Mastoiditis
Mastoiditis is a bacterial infection affecting the mastoid process, a part of the temporal bone located behind the ear. It commonly arises from an unresolved middle ear infection, where bacteria spread into the air-filled cavities of the mastoid, leading to inflammation and infection. While mastoiditis predominantly occurs in children, it can also impact adults, presenting in either acute or chronic forms. Symptoms include fever, irritability, swelling and tenderness around the ear, and drainage from the ear, with potential complications like hearing loss and facial paralysis if left untreated. Diagnosis typically involves a physical examination and imaging tests, such as a CT scan, to identify the extent of the infection. Treatment primarily involves antibiotics, which may be administered intravenously for acute cases, and may include procedures like myringotomy or mastoidectomy in more severe circumstances. The advancements in antibiotic treatments have notably reduced the mortality associated with this condition. Prompt medical attention is crucial for anyone experiencing symptoms related to mastoiditis.
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Mastoiditis
Mastoiditis is a bacterial infection within the mastoid process of the skull. The mastoid process is part of the temporal bone of the skull and located behind the ear. Mastoiditis affects the air cells within the mastoid process surrounding the inner and middle ear. Mastoid cells usually become infected when a middle ear infection remains unaddressed or unresolved and infected fluid drains into the mastoid process. A number of important structures are located in and around the mastoid bone as well, so an infection in this area can quickly spread to places outside the mastoid and can lead to serious health problems. Mastoiditis is most commonly seen in children but can affect adults as well. It can be acute, which means it lasts for only a short period, or chronic, meaning it reoccurs regularly. Treatment includes antibiotics and, for more serious conditions, surgery.
Background
The mastoid bone, also called the mastoid process, is part of the skull located behind the ear. It is a segment of the temporal bone, which is a large bone located just above the ear along the middle of the skull near the temple. The mastoid process is shaped like a cone and projects from the temporal bone. The word “mastoid” derives from the Greek word for “breast” and was named as such due to its shape. The mastoid process is a point of attachment for several muscles found in the neck and back. The mastoid process tends to be larger in men than in women, mainly because men’s muscles in this area are larger, and the male body evolved to accommodate them. The mastoid process contains a number of air-filled cavities that harbor what are known as mastoid air cells. Mastoid cells communicate with the middle ear and undertake several functions that are important for middle-ear health, such as regulating ear pressure and protecting fragile ear structures. When the cells become infected or inflamed, mastoiditis may occur.
Mastoiditis develops when mastoid air cells become infected from bacteria. The most common bacterial strain found among patients with mastoiditis is Streptococcus pneumoniae, which has a prevalence of 25 percent. Other bacterial strains associated with mastoiditis include Group A beta-hemolytic streptococci, Staphylococcus aureus, Streptococcus pyogenes, Moraxella catarrhalis, Haemophilus influenza, Pseudomonas aeruginosa, Mycobacterium species, and certain types of fungi. Mastoid cell infections occur in several ways. The most common cause is a middle-ear infection, also known as acute otitis media. Bacteria spread into the air-filled cavities of the mastoid process, infecting and inflaming the cells within. This can damage the bony structures nearby if the infection spreads. Another less common cause of mastoiditis is cholesteatoma, a growth of cells in the middle ear or mastoid process that expands rapidly and can block drainage of the ear. Mastoiditis was once associated with high mortality rates among children, but the development of antibiotics has drastically lowered the prevalence of the infection across all populations.
Overview
Mastoiditis can present in several ways. Some common signs and symptoms of the infection include fever, irritability, tiredness, swelling of the earlobe or the area around the ear, redness and tenderness behind the ear, swelling and drooping of the ear, and drainage coming from the ear. If left untreated, mastoiditis can lead to a number of serious complications such as facial paralysis, hearing loss, and abscessing of the brain or meningitis. Less severe complications include nausea, vomiting, vertigo, vision changes, and headache. Headaches should be reported to physicians as they could be a sign of a blood clot in the brain.
If a person is experiencing an earache with a fever and soreness behind the ear, he or she should seek the advice of a medical professional. When diagnosing mastoiditis, doctors will check the patient’s temperature and look for redness, swelling, and tenderness behind the ear. Doctors also use an instrument called an otoscope to look inside the ear for any sign of infection. Doctors will often collect a sample of the fluid inside the ear for testing to confirm the species of bacteria. By determining what bacterium is causing the infection, the doctor can prescribe the correct type of antibiotic to fight it. For those experiencing severe symptoms, a physician will likely order a CT scan (computed tomography scan), which produces X-ray images of the mastoid area. Medical imaging helps physicians see if there are any pockets of fluid around the mastoid that need to be drained.
Antibiotics are the main form of treatment for mastoiditis, both acute and chronic. Acute mastoiditis is usually treated with antibiotics administered via an intravenous line (IV). Chronic mastoiditis is treated with antibiotics taken orally as well as antibiotic eardrops and regular ear cleanings by a doctor. If antibiotic treatments fail to clear up the infection, surgery may also be necessary. Some patients with mastoiditis need a myringotomy, a procedure that drains the fluid from the middle ear. During this procedure, the surgeon cuts a small hole in the eardrum to drain fluid and relieve pressure in the middle ear. Sometimes the surgeon will insert a small tube in the eardrum to ensure that drainage continues. This tube usually falls out of the eardrum in six to twelve months. For those patients with serious complications, such as an abscess or a bone erosion, a surgeon may need to remove the infected mastoid bone entirely. This procedure is known as a mastoidectomy.
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