Mastoiditis is an infection of your mastoid process, or the large bone behind your ear. Middle ear infections cause most cases of mastoiditis. Healthcare providers treat mastoiditis with antibiotics. More serious cases require surgery. Mastoiditis was once a common, serious illness. Now, thanks to antibiotics and vaccinations, it’s considered a rare condition.


Child in profile showing mastoid bone location. Inset shows swelling behind ear that is mastoiditis symptom.
Location of mastoid bone and swelling that is mastoiditis symptom.

What is mastoiditis?

If you have mastoiditis, you have a bacterial infection in your mastoid — the big bone behind your ear. Mastoiditis starts as a middle ear infection. It once was a common cause of death in very young children. Now, thanks to vaccinations that prevent infection and antibiotics to cure infections, mastoiditis is a relatively rare condition. But people can still develop mastoiditis if they have untreated middle ear infections. Healthcare providers usually use antibiotics to treat this condition. They may also do surgery to treat more serious infections.

What are types of mastoiditis?

There are two types: Chronic mastoiditis and acute mastoiditis:

  • Chronic mastoiditis lasts a month or longer or comes back after antibiotic treatment.
  • Acute mastoiditis typically goes away within a month after treatment and doesn’t come back.

Who’s affected by mastoiditis?

Although anyone can get mastoiditis at any age, children age 2 and below are more likely to develop mastoiditis.


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Symptoms and Causes

What are mastoiditis symptoms?

Most of the time, mastoiditis symptoms develop days or weeks after you or your child develop a middle ear infection. Mastoiditis causes a throbbing pain that doesn’t go away. Other symptoms include:

  • The skin covering your or your child’s mastoid may look red and swollen.
  • It may hurt when someone touches the area behind your or your child’s ear.
  • You may notice your or your child’s ear looks as if it’s being pushed down and to the side.
  • You or your child may have a fever.
  • You may notice pus or a thick fluid flowing from your or your child’s ear.
  • You or your child may have hearing loss that gets worse over time.

Very young children — children ages 2 and younger — may have the following symptoms:

  • Ear pulling.
  • Lethargy.
  • Fever.
  • Fussiness.
  • Irritability.

What causes mastoiditis?

Mastoiditis typically happens when middle ear infections go untreated, allowing the infection to spread into the mastoid.

Can I develop mastoiditis without an ear infection?

Yes, sometimes a condition called cholesteatoma can cause mastoiditis. Cholesteatoma is an abnormal skin growth in your middle ear and temporal bone behind your eardrum. Cholesteatomas can be filled with fluid or air.


Diagnosis and Tests

How do healthcare providers diagnose mastoiditis?

A healthcare provider will do a physical examination, using an otoscope to look at the inside of your or your child’s ear. They may also do the following tests:

  • Blood tests.
  • Ear culture. If there’s pus coming from your or your child’s ear, your provider may analyze for bacterial infections.
  • Computed tomography (CT) scan. This test creates detailed images of the inside of your or your child’s skull so providers can check on the mastoid infection.

Management and Treatment

How do healthcare providers treat mastoiditis?

Many times, providers treat mastoiditis with antibiotics and steroids. But if antibiotics don’t seem to help or there’s an abscess in the mastoid, providers may recommend surgery to remove the infected bone. Surgery for mastoiditis may include:

  • Tympanostomy: Providers place small hollow cylinders called ear tubes into your or your child’s eardrum. This surgery treats chronic middle ear infections and acute mastoiditis.
  • Mastoidectomy: Providers remove the infected part of your or your child’s mastoid bone.



Can mastoiditis be prevented?

You may not be able to prevent mastoiditis, but there are things you can to do protect yourself and your child:

  • The pneumococcus bacteria causes several infections, including middle ear infections that can lead to mastoiditis. The U.S. Centers for Disease Control and Prevention (CDC) recommend children up to age 2 receive pneumococcal vaccinations.
  • If you or your child do develop ear issues, talk to a healthcare provider about any steps you should take to reduce the chance you or your child will develop mastoiditis.
  • Take steps to prevent middle ear infections.

What can I do to prevent middle ear infections?

There are many things you can do to avoid middle ear infections that can lead to mastoiditis, such as:

  • Limit use of pacifiers. Binkies (pacifiers) may be parents’ go-to for fussy babies and fractious toddlers. But some studies show extended pacifier use increases the risk of developing middle ear infections.
  • Don’t smoke. Studies have shown that second-hand smoke increases the likelihood of ear infections. Be sure no one smokes in the house or car — especially when children are present — or at your daycare facility.
  • Control allergies. Inflammation and mucus caused by allergic reactions can block your or your child’s eustachian tube and make ear infections more likely.
  • Prevent colds. Most ear infections start with a cold, so try to limit your or your child’s exposure.

Outlook / Prognosis

What can I expect if I have/my child has mastoiditis?

Usually, mastoiditis symptoms go away a few days after you or your child start taking antibiotics. It’s important that you or your child finish taking all of the antibiotics as prescribed so the infection doesn’t come back.

A note from Cleveland Clinic

Mastoiditis happens when common middle ear infections go untreated and spread to your mastoid. That’s the large bone behind your ear. Years ago, mastoiditis was a common, serious illness that could be fatal for very young children. Now, we have vaccinations to prevent the middle ear infection that causes mastoiditis. And we have antibiotics to treat those infections. If you think you or your child have a middle ear infection, contact a healthcare provider so you or your child can get treatment and reduce the risk of developing mastoiditis.

Medically Reviewed

Last reviewed on 11/21/2022.

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