Mastoiditis – risky consequence of middle ear inflammation

An acute inflammation of the middle ear can develop into mastoiditis. The infection then spreads to part of the temporal bone. If left untreated, it can lead to life-threatening meningitis.

Overview: What is mastoiditis?

Although acute mastoiditis occurs rarely, it is one of the most common complications of middle ear inflammation. One in a thousand affected persons develops this secondary disease following a middle ear infection.

It is a purulent inflammation of the so-called mastoid. This bone (med.: Os mastoideum) behind the auricle – also known as the mastoid process – is part of the temporal bone, a part of the skull bone. You can feel it as a bulge behind your ear. Air-filled cavities run through the mastoid, which is lined with a mucous membrane. If mastoiditis develops as a result of middle ear inflammation, pus enters the cavities. If it is not the bone of the mastoid process that is inflamed, but only the mucous membrane, it is a case of concomitant mastoiditis.

Mastoiditis: causes and risk factors

Mastoiditis is usually a secondary disease or complication of an inflammation of the middle ear. Children and young people are particularly affected. Because otitis media can be treated well, only 1.2 to 1.4 percent of children suffer this complication, adults even less frequently.

This is caused by a child’s infection with bacteria such as pneumococci, streptococci and Haemophilus influenzae type b. Babies are also frequently infected with staphylococci. Mastoiditis is usually preceded by a whole series of viral infections that cause inflammation of the throat and pharynx. The viral infection lowers the body’s immune defenses. Bacteria therefore have an easy time of it. They enter the middle ear via the throat and the Eustachian tube in the ear, where they trigger an inflammation. If it is treated too late or not sufficiently, mastoiditis develops.

Some risks can promote mastoiditis. This includes that

  • secretions can drain from your ear with difficulty,
  • your immune system is weakened,
  • antibiotic treatment for the middle ear infection did not work, for example because you stopped taking the antibiotic too early,
  • there is a particularly high virulence (infectious power) of the pathogens.

Complications of mastoiditis

If mastoiditis is not treated or is treated inadequately, it can lead to serious or even life-threatening complications, especially if the pus cannot drain to the outside:

  • An encapsulated collection of pus (abscess) may form under the periosteum of the mastoid process.
  • There is a risk of pus entering the lateral neck and throat muscles (Bezold abscess).
  • The bacteria can spread further in the body, for example to the inner ear or the meninges.
  • An encapsulated collection of pus in the brain is particularly dangerous because it can squeeze or encapsulate various structures in the brain.
  • If bacteria enter the bloodstream, they can cause blood poisoning.
  • If the inflammation damages the facial nerve in the vicinity of the mastoid, facial paralysis can occur.
  • If the inflammation damages the inner ear and/or the organ of equilibrium, deafness and dizziness may occur.

Symptoms: Pain and pressure behind the ear

The symptoms of mastoiditis are similar to those of acute otitis media. However, they are often more severe or return about two to three weeks later after an initial improvement. The signs include:

  • Increasing earache,
  • renewed flare-up and prolonged fever,
  • General feeling of weakness and illness,
  • deteriorating hearing,
  • synchronous tapping in the ear with the pulse.

And characteristic of mastoiditis

  • There is a reddened swelling filled with tissue fluid on the mastoid process.
  • The reddened area behind the ear hurts when touched.
  • Large quantities of milky secretions flow from the ear.
  • The swelling pushes the ear down to the side, causing it to protrude slightly, especially in smaller children.

In the case of small children, it is difficult to distinguish the symptoms of otitis media. There are indications that they keep touching their ears and shaking their heads. They often also suffer from nausea and vomiting.

Symptoms of chronic mastoiditis

Chronic mastoiditis, usually as a result of a long-lasting middle ear infection, occurs less frequently than the acute form. In her case, too, the mastoid process becomes inflamed. However, it is often barely noticeable – experts refer to it as veiled or larvated mastoiditis – because its symptoms are only mild. These include:

  • Loss of appetite
  • Headache
  • Fatigue
  • Abdominal pain

Due to the unspecific signs, it sometimes remains undetected for weeks or even months. During this time, bacteria continue to multiply, spread throughout the body and also infect other areas. The chronic form of mastoiditis can result in considerable consequential damage.

Mastoiditis: Diagnosis with us

If you visit us with a long-standing or recurring middle ear infection, we will probably examine you or your child for mastoiditis.

After a preliminary discussion about your complaints, we will look out for typical symptoms such as

  • a swelling behind the ear,
  • Pressure pain at this point,
  • a protruding ear,
  • Discharge of secretion.

We carry out an ear examination using a microscope, known as ear microscopy. We can recognize signs of middle ear inflammation and see whether the posterior auditory wall is swollen and reddened due to mastoiditis.

If there is a suspicion of complications, for example that pus has penetrated into surrounding areas such as the inner ear, a computer tomography scan can clarify this.

A blood test may show whether inflammation levels are elevated. The following values, among others, are measured:

  • White blood cell count
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)

Other examination methods include hearing tests or a swab to define the pathogens or imaging procedures such as computer tomography (CT) or magnetic resonance imaging (MRI).

Mastoiditis: prevention, early detection, prognosis

You can prevent mastoiditis by completely curing an existing middle ear infection. This includes taking the prescribed antibiotics as prescribed. If you do not swallow them long enough, for example, pathogens can become “immune” and cause another outbreak of the disease. This in turn can lead to mastoiditis.

If mastoiditis is detected early, we can usually prevent complications: If you or your child suffer from a middle ear infection that has not completely subsided after two weeks, you should see us immediately! The same applies if the symptoms of a middle ear infection recur or increase again.

If mastoiditis is treated in good time, the prognosis is favorable. If no further complications occur, it almost always heals without consequences and the hearing ability is preserved. If mastoiditis becomes complicated and the brain, for example, is affected, this can be life-threatening. It is therefore very important to consult us at the first sign of this complication of otitis media.

Mastoiditis: Treatment

Antibiotics are the treatment of choice for bacterial infections. They can reduce the inflammation. Intravenous administration is usually necessary. Patients are also given painkillers if this is necessary.

Depending on the extent of the inflammation, a surgical procedure known as a mastoidectomy may be necessary. The surgeon removes bone in the area of the mastoid process. To allow the fluid (usually pus) to drain out of the ear, the surgeon inserts a thin tube (drainage) to drain it away. In addition, an incision is made in the eardrum and a small tube is inserted so that the fluid can drain better.

If you have mastoiditis treated immediately – then it usually takes a favorable course. However, a quick visit to the doctor is mandatory: the pus accumulated during the inflammation can break into neighboring regions and damage them. Abscesses can form under the skin, in the muscles or inside the skull.