What is mastoiditis and how does it develop?

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Mastoiditis is an infection of the mastoid bone, which is located behind the ear and forms part of the temporal bone. It most often develops as a complication of a middle ear infection, also called acute otitis media. When bacteria spread from the middle ear into the air-filled spaces of the mastoid bone, inflammation and infection can occur.

The mastoid bone has a honeycomb-like structure with small air cells. If infection reaches these spaces, pus and swelling can build up, causing pain, redness, and pressure behind the ear. Mastoiditis is more common in children, but it can also affect adults.

What are the classic symptoms of mastoiditis?

Classic symptoms of mastoiditis usually appear during or after an ear infection. The area behind the ear may become red, swollen, painful, and tender. The ear may also appear pushed forward because of swelling behind it.

Common symptoms include:

Ear pain
Swelling behind the ear
Redness behind the ear
Fever
Ear drainage
Hearing loss
Headache
Tenderness around the mastoid bone
Irritability in children

Some people may also have a bulging or infected eardrum, especially if the mastoiditis is related to an untreated or worsening middle ear infection.

How is mastoiditis diagnosed?

Mastoiditis is diagnosed through a combination of medical history, physical examination, ear examination, and imaging when needed. A healthcare provider will usually inspect the ear canal, eardrum, and the area behind the ear for redness, swelling, tenderness, or drainage.

Diagnostic methods may include:

Otoscopic ear examination
Physical examination of the mastoid area
Hearing evaluation
Blood tests if infection is suspected
Ear fluid culture in selected cases
CT scan to assess mastoid bone involvement
MRI if deeper complications are suspected

CT imaging can help show whether the infection has affected the mastoid air cells or spread to nearby structures.

What are the possible complications of untreated mastoiditis?

Untreated mastoiditis can become serious because the mastoid bone is close to the middle ear, inner ear, facial nerve, brain, and major blood vessels. If the infection spreads, it may cause severe complications.

Possible complications include:

Permanent hearing loss
Meningitis
Brain abscess
Blood clot near the brain
Facial nerve weakness or paralysis
Inner ear infection
Spread of infection to nearby tissues
Sepsis in severe cases

Prompt treatment is important to reduce the risk of long-term damage and life-threatening infection.

What are the emergency warning signs of mastoiditis that require immediate medical attention?

Mastoiditis can sometimes progress quickly, especially in children. Emergency medical care is needed if symptoms suggest spreading infection or neurological involvement.

Warning signs include:

Severe headache
High fever
Confusion
Drowsiness or reduced alertness
Swelling spreading to the face or neck
Stiff neck
Vomiting with severe illness
Vision changes
Dizziness or balance problems
Facial weakness
Severe pain behind the ear

The NHS advises urgent medical help for suspected mastoiditis, especially if an ear infection does not improve with treatment or mastoiditis treatment is not working.

Can mastoiditis be treated without surgery?

Yes, some cases of mastoiditis can be treated without surgery, especially if they are detected early. Treatment usually involves antibiotics, and many patients need intravenous antibiotics in a hospital setting.

Treatment may include:

Oral antibiotics for mild cases
IV antibiotics for more serious infection
Pain relief medication
Ear drainage if fluid or pus is present
Myringotomy or ear tube placement
Mastoidectomy in severe or persistent cases

Surgery may be needed if antibiotics do not control the infection, if an abscess forms, or if imaging shows serious mastoid bone involvement.

How can I prevent mastoiditis?

The most effective way to reduce the risk of mastoiditis is to treat ear infections promptly and properly. Since mastoiditis often develops from untreated or poorly controlled middle ear infections, early care is important.

Prevention tips include: