What is mastoiditis?

Mastoiditis is a bacterial infection in the mastoid bone of the skull. It can be quite painful and is a serious condition. Often a complication of an ear infection, mastoiditis requires medical attention and intervention.

Many cases of mastoiditis can be effectively treated with antibiotics, especially if they are diagnosed early. If the antibiotics are not effective, however, your doctor may recommend surgery.

The bone directly behind your ear is a protrusion of your skull called the mastoid. The mastoid is the back part of the temporal bone. It is located right next to your inner ear. The bone has a honeycomb-like structure, which means that it has many small pockets of air inside of it. A bacterial infection of this bone, or the air pockets inside it, is called mastoiditis. Symptoms of mastoiditis include:

Mastoiditis is most often caused by an untreated inner or middle ear infection that spreads into the sponge-like structure of the mastoid bone. Mastoid bone infections are most frequently seen in children, though they can occur in adults. An infected mastoid can be an acute or a chronic condition, both of which require medical care.

Diagnosis for mastoiditis

If you have symptoms of an ear infection, your doctor will examine your ears, especially the one that is causing discomfort. They may perform a hearing test. Your doctor will also examine your head to determine if the infection has spread into the mastoid bone. 

Your doctor may perform other tests to get a complete picture of the infection. These might include blood tests to examine your white blood cell count and a spinal tap to determine whether the infection has reached your cerebrospinal fluid. Your doctor may also collect some of the fluid that is around the infected area to culture the bacteria and identify it. 

Your doctor may also use a computerized tomography (CT) or magnetic resonance imaging (MRI) scan to further assess the infection in your mastoid bone.

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Treatments for mastoiditis

If your doctor is able to diagnose mastoiditis in the early stages of infection, it may be treated with antibiotics. Serious cases of mastoiditis could require intravenous (IV) antibiotics and hospitalization, antibiotic injections into the infected mastoid bone, as well as topical and oral antibiotics.

If antibiotics are not effective, your doctor may consider surgery. They may refer you to an Ear, Nose, and Throat Specialist (also called an otolaryngologist) for the procedure.

Medications

When choosing the right antibiotic to treat mastoiditis, your doctor will select one that will penetrate your central nervous system. The antibiotic will kill the bacteria there and in the mastoid bone. It is common to use a combination of antibiotics in different ways to treat the infection in the mastoid bone. You may receive these through an IV, direct antibiotic injections into the infection, antibiotics taken orally, and/or topical applications to your skin around the infected area.

The most commonly used antibiotics are ceftriaxone, vancomycin, and linezolid. Your doctor will decide the best option for you based on your symptoms, overall health, age, and other factors.

Surgery

If antibiotics do not effectively eliminate the infection in the mastoid bone, your doctor might perform surgery. This could involve the removal of part of the mastoid bone (called a mastoidectomy) or the placement of tympanostomy tubes. 

Home care

Mastoiditis is a serious condition and requires professional medical care. If you have the symptoms of an ear infection, you should talk to your doctor. The best way to avoid mastoiditis is to promptly and thoroughly manage any ear infections. This ensures that they do not spread into your mastoid bone.

Possible complications and side effects

If a mastoid bone infection is not treated, it can cause serious complications including:

  • Permanent hearing loss
  • Facial paralysis
  • Cranial nerve damage
  • Labyrinthitis (an inflammation disorder in the inner ear)
  • Abscesses in the skull
  • Blood clots
  • Meningitis (inflammation of the covering of the brain or spinal cord)
  • Death

The antibiotics that your doctor uses to treat mastoiditis may have side effects. Discuss any of these side effects of antibiotics with your doctor.

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Medically Reviewed on 3/15/2021
References
Boston Children’s Hospital: “Testing and Diagnosis for Mastoiditis in Children.”

Columbia University Department of Otolaryngology Head and Neck Surgery: “Mastoiditis.”

Columbia University Department of Otolaryngology Head and Neck Surgery: “Tympanostomy Tubes.”

Merck Manual Professional Version: “Mastoiditis.”

National Health Service: “Mastoiditis.”

PediatricEducation.org: “What Are the Complications of Mastoiditis?”

Stanford Children’s Health: “Mastoiditis in Children.”