Mastoiditis is an inflammation or infection of the mastoid bone which consists of air cells that drain the middle ear, a portion of the temporal bone of skull, located just behind the ear, usually seen as a complication of acute otitis media (middle ear infection). Mastoiditis is a bacterial infection of the mastoid air cells (small, air-filled cavities located in the mastoid process, which is the bulge in the skull behind the ear) if untreated can destroy the skull bone leading to hearing loss and other complications including death, seen commonly in children.

Causes

Mastoiditis is usually caused by a middle ear infection (acute otitis media). The infection may spread from the ear to the mastoid bone of the skull. The mastoid bone fills with infected materials and its honeycomb-like structure may deteriorate.

Mastoiditis usually affects children, now it is a relatively uncommon and much less dangerous condition after introduction of antibiotics.

Mastoiditis may be caused by various bacteria. Bacteria that cause mastoiditis include pneumococcus (usually in children under age 6), Hemophilus influenzae, beta-hemolytic streptococci, staphylococci, and gram-negative organisms.

Mastoiditis is usually a complication of chronic otitis media and, less frequently, of acute otitis media.

Symptoms

• Thick, purulent discharge that gradually becomes more profuse
• Ear pain or discomfort
• Fever, may be high or suddenly increase
• Headache
• Hearing loss
• Redness of the ear or behind the ear
• Swelling behind ear, may cause ear to stick out
• recent ear infection
• irritability

• Postauricular erythema and edema (may push the auricle out from the head)

• Edema of the tympanic membrane

Tests and Diagnosis

An examination of the head may reveal signs of mastoiditis. The following tests may show an abnormality of the mastoid bone:

• Otoscopy
• Tympanometry
• Blood Tests
• CTscan of the ear
• Head CT scan
• Skull x-ray

Complete medical history and physical examination.

• Otoscopy:Inspection of the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside of the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.
• Tympanometry: a test that can be performed in most physician offices to help determine how the middle ear is functioning and helps to detect any changes in pressure in the middle ear.
• Routine tests
• Blood routine
• X-rays of the head - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues and bones of the head onto film.
• Culture from the infected ear

 

If symptoms of a brain abscess or other intracranial complication are noted, the following tests are advised:

• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

 

If your child has symptoms of meningitis, then an lumbar puncture may be needed:

 

• Lumbar puncture - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.

Treatment

Specific treatment for mastoiditis will be determined on:

• Child’s age, overall health and medical history
• Extent of the disease
• Child’s tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Opinion or preference

Medicines

Mastoiditis may be difficult to treat because medications may not reach deep enough into the mastoid bone. It usually requires hospitalization and may require repeated or long-term treatment. The infection is treated with antibiotics by injection, then antibiotics by mouth.

Surgery

• To remove part of the bone and drain the mastoid (mastoidectomy) may be needed if antibiotic therapy is not successful. This procedure involves removal of the diseased bone and cleansing of the affected area, after which a drain is inserted.

• Surgery to drain the middle ear through the eardrum (myringotomy) may be needed to treat the middle ear infection. A surgical procedure which involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube may be placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating, and it usually falls of after 6 to 12 months on its own.

• A chronically inflamed mastoid bone requires radical mastoidectomy - excision of the posterior wall of the ear canal, remnants of the tympanic membrane, and the malleus and incus (although these bones are usually destroyed by infection before surgery). The stapes and facial nerve remain intact.

Possible Complications   

• Destruction of the mastoid bone
• Dizziness or vertigo
• Epidural abscess (brain abscess)
• Facial paralysis
• Meningitis
• Partial or complete hearing loss
• Spread of infection to the brain or throughout the body

Early and proper treatment of mastoiditis is necessary to prevent the development of these life-threatening complications.