What is mastoiditis?
Mastoiditis is an infection in the mastoid bone, located just behind the ear. A mastoid infection, also called “mastoiditis,” is usually a complication of a middle ear infection. Most cases of mastoiditis are in children less than two years old because young children get ear infections much more often than adults.
Signs of a mastoid infection
The symptoms of a mastoid infection can include:
Mastoiditis can cause headaches, severe ear pain, or pain behind the ear. The area behind the ear may be tender to the touch. A child too young to tell you about their pain may pull at their ear or be fussy or grouchy.
Redness and swelling
The area behind the ear may be red, swollen, and warm. It may swell so much that the earlobe is pushed out or forward.
A sudden, high fever or an increase in fever are common in mastoiditis.
Mastoiditis can cause hearing loss in the affected ear. This is usually temporary if the infection is treated early enough.
Causes of a mastoid infection
The mastoid contains air cells that allow fluid to drain from the middle ear. Mastoiditis is almost always caused by a middle ear infection that spreads into the mastoid air cells. Rarely, the mastoid air cells can become infected on their own.
Antibiotic treatment of middle ear infections can help prevent mastoiditis. Before antibiotics were widely used, 20% of middle ear infections resulted in mastoiditis. By 2008, the rate had dropped to 0.002%.
Diagnosis for a mastoid infection
The doctor will ask questions about your child’s medical history and their current symptoms. After a complete physical exam, the doctor will use an otoscope to look carefully at the child’s ears, nose, and throat. An otoscope is a handheld instrument with a light on it that helps the doctor see inside the ear.
The doctor may order blood work and an imaging test of the mastoid area, such as an X-ray or a computed tomography (CT) scan. Fluid from the affected ear may be sent to a lab for testing.
Treatments for a mastoid infection
Most children with mastoiditis need to be admitted to the hospital for treatment. Sometimes, a child with an uncomplicated case may not have to stay overnight at the hospital. An uncomplicated case means the child has no other medical issues — such as diabetes. It also means that the child does not yet have signs like a high fever or a large amount of redness and swelling behind the ear.
Whether or not they need to stay at the hospital, a child with mastoiditis will be evaluated by an otolaryngologist and given intravenous (IV) antibiotics. An otolaryngologist is a doctor who specializes in treating the ears, nose, and throat and is sometimes called an ENT doctor.
The otolaryngologist may do a brief procedure called a myringotomy, also known as ear tubes surgery. Your child will be given medicine that makes them go to sleep while the doctor makes a tiny hole in the eardrum. This relieves the pressure inside the ear, restores the child’s hearing, and allows fluid to drain.
The fluid then can be tested to determine which bacteria is causing the infection so that the doctor knows which antibiotic to use. During the myringotomy, a tiny plastic tube may be placed in the eardrum to prevent the fluid from building up again. The tube will fall out on its own in 6-12 months.
Most children with uncomplicated mastoiditis get better with simple treatments like antibiotics, steroids (a type of medicine that reduces inflammation), and myringotomy.
If your child is not getting better within 48 hours, they may need a mastoidectomy. This is a surgery in which part of the infected mastoid is removed. It can help prevent the mastoiditis from spreading to other parts of the body.
It is important to treat mastoidectomy so that it doesn’t cause complications such as:
- Seizures
- Facial nerve palsy – damage to the nerves of the face
- Permanent hearing loss
- Meningitis – a serious infection of the tissue that covers the brain
- Brain abscess – a pocket of infection inside the brain
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Children's Hospital of Pennsylvania: "Mastoiditis."
Saint Luke's: "When Your Child Has Mastoiditis."
Stanford: "Mastoiditis in Children."
StatPearls: "Mastoiditis."
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