What are the symptoms of mastoiditis?

Symptoms of Mastoiditis

The classic symptoms of mastoiditis include postauricular swelling, erythema or tenderness, protrusion of the auricle, fever, ear pain, and ear discharge, often accompanied by signs of middle ear infection. 1

Primary Symptoms

Mastoiditis typically presents with a constellation of symptoms that reflect the underlying inflammatory process in the mastoid air cells. These include:

• Ear-specific symptoms:

  • Otalgia (ear pain)
  • Otorrhea (ear discharge)
  • Hearing loss
  • Protrusion of the auricle (pinna)
  • Postauricular swelling and erythema
  • Mastoid tenderness with palpation 1, 2

• Systemic symptoms:

  • Fever
  • Malaise
  • Headache 3

Clinical Presentation Based on Disease Stage

The presentation of mastoiditis can vary depending on whether it's acute, subacute, or has progressed to involve complications:

• Early/Uncomplicated Mastoiditis:

  • Often follows acute otitis media
  • Reddened and bulging tympanic membrane
  • Ear pain that may worsen despite treatment for otitis media
  • Conductive hearing loss 3, 2

• Advanced/Complicated Mastoiditis:

  • More pronounced postauricular swelling
  • Significant protrusion of the auricle
  • Possible fluctuance behind the ear (suggesting subperiosteal abscess)
  • Persistent high fever
  • Increasing pain 1, 2

Warning Signs of Complications

It's crucial to recognize symptoms that may indicate complications of mastoiditis, which can be life-threatening:

• Intracranial complications:

  • Severe headache
  • Altered mental status
  • Meningismus (neck rigidity)
  • Seizures
  • Neurological deficits 3, 1

• Other serious complications:

  • Facial nerve paralysis (facial asymmetry, inability to close eye)
  • Vertigo (suggesting labyrinthitis)
  • Signs of sepsis 1, 4

High-Risk Populations

Certain populations require heightened vigilance for mastoiditis:

• Children and adolescents have higher risk of developing mastoiditis and its complications 1
• Immunocompromised patients may present with atypical or more severe symptoms 1
• Elderly patients often present with atypical symptoms and have higher risk of complications 5

Important Clinical Considerations

• Mastoiditis can develop despite prior antibiotic treatment for acute otitis media, with studies showing 33-81% of patients diagnosed with acute mastoiditis had received antibiotics prior to admission 1
• The typical clinical presentation (postauricular swelling, erythema, tenderness, and protrusion of the auricle) is observed in only about 48% of adult cases, making diagnosis challenging 5
• In adults, mastoiditis may present in latent forms with prolonged and insidious development followed by rapid clinical deterioration 5

Early recognition of mastoiditis symptoms is critical, as delayed diagnosis and treatment increase the risk of serious complications including intracranial extension, venous sinus thrombosis, facial nerve paralysis, and septicemia 1, 2.