From the Guidelines
Mastoiditis is a serious infection of the mastoid bone, typically developing as a complication of untreated or severe middle ear infections (otitis media), and requires prompt medical treatment to prevent serious complications. Mastoiditis is characterized by symptoms such as pain, redness, and swelling behind the ear, fever, ear drainage, and hearing loss. The condition occurs because the mastoid bone contains air cells that connect to the middle ear, allowing bacteria to spread when ear infections are left untreated 1. According to recent studies, the incidence of mastoiditis has not increased despite the introduction of guidelines to reduce antibiotic use for acute otitis media (AOM) 1.
Key Points
- Mastoiditis is a complication of untreated or severe middle ear infections (otitis media)
- Symptoms include pain, redness, and swelling behind the ear, fever, ear drainage, and hearing loss
- The condition requires prompt medical treatment, usually with intravenous antibiotics such as ceftriaxone or vancomycin, typically administered for 10-14 days
- Severe cases may require surgical intervention called mastoidectomy to drain the infection and remove damaged bone tissue
- Without proper treatment, mastoiditis can lead to serious complications including meningitis, brain abscess, facial nerve paralysis, or hearing loss Some studies suggest that antibiotics administered for AOM treatment do not eliminate the risk of developing mastoiditis, with 33% to 81% of patients diagnosed with mastoiditis having been treated with antibiotics prior to admission 1.
Treatment Approaches
- Intravenous antibiotics, either alone or combined with myringotomy and TT insertion and/or needle aspiration of the subperiosteal abscess
- Mastoidectomy rates between 29% and 93% of patients with mastoiditis, depending on clinical practice and disease severity
- Algorithm-based treatment, where in uncomplicated cases, computerized tomography (CT) scanning is postponed and treatment is initiated with intravenous antibiotics, with or without myringotomy and/or drainage or aspiration of any subperiosteal abscess 1. Children are more commonly affected than adults due to their developing immune systems and more frequent ear infections. Anyone experiencing symptoms of mastoiditis should seek immediate medical attention to prevent potential complications.
From the Research
Definition of Mastoiditis
Mastoiditis is an infection of the mastoid bone, which is located behind the ear. It can be acute or chronic and is often caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus 2, 3.
Causes and Risk Factors
The causes and risk factors of mastoiditis include:
- Acute otitis media (middle ear infection) that spreads to the mastoid bone 2, 4
- Bacterial infection, with common causative organisms including Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus 2, 3
- Antibiotic treatment for otitis media, which may not always prevent the development of mastoiditis 2, 4
- Immunocompromised state, although most cases occur in immunocompetent children 5
Symptoms and Complications
The symptoms and complications of mastoiditis include:
- Chronic tympanostomy tube otorrhea (discharge from the ear) with abundant granulation tissue 5
- Coalescent mastoiditis (infection of the mastoid bone) 5
- Intracranial complications, such as cerebellar abscess, subdural abscess, and bacterial meningitis 2, 6
- Extracranial complications, such as subperiosteal abscess and lateral sinus thrombosis 6
Treatment and Management
The treatment and management of mastoiditis include:
- Antibiotic therapy, which may be systemic or topical 2, 5
- Surgical intervention, such as mastoidectomy, which may be necessary in severe cases or to drain abscesses 2, 6
- Myringotomy (surgical incision in the eardrum) to relieve pressure and promote drainage 2
- Conservative management, which may include observation and supportive care 6