Mastoiditis is a bacterial infection of the air cells in the mastoid bone
of the skull. Mastoiditis most commonly affects children. Before the use
, mastoiditis was one of the leading causes of death in children. As of
the early 2000s, it is a relatively uncommon and much less dangerous
Mastoiditis is usually a consequence of a middle ear infection called
(AOM). The infection
Computed tomography scan (CT scan) showing inflammation and fluid
within the air spaces (represented in yellow) of the mastoid.
(© Neil Borden/Photo Researchers, Inc.)
may spread from the ear to the mastoid bone of the skull, which is the
bony bump off the base of the skull, located just behind the ears slightly
above the level of the earlobe. The mastoid bone is composed of air cells
that are in communication with the middle ear. If the air cells fill with
infected materials, the mastoid honeycomb-like structure may deteriorate.
Mastoiditis has been classified into two types, acute and subacute. Acute
or classic mastoiditis refers to acute disease following AOM and involves
the development of an abscess behind the ear. Subacute mastoiditis refers
to a more chronic disease, often following partial treatment of AOM with
In the United States and first world countries, the incidence of
mastoiditis is 0.004 percent. Developing countries have a higher incidence
of mastoiditis, presumably resulting from untreated otitis media. The
highest incidence occurs in infants aged six to 13 months. As of 2004
reports indicated that acute mastoiditis is on the increase.
Causes and symptoms
The bacteria that cause mastoiditis are those most commonly associated
with AOM. They include the following:
Gram-negative organisms are found more frequently in chronic mastoiditis,
and in young infants, which may be due to prolonged antibiotic therapy.
The main symptoms of mastoiditis are increasing earache,
, and the development of redness and swelling behind the ear. The eardrum
is inflamed with swelling of the ear canal wall. Mastoiditis typically
develops over the few days following an ear infection. This interval is
sometimes more prolonged particularly if the initial infection was treated
with antibiotics but not completely eliminated (subacute mastoiditis).
Children will usually complain of severe
in the affected ear, which may become swollen. Parents should contact
their healthcare provider if a child's symptoms indicate
mastoiditis. Appointments with the healthcare provider should also be made
if a known ear infection does not respond to treatment or is followed by
—A localized collection of pus in the skin or other body tissue
caused by infection.
—A chart or graph of the results of a hearing test conducted with
audiographic equipment. The chart reflects the softest (lowest volume)
sounds that can be heard at various frequencies or pitches.
Computed tomography (CT)
—An imaging technique in which cross-sectional x rays of the body
are compiled to create a three-dimensional image of the body's
internal structures; also called computed axial tomography.
—Refers tof bacteria that have a cell wall composed of a thin
layer of peptidoglycan surrounded by an outer membrane made of
polysaccharides and proteins. They take on the red color of the
counterstain used in the Gram stain procedure.
—The prominent bone behind the ear that projects from the
temporal bone of the skull.
—An inflammation of the bone behind the ear (the mastoid bone)
caused by an infection spreading from the middle ear to the cavity in
the mastoid bone.
—A surgical procedure in which an incision is made in the ear
drum to allow fluid or pus to escape from the middle ear.
—Inflammation of the ear, which may be marked by pain, fever,
abnormalities of hearing, hearing loss, noise in the ears, and dizzy
—A hand-held instrument with a tiny light and a funnel-shaped
attachment called an ear speculum, which is used to examine the ear
canal and eardrum.
Antibiotics are typically the first course of action in treating
mastoiditis. If these do not work, a tube can be inserted to drain off pus
or fluid. An incision can be made with the same end purpose. Surgery may
also be a recourse, to remove the affected portion of the mastoid bone, to
remove a cyst should one be present, and do any further repair required.
Mastoiditis is curable with treatment but may be hard to treat and may
recur. Acute mastoiditis usually recovers completely after treatment with
no long term damage to hearing and no increased risk of further ear
trouble later in life if complications have not occurred.
Rapid and complete treatment of ear infections significantly lowers the
risk of developing mastoiditis.
Ear pain is a common complaint from children, but parents should suspect
serious ear infection if the ear area is red and swollen. Mastoiditis
often causes the ear to be sticking out at an angle. Parents should be
aware that ear infections are very common in children, especially those
younger than two years of age.
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American Academy of Otolaryngology—Head and Neck
One Prince St., Alexandria VA 22314–3357. Web site:
American Hearing Research Foundation.
55 E. Washington St., Suite 2022, Chicago, IL 60602. Web site:
Better Hearing Institute.
515 King Street, Suite 420, Alexandria, VA 22314. Web site:
"Mastoiditis." Available online at
October 20, 2004).