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Otorhinolaryngology focuses on the ear, nose, and throat. Learn about the diagnosis and treatment of hearing loss, sinusitis, tonsillitis, and voice disorders.
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Diagnosing mastoid disease requires a combination of detective work and advanced technology. Due to the mastoid bone’s concealment beneath the skin and skull, doctors are unable to visually diagnose the condition. They must rely on specialized scans and detailed hearing evaluations to build a clear picture of the problem.
The journey to diagnosis usually begins with a visit to an Ear, Nose, and Throat (ENT) specialist, also known as an otolaryngologist. This specialist has the tools and expertise to look deep into the ear canal and assess the health of the bone behind it. The goal of diagnosis is to determine the extent of the infection, checking whether it is confined to the mastoid or if it threatens nearby structures like the brain or facial nerve.
The first step is a physical exam using an otoscope—a handheld light with a magnifying lens. The doctor looks in the ear canal to check the eardrum. In cases of mastoiditis, the eardrum often looks red or bulging or may have a hole (perforation) with pus draining out.
The doctor will also check for the “sagging” of the ear canal wall. When the mastoid bone is full of pressure, the back wall of the ear canal can swell and droop downwards. This is a very specific sign of mastoid disease. They will also feel (palpate) the bone behind the ear. If the patient flinches or complains of pain when this bone is tapped or pressed, it is a strong indicator of inflammation inside the bone.
The most critical tool for diagnosing mastoid disease is the CT scan of the temporal bone. This is a special X-ray test that creates detailed cross-sectional images of the head. This test is considered the most reliable method for identifying bone problems.
On a healthy CT scan, the mastoid bone looks like a black honeycomb because it is filled with air. In a diseased mastoid, the honeycomb looks gray or white. This white color indicates that the air cells are filled with fluid, pus, or solid tissue like a cholesteatoma. The scan also shows if the thin bony walls of the honeycomb are eroding or breaking down.
For the surgeon, the CT scan is a roadmap. It shows exactly where the facial nerve is located, how low the brain hangs, and where the major blood vessels are. It tells the surgeon how extensive the disease is and helps them plan exactly how much drilling will be needed. It is a painless, noninvasive test that takes only a few minutes but provides vital safety information.
A comprehensive hearing test, or audiogram, is performed to assess how much hearing has been lost. The patient sits in a soundproof booth and listens to beeps and words.
The test helps distinguish between two types of hearing loss. “Conductive” loss means sound is physically blocked from getting through the ear—this is common with fluid or cholesteatoma in the mastoid. Sensorineural loss means the inner ear nerve is damaged. This kind of damage is less common but can happen if the infection has released toxins that seeped into the inner ear. Knowing the type of hearing loss helps the surgeon predict whether hearing can be restored after the disease is removed.
In some cases, a CT scan is not enough. If the doctor suspects the infection has spread into the brain (causing an abscess) or if they need to distinguish between fluid and a solid cholesteatoma, they may order an MRI.
An MRI uses magnets to look at soft tissues. It is excellent at showing the brain and facial nerves. It is often used if the patient has symptoms like severe headache, confusion, or facial weakness, which suggest complications beyond the ear. It is a longer test than a CT scan and can be noisy, but it provides a different layer of detail that is crucial for complex cases.
If there is active drainage coming from the ear, the doctor will take a swab of the fluid. This sample is sent to a lab to see exactly which bacteria are causing the infection.
This is called a culture. Once the bacteria are grown in the lab, they are tested against different antibiotics to see which ones kill them best. This helps the doctor choose the right medication to use before and after surgery. Chronic infections, often caused by resistant “superbugs” like MRSA or Pseudomonas that standard antibiotics cannot kill, require special attention.
In the ENT office, the doctor often uses a binocular microscope to look into the ear. This provides a 3D view and allows the doctor to use tiny suction tools to clean out wax and pus. This cleaning is often necessary to see the eardrum clearly. Under the microscope, the doctor can spot tiny details like small pockets of cholesteatoma or subtle defects in the ear canal bone that a handheld light might miss.
Patients should come to their appointment prepared to give a full history. The doctor will want to know about childhood ear infections, previous surgeries, and any history of dizziness. Bringing old hearing tests or medical records can be very helpful.
The diagnosis phase can feel overwhelming with all the scans and tests, but it is thorough for a reason. Operating on the mastoid bone requires precision. The more information the surgeon has beforehand, the safer and more effective the surgery will be. These tests ensure that the treatment plan is tailored exactly to the patient’s unique anatomy and disease severity.
Send us all your questions or requests, and our expert team will assist you.
No. A CT scan is completely painless. You simply lie still on a table for about 5 to 10 minutes while the machine takes pictures. It is not an enclosed tube like some MRI machines.
The hearing test establishes a baseline. It helps the surgeon know if the hearing bones are damaged and measure the success of the surgery later on.
Standard plain X-rays are rarely used anymore because they are not detailed enough. They can show a “cloudy” mastoid, but they cannot show the tiny, critical details needed for surgery. A CT scan is much better.
If the culture shows resistant bacteria, the doctor might prescribe intravenous (IV) antibiotics or specialized ear drops. Surgery is often the best solution because it physically removes the infected bone where bacteria hide.
No. MRI is usually reserved for complicated cases where there is concern about the brain or facial nerve. For most standard mastoidectomies, a CT scan is sufficient.
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