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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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Recognizing the symptoms of mastoid disease is the first step toward getting the right treatment. The problems usually start in the ear but can spread to affect the entire side of the head. Because the mastoid bone is so deep, patients often do not see any changes on the outside until the condition is quite advanced. Instead, they feel a progression of discomfort, pressure, and changes in their hearing.
The middle ear is almost always the cause of mastoid issues. The ear and the mastoid bone are essentially one room divided by a doorway. If the ear is sick, the mastoid is sick. The symptoms can range from the dramatic, sudden pain of an acute infection to the slow, silent destruction of a chronic cyst. This section explores the physical sensations patients experience and the underlying biological reasons why the mastoid bone becomes diseased.
Acute mastoiditis is a medical emergency that presents with unmistakable signs. It typically follows an ear infection that seemed to be getting better but then suddenly got worse. The most prominent symptom is pain. This is not just a mild earache; it is a deep, boring pain behind the ear that interferes with sleep.
The hallmark sign of acute mastoiditis is swelling over the mastoid bone. The skin behind the ear becomes red, hot, and tender to touch. As the pus builds up inside the bone, it pushes against the outer shell. In children, this pressure can be so great that it pushes the earlobe forward and down, making the ear look like it is sticking out from the head. This “protruding ear” is a classic warning sign that parents should never ignore.
Along with the pain and swelling, patients often run a high fever. There may be a creamy, thick discharge draining from the ear canal. If the eardrum has burst, the pus escapes out the ear. However, sometimes the eardrum is intact, and the pus is trapped entirely inside the bone, which makes the pain even worse. The patient will generally feel very unwell, lethargic, and irritable.
Chronic mastoiditis is a stealthier condition. It does not always cause a fever or intense pain. Instead, the primary symptom is persistent, long-term ear drainage. This drainage, called otorrhea, might be yellow, green, or brown. It often has a foul odor that does not go away with regular cleaning.
Patients with the chronic form might live with it for years. They become used to having a “wet ear.” They might carry cotton balls or tissues to wipe their ear throughout the day. The pain is usually a dull ache or a feeling of heaviness on one side of the head. Over time, the chronic infection eats away at the healthy air cells, replacing them with scar tissue. The result leads to a progressive hearing loss that slowly gets worse.
One of the frustrating aspects of mastoid disease is that oral antibiotics often fail to cure it. This is due to the structure of the bone. The mastoid is a honeycomb of tiny, separate rooms. When these rooms fill with pus and the bone becomes inflamed, the blood supply to the area is reduced.
Antibiotics travel through the blood. If the blood cannot get to the bone effectively, the medicine cannot reach the bacteria. Furthermore, in chronic cases, the bacteria form a “biofilm”—a slimy shield that protects them from drugs. This phenomenon phenomenon is why patients often take antibiotics for weeks, feel a little better, and then get sick again as soon as the pills stop. The infection is hiding in the bone where the pills can’t reach, necessitating surgical removal.
Living with mastoid disease is draining. The constant drainage requires constant management. Patients worry about water getting in their ear when they shower or swim, as moisture fuels the infection. The hearing loss makes social interactions difficult and isolating.
The subtle, chronic pain can lead to irritability and fatigue. For children, it can affect their speech development and performance in school because they cannot hear the teacher clearly. Recognizing these impacts is important because surgery is not just about fixing a bone; it is about restoring the patient’s ability to live freely without the burden of a chronic, messy, and painful ear condition.
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Yes. Most cases of mastoiditis start as a regular middle ear infection (otitis media). If the infection is aggressive or not treated effectively, it spreads backward into the mastoid bone.
The offensive smell comes from the type of bacteria involved (often Pseudomonas or anaerobes) and from decaying skin cells trapped in the ear. It is a sign of active, chronic infection.
Dizziness is not common in early stages, but it is a warning sign in advanced disease. It means the infection or cyst is eroding the bone covering the balance organs.
Yes, but it is much more common in young children. In adults, mastoid issues are more likely to be chronic (long-term) or related to cholesteatoma.
No. Earwax is produced in the outer ear canal. Mastoid problems happen in the middle ear and the bone behind it. Wax blockage is a separate, minor issue.
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