Mastoiditis

What is mastoiditis?

Mastoiditis is a bacterial infection in a part of your temporal bone — 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 infections and antibiotics that cure them, mastoiditis is a rare condition.

But you can still get mastoiditis if you have an untreated middle ear infection. Although anyone can get mastoiditis at any age, children 2 years old and younger are especially vulnerable. It’s important to know the signs of mastoiditis so that you can seek treatment for yourself or your child as soon as possible.

Types of mastoiditis

There are two types of mastoiditis:

• Acute mastoiditis typically occurs a few days after an ear infection. It goes away within a month after treatment and doesn’t come back.
• Chronic mastoiditis is associated with a longstanding ear infection (typically present for at least a month).

What are mastoiditis symptoms?

Usually, symptoms of mastoiditis develop days or weeks after a middle ear infection. Mastoiditis symptoms include:

• Throbbing ear pain that doesn’t go away
• An ear that looks as if it’s sticking out more than your ear on the other side
• Swollen skin or redness (may appear purplish on dark skin tones) behind your affected ear
• Doughy or soft-feeling bone behind your ear
• Ear drainage that contains pus
• Worsening hearing loss
• Headache
• Fever
• Vertigo
• Confusion
• Double vision

In addition to the symptoms above, very young children — children ages 2 and younger — may pull their affected ear and be fussy or less active.

What causes mastoiditis?

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

Rarely, people develop mastoiditis without a middle ear infection. This happens when a condition called cholesteatoma causes mastoiditis. Cholesteatoma is an abnormal skin growth in your middle ear. It can block fluids that need to drain from your middle ear and lead to mastoiditis.

What are the complications of this condition?

Without treatment, the infection can spread and cause complications like:

• Facial paralysis
• Partial or complete hearing loss
• Inner ear infection (labyrinthitis)
• Infection of tissues covering your brain (meningitis)
• Swelling in your brain (encephalitis)
• Life-threatening inflammation throughout your body (sepsis)

Life-threatening complications from mastoiditis are much less common than they once were. Still, it’s important to get treatment immediately to avoid long-term issues.

How is mastoiditis diagnosed?

A healthcare provider will use an otoscope to look inside your ear. They may also do the following tests:

• Blood tests. They may check your blood for signs of an infection or inflammation.
• Ear culture. Your provider will test the drainage coming from your ear for signs of the bacteria.
• Computed tomography (CT) scan. This test creates detailed images of the inside of your skull so providers can see where the infection is.
• Magnetic resonance imaging (MRI). Providers sometimes use this test to check the area between your ear and your brain.

How is mastoiditis treated?

Often, healthcare providers treat mastoiditis with antibiotics and steroids. If your middle ear isn’t draining infected fluid on its own, they’ll perform a myringotomy. For this procedure, a provider makes a tiny hole in your eardrum, so the fluid gathered behind it can drain. They may place small, hollow cylinders called ear tubes into the hole, so the fluid can continue to seep out. The ear tubes usually fall out on their own within six months to a year.

If these treatments don’t help or there’s a pocket of pus (abscess) in part of your temporal bone, you may need surgery (mastoidectomy) to remove the infected bone.

Can mastoiditis be prevented?

The best thing you can do to reduce your risk of mastoiditis is to get treated for ear infections ASAP. You can also take steps to protect your child from infections. You can:

• Vaccinate your child. The U.S. Centers for Disease Control and Prevention (CDC) recommends children up to age 2 receive pneumococcal vaccinations. This vaccine protects against the bacteria that most commonly cause ear infections that lead to mastoiditis.
• Limit the use of pacifiers. Pacifiers may be parents’ go-to for fussy babies and toddlers. But extended pacifier use increases the risk of developing middle ear infections.
• Don’t smoke. Secondhand smoke increases the likelihood of ear infections. Be sure no one smokes around your child.
• Control allergies. Inflammation and mucus caused by allergic reactions can block your child’s eustachian tube. This increases the risk of ear infections.
• Prevent colds. Most ear infections start with a cold, so try to limit your child’s exposure to other kids who are sick as best as you can.

What can I expect if I have/my child has this condition?

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

For severe cases, you or your child may need follow-up appointments to check for long-term hearing loss.

How do I take care of myself?

Follow your healthcare provider’s instructions about caring for yourself or your child after treatment. For example, you may need to avoid swimming for a while to keep water out of your ear. You may need to put a cotton ball lined with petroleum jelly (like Vaseline®) in your ear when you’re bathing or showering to keep water out.

Your provider will tell you what to do.

When should I see my healthcare provider?

Contact a healthcare provider if you or your child has symptoms of an ear infection, like ear pain that doesn’t improve. Ear infections are treatable. But ignoring symptoms can allow the infection to spread.

What questions should I ask my healthcare provider?

Questions to ask include:

• What treatments will my child need to get rid of mastoiditis?
• Will they need to be admitted to the hospital?
• What are signs the infection has returned?
• How can I prevent future ear infections?
• Will my child need tests to check for hearing-related issues?