Symptoms of Mastoiditis
The primary symptoms of mastoiditis include postauricular swelling, mastoid tenderness, fever, ear pain (otalgia), ear discharge (otorrhea), and protrusion of the auricle (pinna). 1
Key Clinical Manifestations
Cardinal Signs and Symptoms
- Postauricular inflammation and swelling - hallmark sign
- Mastoid tenderness - pain when pressure is applied to the mastoid area
- Protrusion of the auricle - the ear sticks out from the head
- Fever - present in approximately 75% of cases 2
- Otalgia (ear pain) - often severe and persistent
- Otorrhea (ear discharge) - may be purulent
Associated Symptoms
- Erythema (redness) over the mastoid area
- Bulging or erythematous tympanic membrane on otoscopy
- Conductive hearing loss
- Malaise and general illness 2
Warning Signs of Complications
Mastoiditis can progress to serious complications if not properly treated. Watch for these warning signs:
- Headache - may indicate intracranial spread
- Vertigo - may suggest labyrinthine involvement
- Meningismus (neck stiffness) - potential sign of meningeal irritation
- Neurological deficits - may indicate intracranial complications
- Seizures - serious sign of central nervous system involvement
- Facial nerve paralysis - indicates facial nerve involvement 3
Clinical Presentation Patterns
The American College of Radiology notes that mastoiditis should be suspected in patients with acute otitis media who present with:
- Failure of antibiotic treatment
- Persistence or worsening of symptoms
- Appearance of new symptoms such as those listed above 4
High-Risk Populations
- Children - mastoiditis is more common in the pediatric population
- Adults with compromised immune systems
- Patients with history of recurrent acute otitis media
- Patients with untreated or inadequately treated otitis media
Diagnostic Considerations
The diagnosis of mastoiditis is primarily clinical, based on symptoms, physical examination, and otoscopy 4. However, when complications are suspected, imaging studies become crucial:
- CT of the temporal bone with IV contrast is the imaging study of choice for diagnosing complicated mastoiditis due to its high sensitivity for detecting bone destruction 4
- MRI is superior for detecting intracranial complications 1
Clinical Pearls
- Mastoiditis can occur even in patients with no previous history of recurrent otitis media 5
- The typical clinical presentation (postauricular swelling, erythema, tenderness, and protrusion of the auricle) is observed in only about 48% of adult cases 3
- Mastoiditis in adults may present with atypical features and often has a more insidious development 3
- Complications such as meningitis, facial nerve paralysis, and labyrinthitis can occur and require immediate attention 3
Early recognition of mastoiditis symptoms is critical as this condition carries significant morbidity and mortality if left untreated or inadequately treated 2.