Mastoiditis

Mastoiditis is an inflammation or infection of the mastoid bone, which is a portion of the temporal bone, or the bone behind the ear. The mastoid consists of air cells that drain the middle ear. Mastoiditis can be a mild infection or can develop into life-threatening complications. Mastoiditis is usually a complication of acute otitis media (middle ear infection).

What causes mastoiditis?

Mastoiditis happens when infection spreads from the middle ear infection into the mastoid air cells. A child with mastoiditis usually has a history of having a recent ear infection or has repeated middle ear infections. The risk of mastoiditis is reduced with the use of antibiotics for ear infections or with ear tube placement. Mastoiditis may be caused by various bacteria.

What are the symptoms of mastoiditis?

The following are the most common symptoms for mastoiditis. However, each child may experience symptoms differently. Symptoms may include:

• Protrusion of the ear (the ear sticks out more)
• Pain behind the ear
• Recent ear infection
• Fever
• Irritability
• Redness or swelling of the bone behind the ear
• Drainage from an ear infection

The symptoms of mastoiditis may resemble other medical conditions or problems. Always consult your child's physician for a diagnosis.

How is mastoiditis diagnosed?

In addition to a complete medical history and physical examination, your child's physician will inspect 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. Your doctor may use an otoscope to blow 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. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to sit very still and not be crying, talking or moving.

Your child's physician may also order the following tests to help confirm the diagnosis:

• Blood work
• X-rays or CT scan of the head
• Culture from the infected ear

If your child has symptoms of a brain abscess or other intracranial complication, your child's physician may order the following:

• Computerized 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 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, radio frequencies and a computer to produce detailed images of organs and structures within the body.

If your child has symptoms of meningitis, your child's physician may order a:

• 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 for mastoiditis:

Specific treatment for mastoiditis will be determined by your child's physician based on:

• Your child's age, overall health and medical history
• Extent of the disease
• Your child's tolerance for specific medications, procedure, or therapies
• Expectations for the course of the condition
• Your opinion or preference

Treatment of mastoiditis usually requires hospitalization and a complete evaluation by a physician that specializes in the ear, nose and throat disorders (otolaryngologist). Your child, in most cases, will receive antibiotics through an intravenous (IV) catheter. Surgery is sometimes needed to help drain the fluid from the middle ear.

Your child's physician may suggest a myringotomy, 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. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after around one year.

What are the effects of mastoiditis?

If the infection continues to spread, despite antibiotic therapy, the following complications may occur:

• Meningitis - an infection surrounding the brain
• Brain abscess - a pocket of pus and infection that may develop in the brain

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