OVERVIEW

What is mastoiditis?

Mastoiditis is often a complication of otitis media.

The mastoid is a bony structure located behind the earlobe. If you touch the bone behind the earlobe, the protruding edge is the mastoid.

Although the mastoid is bone, its interior contains many air cells like a honeycomb, connected to the middle ear and lined with modified respiratory epithelium.

When acute otitis media occurs, the inflammation may spread to the mastoid, causing mastoiditis.

SYMPTOMS

What are the symptoms and manifestations of mastoiditis?

The manifestations of mastoiditis can range from mild to severe. Mild cases may only involve ear discomfort and can resolve on their own without medication, while severe cases may lead to life-threatening complications. Common symptoms include:

• Tenderness, redness, and swelling behind the ear;

• Abnormal ear position, where the ear protrudes outward due to inflammatory swelling;

• Fever, lethargy, ear pain, hearing loss, etc. In younger infants, symptoms may include irritability and poor mental state.

What diseases can mastoiditis cause?

Complications of mastoiditis are related to the spread of infection from the middle ear and mastoid to adjacent structures. Due to the proximity of the middle ear and mastoid to the brain, complications can be intracranial or extracranial.

Extracranial complications include:

• Subperiosteal abscess: Patients may experience worsening pain, localized skin erythema, and a fluctuant sensation over the mastoid. About half of mastoiditis patients develop subperiosteal abscesses.

• Facial nerve palsy: The facial nerve travels from the brain through a narrow passage in the petrous part of the temporal bone to reach the face. Inflammation in the mastoid can compress the facial nerve, leading to palsy.

• Hearing loss: Mastoiditis and otitis media can cause narrowing of the ear canal and middle ear effusion, affecting sound conduction and temporarily impairing hearing. With treatment, hearing can recover without permanent loss. However, if the inflammation damages the ossicles or cochlea, permanent hearing loss may occur. Regular hearing tests should be conducted after treatment.

• Labyrinthitis: The inner ear labyrinth transmits sound signals to the brain and helps with spatial orientation. Labyrinthitis may cause tinnitus, dizziness, nausea, and vomiting.

• Skull osteomyelitis: Infection spreading from the mastoid to other parts of the skull may lead to osteomyelitis.

Intracranial complications include meningitis, brain abscess, and epidural or subdural abscesses.

The most fundamental measure to prevent complications is early and active treatment.

Can mastoiditis affect hearing?

Mastoiditis and otitis media can cause narrowing of the ear canal and middle ear effusion, temporarily impairing hearing by affecting sound conduction. With treatment, hearing can recover without permanent loss.

However, if the inflammation damages the ossicles or cochlea, permanent hearing loss may occur.

After treatment, regular hearing tests should be conducted.

CAUSES

What causes mastoiditis?

Mastoiditis is often a complication of otitis media. The mastoid and middle ear are connected, so when otitis media occurs, the inflammation can spread to the mastoid, leading to mastoiditis.

Due to developmental factors, the eustachian tube connecting the nasal cavity and middle ear in children is shorter and flatter than in adults. Upper respiratory infections are also more likely to spread to the middle ear, causing otitis media. Therefore, mastoiditis is more common in children than in adults.

DIAGNOSIS

How to diagnose mastoiditis?

Diagnosis of mastoiditis is primarily based on clinical manifestations. In some cases, a CT scan may be performed to confirm the diagnosis.

What tests are needed for mastoiditis?

Diagnosis typically relies on symptoms and physical examination, with imaging tests rarely required. However, for complex cases, a CT scan may be conducted: it can confirm the diagnosis and assess the extent of infection.

TREATMENT

How should mastoiditis be treated?

The main treatments are antibacterial drugs and drainage of the middle ear and mastoid.

• For patients with mild symptoms, intravenous antibacterial drugs can be used to achieve the goal of anti-infection. If symptoms do not improve, a minor surgery is needed to drain the inflammatory fluid from the middle ear and mastoid.

• If symptoms are severe, such as the formation of a subperiosteal abscess, and antibacterial treatment is ineffective, drainage of the abscess is required.

• If complications such as osteomyelitis or meningitis occur, longer-term antibacterial treatment or surgical intervention to clean the abscess is necessary.

• Since antibacterial drugs struggle to reach effective concentrations in bony tissues like the mastoid, treatment for mastoiditis is prolonged. Intravenous antibiotics are typically required for 7–10 days, followed by oral antibiotics, with a total treatment duration of about 4 weeks.

Can mastoiditis be completely cured? Are there any sequelae or risks of recurrence after treatment?

Timely, sufficient, and full-course antibacterial treatment can cure mastoiditis without recurrence or sequelae such as hearing loss.

However, if treatment is delayed and intracranial infection occurs, permanent neurological damage or even death may result.

If medication is not administered properly, the infection may persist, leading to chronic inflammation, which is more difficult to treat.

DIET & LIFESTYLE

What should patients with mastoiditis pay attention to in daily life?

Patients with mastoiditis do not require special precautions in daily life.

PREVENTION

How to prevent mastoiditis?

Most cases of mastoiditis result from the spread of otitis media. In daily life, avoid using sharp objects to clean the ears and prevent prolonged water retention in the ear. Timely treatment of otitis media can help reduce the occurrence of mastoiditis.