Mastoiditis Symptoms
The classic symptoms of mastoiditis include postauricular swelling, erythema or tenderness, protrusion of the auricle, fever, otalgia (ear pain), and otorrhea (ear discharge), often accompanied by signs of middle ear infection. 1, 2
Clinical Presentation
Common Symptoms
- Postauricular signs:
- Swelling behind the ear
- Redness (erythema) in the mastoid area
- Tenderness when the mastoid is palpated
- Ear-related symptoms:
- Protrusion of the auricle (ear sticking out)
- Otalgia (ear pain)
- Otorrhea (discharge from the ear)
- Systemic symptoms:
- Fever
- Malaise
The typical clinical presentation with all these features is observed in approximately 48% of adult cases 3, meaning that many patients may present with only some of these symptoms.
Atypical Presentations
Mastoiditis may present in less obvious forms, particularly in:
- Adults (who often have more insidious development)
- Patients who have received antibiotics (masked mastoiditis)
- Elderly patients
- Immunocompromised individuals
In these cases, symptoms may be vague and non-classical, potentially delaying diagnosis 4. The first sign may even be complications such as meningitis or brain abscess.
Warning Signs of Complications
Mastoiditis can lead to serious complications that present with additional symptoms:
- Meningitis: Headache, neck stiffness (meningismus), neck rigidity, photophobia
- Intracranial abscess: Severe headache, altered mental status, seizures
- Facial nerve paralysis: Weakness or paralysis of facial muscles
- Labyrinthitis: Vertigo, hearing loss, balance problems
- Venous sinus thrombosis: Severe headache, altered consciousness
- Subperiosteal abscess: Fluctuant swelling behind the ear
These complications are more common in children under 24 months of age 5 and in patients with high C-reactive protein values (>7.21 mg/dL) 5.
Risk Factors for Complications
Certain factors increase the risk of developing complications from mastoiditis:
- Young age (children and adolescents)
- Immunocompromised status
- Delayed treatment
- Infection with virulent organisms
- Elevated inflammatory markers (leukocyte count, C-reactive protein) 2, 5
Diagnostic Considerations
When mastoiditis is suspected based on symptoms, imaging may be necessary:
- High-resolution temporal bone CT scan with contrast is the first-line imaging modality to assess bone destruction and identify complications 2
- MRI with contrast is recommended when intracranial complications are suspected 2
It's important to note that prior antibiotic treatment for acute otitis media does not reliably prevent mastoiditis, with studies showing 33-81% of patients diagnosed with acute mastoiditis had received antibiotics prior to admission 2.
When to Suspect Masked Mastoiditis
Be particularly vigilant for masked mastoiditis in high-risk patients:
- Newborns
- Diabetic patients
- Elderly individuals
- Immunosuppressed patients
- Debilitated patients
In these groups, symptoms may be subtle but the risk of rapid progression to serious complications is high 4, 6.