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H70.1 Chronic Mastoiditis – Causes & Treatment
H70.1 is the ICD-10 code for chronic mastoiditis – a persistent inflammation of the mastoid bone behind the ear, often resulting from recurrent middle ear infections.
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H70.1 is the ICD-10 code for chronic mastoiditis – a persistent inflammation of the mastoid bone behind the ear, often resulting from recurrent middle ear infections.
What is H70.1 – Chronic Mastoiditis?
H70.1 is the ICD-10 diagnosis code for chronic mastoiditis. This refers to a long-lasting inflammation of the mastoid process, a bony prominence of the skull located directly behind the outer ear. The mastoid contains air-filled cells that are directly connected to the middle ear. In chronic mastoiditis, this tissue remains persistently inflamed and is often structurally altered over time.
Causes
Chronic mastoiditis typically develops as a consequence of untreated or inadequately treated acute mastoiditis or recurrent middle ear infections (otitis media). Other contributing factors include:
- Chronic otitis media with eardrum perforation
- Cholesteatoma – a benign but destructive tissue growth in the middle ear
- Bacterial infections (e.g., Pseudomonas aeruginosa, Staphylococcus aureus)
- Impaired ventilation of the middle ear and mastoid
- Incompletely resolved acute mastoiditis (ICD-10: H70.0)
Symptoms
The symptoms of chronic mastoiditis are often less intense than those of the acute form but may persist for months or years. Typical symptoms include:
- Persistent or recurrent ear pain
- Ear discharge (otorrhoea) – often foul-smelling
- Hearing loss in the affected ear
- Pressure or swelling behind the ear
- General malaise, occasionally low-grade fever
- In severe cases: dizziness or neurological symptoms
Diagnosis
The diagnosis of chronic mastoiditis (H70.1) is made through a combination of clinical examination and imaging:
- Ear microscopy: Assessment of the eardrum, ear canal, and any discharge
- Audiometry: Evaluation of hearing function
- CT scan of the temporal bone: Gold standard for visualising bony changes in the mastoid
- MRI: For assessing soft tissue changes and potential complications
- Swab and culture: Pathogen identification for targeted antibiotic therapy
Treatment
Treatment depends on the extent of the disease and the presence of complications:
Conservative Treatment
- Topical and systemic antibiotics based on culture results
- Regular ear cleaning (aural toilet with suction under microscopy)
- Ear drops with antibiotic and/or anti-inflammatory properties
Surgical Treatment
- Mastoidectomy: Surgical removal of diseased mastoid tissue – indicated in advanced cases or when conservative therapy fails
- Removal of a cholesteatoma if present
- Tympanoplasty: Reconstruction of the eardrum and ossicular chain
Possible Complications
If chronic mastoiditis is not adequately treated, serious complications may arise:
- Intracranial spread: Meningitis, brain abscess, sinus vein thrombosis
- Facial nerve palsy (facial nerve paresis)
- Labyrinthitis with permanent hearing loss or balance disorders
- Subperiosteal abscess behind the ear
References
- World Health Organization (WHO): ICD-10 International Classification of Diseases, 10th Revision – H70.1 Chronic mastoiditis. www.who.int
- Gleeson M. et al. (eds.): Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 7th Edition. Hodder Arnold, 2008.
- Schwartz RH, Rodriguez WJ: Acute otitis media and mastoiditis. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Elsevier, 2020.
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