Mastoiditis - Causes, Symptoms, Diagnosis and Treatment

What is mastoiditis?

Mastoiditis is an infection of the mastoid bone. The mastoid bone is located just behind the ear and has many air cavities that protect the delicate structures of the ear, regulate ear pressure, and protect the temporal bone during trauma.
During mastoiditis, these air cavities are infected and filled with discharge. Nowadays, severe mastoid infections are rare as they can be easily treated via antibiotics. However, in rare cases, if the patient has a severe untreated or antibiotic-resistant ear infection, they can get mastoiditis.

How is mastoiditis caused?

Mastoiditis generally results from middle ear infections. Sometimes, if the infection is too severe or recurring, or if the patient is not diligent about following their treatment course, it can spread to the mastoid bone.
In some cases, this infection can even result in the growth of a cholesteatoma, a benign cyst that invades the middle ear and mastoid, leading to further deterioration of the ear canal and permanent hearing loss.

Types, Causes and Symptoms of Mastoiditis

Types of Mastoiditis:

• Acute mastoiditis
• Chronic mastoiditis

Causes of Mastoiditis:

• Middle ear infections (acute otitis media)
• Cholesteatoma

Symptoms of Mastoiditis:

• Fever
• Headache
• Hearing loss
• Redness, swelling, and tenderness behind the ear
• Drainage from the ear
• Bulging and drooping of the ear

Diagnosis of Mastoiditis

Self-diagnosis:

It is easy to self-assess for mastoiditis. If you (or your child) have a high fever, redness and swelling behind the ear, and severe earache, there is a high chance that you may have mastoiditis.

Physical examination:

During the physical examination, your ENT surgeon will palpate your ear swelling and look through the ear canal using an otoscope. If they suspect the presence of a mastoid infection, they will schedule further diagnostic tests for you.

Diagnostic tests:

The following diagnostic tests usually confirm mastoiditis:

• Lab culture of the ear discharge
• Blood tests like WBC count, CBC, etc.
• CT scan of the ear
• Head CT scan
• X-ray of the skull

The culture helps identify the causing organism behind the ear infection, while the imaging and blood tests help the surgeon ascertain if there is any degeneration in the mastoid bone, along with the severity of the conditions, and helps them formulate the right treatment plan.

In severe cases, if there is a sign that the infection has spread to the skull and brain, you may also need a lumbar puncture (or spinal tap) for diagnosis.

Risks & Complications Of Mastoiditis

If left untreated:

If left untreated or improperly treated, mastoid infections can spread to other parts of the body and result in severe complications such as:

• Destruction of the mastoid bone
• Dizziness and vertigo
• Vision changes
• Facial paralysis
• Meningitis
• Epidural abscess
• Irreversible partial or total hearing loss
• Sepsis, i.e., the spread of infection throughout the body, etc.

Prevention of Mastoiditis

Mastoid infections usually occur in children due to improper management of initial ear infections. You can prevent mastoid infections by:

• Take medicines for your ear infections as prescribed. If you skip any dose of your antibiotics, it will make it easier for the infection to return in the future.
• Do not self-medicate. If you take medications on your own without a proper prescription from your doctor, you may end up with antibiotic-resistant infections in the future.
• Eat a balanced diet and follow a hygienic lifestyle to avoid recurring ear infections.

When to consult a doctor ?

You should consult a doctor immediately after having a fever or earache. You can visit your regular physician, who will recommend an ENT consultation to you if needed. Any delay in getting proper treatment can result in further complications, therefore, you should seek immediate treatment if you have any issues.

For mastoiditis, you should seek an ENT specialist if:

• your ear infection is not responding to treatment,
• there is no improvement in your symptoms, or
• you have a large swelling behind your ear.

Treatment options, Cost and Insurance Coverage: Mastoiditis

Treatment Overview:

Generally, mastoid infections are treated through conservative treatments. The most prevalent treatment for acute mastoid infections is antibiotic treatment. Your ENT doctor can prescribe you antigen-specific antibiotics for better results.

If you do not benefit from conservative management, your doctor may recommend surgical intervention. The first line of surgery is drainage of ear discharge through a myringotomy. If there is no improvement even then, you may need mastoidectomy surgery. During mastoidectomy, the surgeon will create an incision behind the ear and remove the diseased parts of the mastoid bone.

Insurance coverage:

Most major health insurance providers cover mastoidectomy surgery, however, the extent of the coverage depends on the policy terms. Generally, the surgery is covered as a daycare procedure, and insurance providers do not provide coverage for an overnight hospital stay. If you are unsure about your policy terms, you can consult your insurance provider.

Pristyn Care also has an expert insurance team that will help you file a claim for insurance coverage, helps you understand your policy terms, and enables you to get reimbursement for medicines and diagnostic tests you have paid out-of-pocket for.

The long-term outlook of the treatment:

Ear infections are a very common health problem, especially during childhood. If you or your child had an ear infection that had progressed to mastoiditis, then it is very likely that you may have needed surgical intervention.

Mastoidectomy surgery has proven to be successful in over 85-90% of cases and is associated with very low recurrence rates. To ensure this, you need to take proper care of yourself after the surgery and follow your ENT surgeon’s directions explicitly.

Facts and Figures Regarding Mastoiditis

Though mastoiditis can occur at any age, it most commonly occurs in children below 2 years of age, with a median age of occurrence equaling 12 months.

• Less than 0.002% of children with acute otitis media get mastoiditis if they receive proper treatment through antibiotics.
• Most cases of mastoiditis occur due to severe ear infections progressing into the mastoid bone.
• In severe cases where the mastoid bone has degenerated too much, the patient may need to get part of the ear canal resected as well, which may lead to some degree of irreversible hearing loss.
• The most common pathogen in mastoiditis is streptococcal pneumonia, followed by other bacteria like S. aureus, S. pyogenes, H. influenzae, etc.
• Mastoiditis usually only occurs in patients with:
  • less than 2 years of age
  • immunocompromised state
  • recurrent ear infections
  • incomplete pneumatization of the process, etc.