Mastoiditis

What causes mastoiditis?

The mastoid bone surrounds and protects the ear. It is part of the temporal bone at the base of the skull and is filled with little pockets of air called mastoid air cells. The mastoid air cells are connected to the middle portion of the ear. When a child develops an infection of the middle ear (otitis media), the lining of the air cells become inflamed. Usually, the inflammation subsides as the ear infection improves. However, if the ear infection does not improve, bacteria can spread and fill the air cells of the mastoid.

Types of mastoiditis

Mastoiditis can be acute, subacute or chronic. Acute mastoiditis refers to bacterial infections of the air cells in the mastoid bone that have lasted less than one month. Acute mastoiditis is the most common type of mastoiditis in children and is a known complication of otitis media. Subacute and chronic mastoiditis both refer to types of low-grade persistent infections of the mastoid and are less common in children.

Signs and symptoms of acute mastoiditis

Children with acute mastoiditis often experience common signs and symptoms of otitis media:

• fever
• earache
• pulling or rubbing the ear
• crying and fussiness
• not sleeping well
• fluid draining from the ear

As well as signs specific to mastoiditis, including:

• protrusion (bulging) of the ear
• tenderness, redness and swelling behind the ear

Who is most at risk for mastoiditis?

Acute mastoiditis is more common in children between the ages of 6 months and 2 years.

How is acute mastoiditis diagnosed?

A health-care provider can diagnose a child with acute mastoiditis by examining them. Health-care providers look for signs of a middle ear infection by checking the eardrum, as well as for a protruding (bulging) ear and swelling, redness or tenderness behind the ear. If the diagnosis is unclear or if there is concern that the infection is severe or that a complication has developed, your child will undergo a CT scan. In these instances, the CT scan results will help the health-care team decide on treatment.

How is acute mastoiditis treated?

Antibiotics

All children with acute mastoiditis receive antibiotics. Usually, intravenous (IV) antibiotics are given in hospital for the first few days until the redness, swelling, tenderness and fever are gone. For children with acute mastoiditis without serious complications, the rest of the antibiotic treatment can usually be given by mouth at home. Most children with acute mastoiditis need to take antibiotics for several weeks to ensure that the infection is fully treated.

Surgery

If the infection is severe or is not improving with antibiotics alone, your child may need to undergo surgery to help clear the infection. This may include myringotomy (a procedure to drain the infection from the middle ear) and placement of a tube (to help fluid drain more easily from the ear and prevent future infection), abscess drainage and mastoidectomy (surgery to remove part of the bone behind the ear).

How to prevent mastoiditis

Preventing otitis media is the best way to reduce complications of otitis media, including mastoiditis:

• Viral upper respiratory infections, including colds, can lead to otitis media. If possible, reduce your child's exposure to those with symptoms of a virus to help reduce the number of viral infections that they experience.
• Wash hands and your child's toys often.
• Ensure that your child is up to date with their vaccinations (shots). Schedule your child's vaccinations when they are due. Vaccinations such as the flu shot for influenza and the pneumococcal vaccine that is part of the routine vaccination schedule offer protection against acute otitis media.
• Protect your child from second-hand tobacco smoke. Exposure to tobacco smoke can increase the number of infections your child experiences.
• If you can, offer your child only breast milk for at least the first three months of life. The antibodies in breast milk may reduce the rate of ear infections and reduce the risk of acute otitis media for your baby during the first six to 12 months of life.
• If you bottle-feed, avoid propping the bottle. This causes the baby to suck excessively and generate extra pressure within the Eustachian tube.
• If your child has had otitis media, try phasing out the use of a pacifier (soother). Using a pacifier may increase the risk of repeated ear infections.
• Consider seeing your health-care provider if your toddler snores or breathes through their mouth. This can be a sign of large adenoids, which increase the risk of ear infections. Your health-care provider can refer your child to a specialist to check their adenoids if necessary.

Complications of acute mastoiditis

Complications are more commonly seen if mastoiditis is left untreated. While rare, they are serious and include:

• abscess (collection of pus) near or within the mastoid
• hearing loss, which may be temporary or permanent
• facial nerve palsy (nerve inflammation causing sudden partial facial weakness)
• labyrinthitis (inflammation of the inner ear), causing ringing in the ears, dizziness, nausea, vomiting or unsteadiness
• meningitis
• blood clots in the brain called cerebral sinovenous thrombosis

Take your child to see a health-care provider if you suspect your child has an ear infection and:

• their symptoms have persisted for 48 hours
• they are less than 6 months of age
• they have liquid draining out of their ear

Take your child to the nearest Emergency Department if:

• your child has redness and swelling behind their ear
• your child's ear seems to stick out
• your child has pain when pressing behind the ear