Mastoiditis: Symptoms, Causes and Prevention

What is mastoiditis?

Mastoiditis is a bacterial infection that affects the mastoid air cells in the mastoid bone, located just behind your ear. It usually develops as a complication of an untreated middle ear infection (otitis media). These air cells help regulate pressure and protect delicate parts of the ear.

When infected, the mastoid bone can become swollen and painful, and in severe cases, the infection may spread to nearby areas, leading to serious complications. Children under 2 years of age are at higher risk, but it can affect people of any age.

Key Risk Factors for Mastoiditis

Certain factors can increase the chances of developing mastoiditis, especially when middle ear infections are not treated properly or on time. Understanding these risks can help with early detection and prevention of this serious condition. Common Risk Factors Include:

• Young age: Mastoiditis is more common in children, particularly those under the age of 2. This is because their Eustachian tubes are shorter and more horizontal, making it easier for infections to spread from the middle ear to the mastoid air cells.
• Frequent ear infections: People who suffer from repeated middle ear infections (otitis media) are at higher risk of developing mastoiditis. In such cases, infection may spread to the mastoid process behind the ear bone if not treated properly.
• Weakened immune system: Individuals with a weak immune system, such as those with diabetes, HIV, or undergoing chemotherapy, are more vulnerable to severe infections, including mastoid.
• Poor access to healthcare: In areas where timely medical care is limited, middle ear infections may go untreated, increasing the risk of complications like acute mastoiditis or even coalescent mastoiditis.
• Chronic ear conditions: People with chronic otomastoiditis, or long-term ear drainage and inflammation, are more likely to develop complications involving the mastoid and middle ear.
• Lack of vaccination: Skipping essential vaccinations, such as pneumococcal and influenza vaccines, may increase the risk of infections that can lead to mastoiditis.

Symptoms of Mastoiditis

Symptoms of mastoiditis usually develop a few days or weeks after an ear infection and can include:

• Constant, throbbing ear pain that doesn’t improve
• Swelling or redness behind the affected ear
• A soft or tender area around the mastoid bone
• The ear appears pushed forward or drooping
• Fluid or pus draining from the ear
• Hearing loss in the affected ear
• Headache and general discomfort
• High fever or chills
• Dizziness or problems with balance (vertigo)
• Irritability, especially in infants and toddlers
• Lethargy or confusion in more advanced cases

Causes of Mastoiditis

Mastoiditis usually develops as a complication of a middle ear infection (otitis media) when the infection spreads to the mastoid air cells in the bone behind the ear. This can lead to swelling, fluid build-up, and damage to the bone structure.

Here are the most common causes of mastoiditis:

• Untreated or severe middle ear infection: Bacteria from the middle ear can spread to the mastoid process of the temporal bone, leading to infection and inflammation.
• Cholesteatoma: An abnormal build-up of skin cells in the middle ear. It can block the natural drainage of the ear, trapping fluids and increasing the risk of infection in the mastoid bone.
• Chronic or recurring ear infections: Long-term infections may cause chronic otomastoiditis, which can gradually affect the mastoid region.

If left untreated, the condition may progress to coalescent mastoiditis, where the infection breaks down the thin walls of the mastoid air cells.

Types of Mastoiditis

Mastoiditis can affect people differently depending on how long the infection lasts and how severe it becomes. Here are the main types:

• Acute Mastoiditis
  • This is the most common type of mastoid disease.
  • It often happens a few days after a middle ear infection (otitis media) spreads to the mastoid and middle ear.
  • Signs may include swelling in the mastoid area, pain on the mastoid process, fever, and ear discharge.
  • It usually clears up within a few weeks with early mastoiditis treatment, often involving antibiotics.
  • In rare cases, a procedure like mastoidectomy may be needed if the infection doesn’t improve.
• Chronic Mastoiditis (Chronic Otomastoiditis)
  • This type develops when an ear infection lingers for a long time (usually more than a month) or keeps recurring.
  • It can damage the mastoid air cells over time and may lead to persistent discharge from the ear and hearing loss.
  • Symptoms may be less severe than the acute form but are long-lasting.
  • Chronic otomastoiditis treatment often requires more than antibiotics and may involve surgical procedures to remove damaged tissue.

Mastoiditis Treatments

Mastoiditis treatment depends on the severity of the infection. It is usually managed with non-surgical or surgical options:

Non-Surgical Treatment

• Antibiotic therapy: The first line of treatment involves antibiotics, often given through an intravenous (IV) line in hospital, especially in acute mastoiditis cases. Oral antibiotics may be used for chronic otomastoiditis treatment or mild infections.
• Ear cleaning and eardrops: For ongoing drainage and to control infection in chronic cases.

Surgical Treatment

If antibiotics alone don’t resolve the infection, or if there is a build-up of fluid or pus, surgical options may be needed:

• Myringotomy: A small incision is made in the eardrum to drain the fluid. A tiny tube may be placed to keep the ear ventilated.
• Mastoidectomy: If the infection has spread into the bone or formed an abscess, a mastoidectomy is performed to remove the infected portion of the mastoid bone. This helps stop the spread and prevent further complications.

Complications of Mastoiditis

Without prompt treatment, mastoiditis can lead to serious complications:

• Facial paralysis
• Partial or complete hearing loss
• Labyrinthitis (inner ear infection causing vertigo, nausea)
• Meningitis or brain abscess
• Encephalitis or epidural abscess
• Septicaemia
• Lateral sinus thrombosis (blood clots in brain veins)

How Can Mastoiditis Be Prevented?

Mastoiditis is a serious infection of the mastoid bone. While not all cases are preventable, taking certain precautions can significantly reduce the risk of developing mastoid disease. Ways to Help Prevent Mastoiditis:

• Treat ear infections early

One of the most effective ways to prevent mastoiditis is to treat ear infections as soon as symptoms appear. Signs like ear pain, fever, or hearing loss should never be ignored. Prompt use of prescribed antibiotics can stop the infection from spreading to the mastoid air cells.

• Maintain good hygiene

Regular handwashing and avoiding close contact with people who are unwell can reduce the spread of infections that affect the middle ear and mastoid area.

• Avoid smoking and second-hand smoke

Smoking weakens the immune system and irritates the airways, increasing the risk of ear infections. Children exposed to second-hand smoke are especially vulnerable to infections that can lead to mastoiditis.

• Manage allergies effectively

Allergies can cause swelling and fluid build-up behind the ear drum, blocking the Eustachian tube and raising the chances of infection. Keeping allergies under control may help prevent complications that involve the mastoid and middle ear.

• Avoid using cotton swabs or sharp objects in the ears

Cleaning ears with cotton buds can push debris deeper into the ear canal and cause injury or infection. This can increase the risk of developing complications such as sore mastoid process or swelling in the mastoid area.

• Stay up to date with vaccinations

Vaccines like the pneumococcal and flu vaccines protect against bacteria and viruses that commonly cause ear infections, particularly in children. Keeping vaccinations current helps reduce the chances of acute mastoiditis and other complications.

• Manage existing health conditions

If you have a condition that weakens your immune system, such as diabetes or chronic respiratory illness, work with your doctor to manage it well. A strong immune system helps prevent infections that may affect the mastoid process of the temporal bone.