What is Mastoiditis & How is it Treated? | Causes, Symptoms, Prevention, and Complications of Mastoiditis

The mastoid is a strong bone present behind the ear. Its infection is known as mastoiditis. It is a rare condition but can prove to be life-threatening if not treated. Mastoiditis is most common in children. Mastoiditis is often caused by a bacterial infection in the middle ear that may spread to the mastoid bone.⁽¹⁾ The mastoid bone has a honeycomb-like structure that fills the infected material and may break down.

A middle ear infection is the common cause of mastoiditis.⁽¹⁾ It happens when without proper treatment the bacteria spreads. It can happen when a person stops the treatment before it is completed and the bacteria get resistant to the prescribed antibiotics.

Sometimes an abnormal growth of the skin known as cholesteatoma in the middle ear causes a blockage, allowing the bacteria to multiply. This can cause mastoiditis.

Cholesteatoma may also lead to ear polyps that can further cause obstruction.

The symptoms of mastoiditis begin after the symptoms of infection have resolved. It may also seem in some as if the ear infection has gotten worse. If suffering from an ear infection and the symptoms don’t seem to get better even after taking antibiotics, one should get checked for mastoiditis.

The symptoms of mastoiditis include:

• Fever and chills
• Excessive throbbing pain in and around the ear
• Bad smell from the ear
• Swelling behind the ear
• Pus or fluid coming from the ear
• Hearing problems including ringing in the ear
• The ear seems like sticking out or pushing forward
• Redness behind the ear

Signs of mastoiditis in children include:

• Mood changes
• Excessive crying
• Constant pulling on ear
• Hitting the side of the head

If not treated, mastoiditis can lead to blood clots, sepsis, or blood infection that can be life-threatening.⁽²⁾

If someone has an ear infection and confusion, weakness, high fever, and swelling around the head, emergency medical care should be looked for.

For diagnosing mastoiditis, the doctor needs the signs and symptoms of the patient. They also enquire about the previous surgeries or diseases of the ear.

• Diagnosing mastoiditis may be easier in children.
• A few tests are recommended by the doctor to confirm the diagnosis of Mastoiditis including:
• Blood test with complete blood count, erythrocyte sedimentation rate, and C-reactive protein.
• CT scan may be necessary to know about the extent of infection, complications in the skull, effects on the mastoid bone, and presence of fluid in the middle ear.

The treatment option for mastoiditis includes the following.

Antibiotics: Mostly antibiotics are used in the treatment of mastoiditis. Some people receive antibiotics intravenously, in which hospitalization may be required.

If the first line of treatment does not work, a blood culture is ordered to determine the type of bacteria. A different course of antibiotics is recommended then.

Surgery: Myringotomy is the first approach to surgery for mastoiditis.⁽³⁾ It includes making a hole in the eardrum and draining the fluid. In children, tubes are placed in the eardrum. Also, oral and IV antibiotics may be needed.

In case of complications such as a blood clot or an abscess, mastoidectomy may be needed, in which the infected part of the mastoid is removed. In case of abscess draining may be needed.

The best way to prevent mastoiditis is to receive effective treatment for an ear infection. Taking the entire course of antibiotics is important to prevent the bacteria from getting resistant. Taking only a partial dose of antibiotic may cause the infection to return. Maintaining hand hygiene can be helpful in preventing infection. Also, avoiding contact with infected people can be helpful. A person has a weakened immune system should immediately consult a doctor for any sign of infection.

If proper treatment is not received, mastoiditis can get complicated and lead to :

• Abscess in the neck muscle
• Labyrinthitis
• Facial nerve palsy
• Bone infection

It is found that the complication affecting the area of the skull that encloses the brain occurs in 6-23% of people.⁽⁴⁾ This may lead to neck stiffness, headache, and a change in mental status. In some people, it may also lead to the development of clots in the brain.

The outlook for mastoiditis can be good with prompt treatment. A study done in 2014 found that 32 children under 16 years receiving treatment for mastoiditis in a hospital had successful recovery and 54% needed mastoidectomy.⁽⁵⁾

Anyone with intense ear pain, swelling, or signs of mastoiditis should look for a prompt diagnosis and treatment.