protrusion of the outer ear caused by swelling pushing it forward
Fever and general feeling of illness
Ear pain and hearing loss
Purulent (pus-like) ear discharge

In severe cases, life-threatening complications can arise, including spread of infection to the brain (meningitis, brain abscess) or thrombosis of the sigmoid sinus (a venous blood vessel within the skull).

Diagnosis

Diagnosis is based on clinical examination and imaging studies:

Otoscopy: Visual examination of the eardrum and external ear canal
CT scan of the temporal bone: The gold standard for evaluating bony structures and identifying complications such as abscesses
MRI: Used as a complement when intracranial complications are suspected
Blood tests: Elevated inflammatory markers (CRP, white blood cell count) confirm an active infection
Culture and sensitivity testing: Identification of the causative organism to guide antibiotic selection

Treatment

Antibiotic Therapy

The primary treatment for mastoiditis involves intravenous antibiotics active against the most common pathogens. Commonly used agents include broad-spectrum penicillins, cephalosporins, or clindamycin. The choice of antibiotic is ideally guided by culture results.

Surgical Treatment

If antibiotic therapy is insufficient or complications arise, surgical intervention may be necessary:

Myringotomy (tympanotomy): A small incision in the eardrum to drain fluid and relieve pressure
Tympanostomy tube insertion: Placement of a small tube in the eardrum to allow ongoing ventilation of the middle ear
Mastoidectomy: Surgical removal of the infected mastoid bone tissue; required in severe or complicated cases

Management of Complications

Intracranial complications such as brain abscesses or meningitis require intensive care and may necessitate neurosurgical procedures.

Prognosis

When diagnosed early and treated appropriately, the prognosis for mastoiditis is generally good. However, if left untreated or if treatment is delayed, serious and permanent complications can occur, including irreversible hearing loss or life-threatening spread of infection. Follow-up care with an ear, nose, and throat (ENT) specialist is recommended after recovery.

References

Patel S, Bhatt A - Mastoiditis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK560877/
Vassbotn FS, Klausen OG, Lind O, Moller P - Acute mastoiditis in a Norwegian population: a 20 year retrospective study. Int J Pediatr Otorhinolaryngol. 2002;62(3):237-242.
Anthonsen K, Hostmark K, Hansen S, et al. - Acute mastoiditis in children: a prospective multicentre study. Acta Paediatrica. 2013;102(6):620-625.

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