Mastoiditis is a serious bacterial infection affecting the mastoid process, the bony structure located directly behind the ear. This honeycomb-like structure, part of the skull’s temporal bone, contains air cells that become infected when a middle ear infection spreads. Because the infection can rapidly erode bone and spread to nearby structures, prompt medical attention is required.
Recognizing the Signs of Mastoiditis
Mastoiditis develops days or weeks after a middle ear infection has gone untreated or has not fully resolved. The most common symptom is intense pain or tenderness in the bone just behind the ear. This area often appears swollen and red, sometimes causing the earlobe to stick out.
Patients frequently experience a fever, indicating a systemic infection. Other signs include a thick, foul-smelling discharge coming from the ear canal. Due to inflammation, individuals may also notice worsening hearing loss in the affected ear.
The Required Medical Specialist
The physician best suited to treat mastoiditis is an Otolaryngologist, commonly known as an ENT doctor. An Otolaryngologist is a surgeon specializing in the diseases of the ear, nose, and throat. While a primary care physician can make the initial diagnosis, they will refer the patient to an ENT specialist for definitive management.
The ENT’s expertise is required because mastoiditis involves complex bony and soft tissue structures near the brain. They are trained to interpret detailed imaging, such as a Computed Tomography (CT) scan, necessary to determine the extent of bone destruction and infection spread. The Otolaryngologist is also qualified to perform surgical interventions if the infection does not respond to medication. Their knowledge of the inner ear and surrounding nerves, including the facial nerve, makes them uniquely qualified to manage this condition.
Standard Treatment Protocols
Once mastoiditis is confirmed, treatment begins with aggressive IV antibiotics. Patients are admitted to the hospital so that broad-spectrum antibiotics, such as vancomycin or ceftriaxone, can be delivered directly into the bloodstream. This method ensures high concentrations of medication reach the infected bone tissue quickly to overcome the bacteria. If the infection is uncomplicated and responds well, the patient may be discharged to complete oral antibiotics.
If the infection progresses or an abscess is present, surgical intervention is necessary. A myringotomy, a minor procedure involving a small incision in the eardrum, may be performed to drain infected fluid from the middle ear. A tympanostomy tube is often inserted to maintain drainage.
If the infection has caused significant bone erosion or symptoms do not improve within 48 hours of IV antibiotics, a mastoidectomy is performed. This surgery involves the Otolaryngologist removing the diseased portions of the mastoid air cells. The goal is to eliminate the source of the infection and prevent its spread.
Understanding Potential Complications
The urgency surrounding mastoiditis treatment stems from the risk of severe complications if the infection spreads beyond the mastoid bone. One outcome is a subperiosteal abscess, a collection of pus beneath the bone lining that causes the ear to protrude. The infection can also erode the thin bone separating the mastoid from the brain, leading to intracranial complications.
These outcomes include meningitis (inflammation of the membranes covering the brain and spinal cord) or a brain abscess (a collection of pus within the brain tissue). The infection may also affect nearby cranial nerves, causing facial nerve paralysis, which results in weakness or drooping on one side of the face. Further spread can result in Bezold’s abscess, where pus drains into the neck muscles, or permanent hearing loss.