mastoiditis

What is Mastoiditis?

Mastoiditis is an infection of the mastoid process, or the large bone behind your ear, that's caused by middle ear infections [1]. It is a complication of a bacterial infection in the middle ear, which can spread to the mastoid bone and cause inflammation [5].

Symptoms of Mastoiditis

The symptoms of mastoiditis can vary depending on the severity of the infection. Common symptoms include:

• Fever
• Persistent, throbbing pain behind the ear (otalgia)
• Otorrhea (discharge or fluid from the ear)
• Hearing loss [3]
• Pain, soreness, or tenderness behind the ear [7][8]

Causes and Development of Mastoiditis

Mastoiditis typically develops as a complication of acute otitis media, which is an infection of the middle ear. The bacteria that cause this infection can spread to the mastoid bone and cause inflammation, leading to mastoiditis [6].

In adults, the most common symptoms of mastoiditis are otalgia, otorrhea, and hearing loss, along with physical signs of mastoiditis such as swelling or redness behind the ear [4].

Definition

A purist's definition of mastoiditis includes all inflammatory processes of the mastoid air cells of the temporal bone [2]. This means that any inflammation or infection in the mastoid bone is considered a form of mastoiditis.

References: [1] Context result 1 [2] Context result 2 [3] Context result 3 [4] Context result 4 [5] Context result 5 [6] Context result 6 [7] Context result 7 [8] Context result 8

Mastoiditis Signs and Symptoms

Mastoiditis, an infection of the mastoid bone behind the ear, can manifest in various ways. The symptoms can be divided into two categories: acute and chronic.

Acute Mastoiditis Symptoms:

• Pain and Swelling Behind the Ear: A throbbing pain that doesn't go away is a common symptom of mastoiditis.
• Redness and Tenderness: The skin covering the mastoid bone may look red and swollen, indicating inflammation.
• Discharge from the Ear: Fluid or pus draining from the ear can be a sign of mastoiditis.
• Fever: A low-grade fever is often present in cases of acute mastoiditis.
• Headache: Some people may experience headaches due to the infection.

Chronic Mastoiditis Symptoms:

• Pain and Swelling Behind the Ear: Chronic mastoiditis can cause persistent pain and swelling behind the ear.
• Discharge from the Ear: Fluid or pus draining from the ear is a common symptom of chronic mastoiditis.
• Low-Grade Fever: A low-grade fever may be present in cases of chronic mastoiditis.

Other Complications:

• Meningitis: In rare cases, mastoiditis can spread to the meninges, leading to meningitis.
• Abscess: An abscess can form behind the ear due to the infection.
• Dizziness and Conductive Hearing Loss: Chronic mastoiditis can cause dizziness and conductive hearing loss.

References:

• [3] Redness behind the ear (this can be harder to see on brown or black skin) · swelling behind the ear, which can cause ...
• [4] Symptoms · Drainage from the ear · Ear pain or discomfort · Fever, may be high or suddenly increase · Headache · Hearing loss · Redness of the ear or behind the ear ...
• [6] Symptoms of mastoiditis · redness, tenderness and pain behind the ear · swelling behind the ear that can cause it to stick out · discharge from the ear · a high ...
• [10] Symptoms of mastoiditis include tenderness, redness, or swelling behind the ear, as well as ear drainage or hearing loss.

Diagnostic Tests for Mastoiditis

Mastoiditis, an infection of the mastoid bone in the skull, can be diagnosed through a combination of clinical evaluation and various diagnostic tests.

• Clinical Evaluation: A doctor's examination of the head may reveal signs of mastoiditis, such as swelling or redness behind the ear. The doctor will also consider the person's symptoms, including fever, ear pain, and difficulty hearing.
• Imaging Tests: Imaging tests are used to confirm the diagnosis and rule out other conditions. These include:
  • CT Scan: A computed tomography (CT) scan of the ear is the standard diagnostic test for mastoiditis. CT scans use X-rays and computer technology to produce detailed images of the internal structures of the ear. The sensitivity of CT scanning for evaluating mastoiditis ranges from 87-100% [5].
  • X-rays: X-rays of the head may also be used to diagnose mastoiditis, although they are less sensitive than CT scans.
• Other Tests: In some cases, additional tests may be performed to confirm the diagnosis and identify the underlying cause of the infection. These include:
  • Lumbar Puncture (Spinal Tap): A lumbar puncture may be performed to determine if there is an infection in the cerebrospinal fluid surrounding the brain and spinal cord.
  • Blood Tests: Blood tests may be used to identify the bacteria causing the infection.

It's worth noting that diagnosis of mastoiditis is often clinical, meaning it's based on a doctor's evaluation of symptoms and physical examination. Imaging tests are usually done to confirm the diagnosis and rule out other conditions [1].

References: [1] Context result 3: May 3, 2022 — Treatment and prevention​​ A doctor may be able to diagnose mastoiditis by considering the symptoms, including the appearance of the swelling. [5] Context result 5: Mar 28, 2024 — CT scanning. CT scanning of the temporal bone is the standard for evaluation of mastoiditis, with published sensitivities ranging from 87-100%. [6] Context result 6: May 2, 2024 — An exam of the head may reveal signs of mastoiditis. The following tests may show an abnormality of the mastoid bone: CT scan of the ear. Head ...

Treatment Options for Mastoiditis

Mastoiditis, an infection of the mastoid bone behind the ear, can be treated with various medications and therapies. The primary goal of treatment is to eliminate the infection and prevent complications.

• Antibiotic Therapy: Antibiotics are the mainstay of treatment for both acute and chronic mastoiditis (1). The type and duration of antibiotic therapy depend on the severity and location of the infection.
• Conservative Surgery: In some cases, conservative surgery may be necessary to drain the infected mastoid air cells and promote healing (2).
• Mastoidectomy: A more invasive surgical procedure, mastoidectomy involves removing infected bone tissue from the mastoid area (3).

Medications Used in Mastoiditis Treatment

The principal medications used in the treatment of mastoiditis are antibiotics. Other medications include:

• Analgesics and Antipyretics: To manage pain and fever associated with the infection.
• Topical Antibiotic-Steroid Combinations: To treat localized infections and reduce inflammation.

Specific Medications Used

Some specific medications used in the treatment of mastoiditis include:

• Fluoroquinolone antibiotic ear drops: For 2-3 weeks to treat chronic or recurrent infections (6).
• Antibiotic injections: Followed by antibiotics taken orally to treat acute infections.
• Acetaminophen: As a pain reliever for patients with documented hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) (15).

Important Considerations

It's essential to note that mastoiditis treatment may require repeated or long-term therapy, especially in cases of chronic or recurrent infections (5, 7). A healthcare professional should be consulted for individualized treatment guidance.

References:

(1) [Search Result 8] (2) [Search Result 3] (3) [Search Result 4] (5) [Search Result 7] (6) [Search Result 6] (15) [Search Result 15]

Differential Diagnosis of Mastoiditis

Mastoiditis, an infection of the mastoid bone in the skull, requires a thorough differential diagnosis to rule out other conditions that may present with similar symptoms. The following are key considerations for a differential diagnosis:

• Otitis media or externa: Middle ear infections can lead to mastoiditis, so it's essential to consider otitis media or externa as a potential cause.
• Trauma to the ear/mastoid: Physical trauma to the ear or mastoid bone can lead to infection and inflammation, mimicking the symptoms of mastoiditis.
• Cervical lymph node enlargement: Enlarged lymph nodes in the neck can be a sign of an underlying infection, which may be related to mastoiditis.
• Meningitis: Inflammation of the membranes surrounding the brain (meninges) can present with similar symptoms to mastoiditis, such as fever and headache.
• Cellulitis: A bacterial skin infection can spread to the mastoid bone, leading to symptoms similar to mastoiditis.
• Parotid swelling: Swelling of the parotid gland, a salivary gland located near the ear, can be a sign of an underlying infection or inflammation.

According to source 2, differential diagnosis is also considered for conditions such as:

• Auricular or mastoid trauma
• Furuncle of meatus of the ear
• Cervical or postauricular (mastoid) lymphadenopathy

It's essential to consider these potential causes and perform a thorough examination, including imaging studies, to accurately diagnose mastoiditis. source 3 notes that mastoiditis is most commonly seen as a complication of otitis media, but it can also be a result of cholesteatoma.

References:

• [1] Mar 28, 2024
• [2] Nov 24, 2021
• [3] Mar 24, 2022