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H70.0 – Acute Mastoiditis: Causes & Treatment
H70.0 is the ICD-10 code for acute mastoiditis – a bacterial infection of the mastoid bone behind the ear, typically a complication of acute otitis media.
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H70.0 is the ICD-10 code for acute mastoiditis – a bacterial infection of the mastoid bone behind the ear, typically a complication of acute otitis media.
What is H70.0 – Acute Mastoiditis?
H70.0 is the ICD-10 diagnosis code for acute mastoiditis, a bacterial infection of the mastoid process – a bony prominence of the temporal bone located directly behind the ear. The mastoid contains air-filled cells connected to the middle ear and can become infected when a middle ear infection spreads or is left untreated.
Causes
Acute mastoiditis most commonly develops as a complication of acute otitis media (middle ear infection). Bacteria spread from the middle ear into the mastoid air cells. The most frequent pathogens include:
- Streptococcus pneumoniae
- Staphylococcus aureus
- Streptococcus pyogenes
- Haemophilus influenzae
- Pseudomonas aeruginosa (particularly in chronic or recurrent cases)
Contributing factors include delayed or incomplete treatment of ear infections, a weakened immune system, and certain anatomical characteristics of the ear.
Symptoms
The characteristic signs and symptoms of acute mastoiditis include:
- Pain behind or around the ear
- Redness and swelling over the mastoid region
- Protruding ear (the outer ear is pushed forward due to swelling)
- Fever and general malaise
- Ear discharge (otorrhea)
- Hearing loss or a feeling of pressure in the ear
In children under two years of age, symptoms may be less specific, making early medical evaluation especially important.
Diagnosis
Diagnosis is primarily clinical and is confirmed through imaging and laboratory tests:
- Clinical examination: Inspection of the external ear, palpation of the mastoid area, and otoscopy
- Blood tests: Elevated inflammatory markers (CRP, leukocytosis)
- CT scan of the temporal bone: Gold standard for assessing mastoid involvement and ruling out complications
- MRI: Used when intracranial spread is suspected
- Culture and sensitivity: To identify the causative organism and guide antibiotic therapy
Treatment
Treatment of acute mastoiditis depends on disease severity and the presence of complications:
Conservative Treatment
Uncomplicated cases are managed with intravenous antibiotic therapy, commonly using broad-spectrum antibiotics such as amoxicillin-clavulanate or cephalosporins. Decongestant nasal drops and analgesics may be used as supportive measures.
Surgical Treatment
Surgery is required when there is no response to antibiotics or when complications arise:
- Myringotomy (paracentesis): Incision of the eardrum to relieve pressure in the middle ear
- Mastoidectomy: Surgical removal of the infected mastoid tissue
- Drainage of a subperiosteal abscess, if present
Complications
Without timely treatment, acute mastoiditis can lead to serious and potentially life-threatening complications:
- Subperiosteal or epidural abscess
- Meningitis (inflammation of the membranes surrounding the brain)
- Sinus thrombosis (blood clot in the cerebral venous sinuses)
- Facial nerve palsy (paralysis of the facial nerve)
- Labyrinthitis (inflammation of the inner ear)
References
- World Health Organization – ICD-10 Classification of Mental and Behavioural Disorders, H70.0, Geneva, 2019
- Limänsky S. et al. – Acute Mastoiditis in Children – Pediatric Infectious Disease Journal, 2021
- Tamir S. et al. – Acute Mastoiditis in Children: Is the Increasing Incidence Real? – International Journal of Pediatric Otorhinolaryngology, 2020
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