Mastoiditis (patient information)

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Mastoiditis
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Mastoiditis?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Mehrian Jafarizade, M.D [2]

Overview

Mastoiditis is the infection of mastoid air cells in the process of temporal bone. It is mostly a complication of ear diseases such as acute otitis media and chronic otitis media, and it tends to occur in children. However after developments of antibiotics acute otitis media complications have decreased significantly.

What are the symptoms of mastoiditis?

Mastoiditis is often difficult to detect because most children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for are:

• Recent episode of ear infection

• Ear pain and posterior ear pain
• Unusual irritability
• Difficulty sleeping
• Tugging or pulling at one or both ears
• Fever
• Fluid draining from the ear
• Loss of balance
• Unresponsiveness to quiet sounds or other signs of hearing difficulty such as sitting too close to the television or being inattentive
• Clumsiness and poor balance
• Headache
• Lethargy
• Common cold symptoms

What causes mastoiditis?

The most common cause of mastoiditis is bacterial infection after or during middle ear infection. The causes are Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus^[1]. Staphylococci, Pseudomonas species and polymicrobials present predominantly seen in non-acute mastoiditis.

Who is at highest risk?

Risk factors for ear infections include the following:

• Infants and young children
• Attending daycare
• Changes in altitude or climate
• Cold climate
• Exposure to smoke
• Genetic factors (susceptibility to infection may run in families)
• Not being breastfed
• Pacifier use
• Recent ear infection
• Recent illness of any type (lowers resistance of the body to infection)

• Immune systems are not fully developed.
• Smaller and straighter eustachian tubes are more prone to clogging.
• Larger adenoids interfering with eustachian tube openings.

Diagnosis

Posterior ear inflammation and redness in physical examination

The simplest way to detect an active infection in the middle ear is to look in the child's ear with an otoscope, a light instrument that allows the physician to examine the outer ear and the eardrum.

There are several ways that a physician checks for middle ear fluid:

• The use of a special type of otoscope called a pneumatic otoscope allows the physician to blow a puff of air onto the eardrum to test eardrum movement.
  • An eardrum with fluid behind it does not move as well as an eardrum with air behind it.

Tympanometry is a test requiring insertion of a small soft plug into the opening of the child's ear canal, providing information indicative of hearing loss from middle ear congestion.

Physician may use CT scan in order to detect complications.

When to seek urgent medical care?

Call your child's doctor if:

• Pain, fever, or irritability do not improve within 24 to 48 hours with antibiotic therapy
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles

For a child younger than 6 months, let the doctor know right away if the child has a fever, even if no other symptoms are present.

Treatment options

Many physicians recommend the use of an antibiotics when there is an active middle ear infection to kill the causative bacteria.

• Once started, the antibiotic should be taken until it is finished. Most physicians will have the child return for a followup examination to see if the infection has cleared.
• Several different antibiotics may have to be tried before an ear infection clears due to possibility of the bacteria developing resistance to the antibiotics.

If a child is experiencing pain, the physician may also recommend a pain reliever, such as tylenol.

Following the physician's instructions is very important. Once started, the antibiotic should be taken until it is finished. Most physicians will have the child return for a followup examination to see if the infection has cleared.

A surgical procedure called a myringotomy should be performed in mastoiditis patients.

• While the child is asleep under general anesthesia, the surgeon makes a small opening in the child's eardrum.

In some patients a device called tempanestomy tube may be used.

• A small metal or plastic tube is placed into the opening in the eardrum, ventilating the middle ear and helps keep the air pressure in the middle ear equal to the air pressure in the environment.
• The tube normally stays in the eardrum for 6 to 12 months, after which it usually comes out spontaneously.
• Remove of mastoid bone may be done in selective patients.

Where to find medical care for mastoiditis?

Directions to Hospitals Treating mastoiditis

Prevention

Prevention of mastoiditis is contingent upon preventing exposure to the cause, including the following:

• Bacteria and viruses responsible for middle ear infection, such as common cold.
  • Vaccinations include pneumococcal and influenza.
• Washing hands frequently.
• Avoiding common cold patients.
• Limiting child enrollment in daycare.
• Avoiding pacifiers for infants.
• Limiting exposure to air pollution, such as secondhand smoke.
• Breastfeeding infants up to 6 months old to help develop their immune systems.
• Antibiotic regimens for children that have high risk for otitis media.
• Completion of prescribed antibiotics for patients.

What to expect (Outlook/Prognosis)?

Without treatment, mastoiditis will result in sever complications such as intracranial extension and permanent neurological deficits or death. The consequences of mastoiditis have been reduced after introduction of antimicrobial agents and adequate therapy of acute otitis media. However mastoiditis has not been eradicated completely and may give rise to sever complications

Complications from mastoiditis, including meningitis and bone and brain abscesses (infections of the brain and bones around the skull) can lead to poor prognosis without treatment.

Untreated mastoiditis may lead to permanent hearing impairment due to persistent fluid in the middle ear reducing a child's hearing.

• Children who have early hearing impairment from frequent ear infections are likely to have speech and language disabilities.

Possible complications

Complications include spread of infection outside of the middle ear

• Bone and brain abscesses
• Meningitis

Other potential complications include the following:

• Ruptured or perforated eardrum.
• Chronic, recurrent ear infections.
• Enlarged adenoids or tonsils.
• Formation of an abscess or a cyst (called cholesteatoma) from chronic, recurrent ear infections.
• Speech or language delay in a child who suffers lasting hearing loss from multiple, recurrent ear infections.

Sources

http://www.nlm.nih.gov/medlineplus/earinfections.html