Mastoiditis is a bacterial infection of the skull behind the ear. It occurs as a result of an untreated or poorly treated middle ear infection and can have life-threatening consequences. Read here how mastoiditis manifests itself and how it is treated.
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At a glance:
What is mastoiditis?
Experts speak of mastoiditis when the mastoid behind the ear (also: os mastoideum or mastoid process) becomes inflamed. Bone inflammation is triggered by bacteria from the middle ear: mastoiditis is one of the most common complications of a otitis media (Otitis media).
Because an otitis media can be treated well, only about 0.1 percent of people with an otitis media are affected by subsequent mastoiditis. The disease is significantly more common in children and adolescents than in adults: around 1.3 percent of children suffer from this complication after a middle ear infection.
Chronic mastoiditis often without symptoms
Chronic mastoiditis is even rarer than acute mastoiditis. The mastoid also becomes inflamed in chronic mastoiditis, but here there are hardly any or only mild symptoms – it is therefore also called veiled or veiled mastoiditis. Chronic mastoiditis often goes undetected for weeks or months, allowing it to spread to other areas of the body.
Causes of mastoiditis
The mastoid is a portion of the temporal bone traversed by mucosal-lined cavities and connected to the middle ear. If the pathogens of a middle ear infection that has not healed enter these cavities, the inflammation spreads to the bones, sometimes forming a purulent one abscess.
In most cases, mastoiditis is caused by pneumococcal bacteria, but it can also occur
behind it. Mastoiditis is usually preceded by a viral infection, which reduces the body’s immune system to such an extent that it first leads to an inflammation of the middle ear and then to mastoiditis
Symptoms: This is how mastoiditis manifests itself
The typical symptoms of mastoiditis often appear two to three weeks after a middle ear infection. Those affected suffer from:
Hearing often deteriorates as well. Typical of mastoiditis is a pressure-sensitive and reddened swelling behind the ear, which can become so large that the ear sticks out. At the same time, a secretion often escapes from the ear (otorrhea).
Chronic mastoiditis is usually much more inconspicuous and manifests itself in non-specific symptoms such as exhaustion, loss of appetitehead or stomach pain.
Diagnosis: This is how mastoiditis is diagnosed
The first point of contact for ear pain is an ENT practice. Here, the symptoms are first inquired about and a physical examination is carried out. An ear microscope (otoscope) is used to examine the eardrum for abnormalities. In the case of mastoiditis, it is usually thickened, bulging, opaque or even perforated. A hearing test checks the extent to which hearing is impaired.
If the suspicion of mastoiditis is confirmed, further examinations are carried out in a hospital. Here, a blood sample is taken to determine the inflammatory parameters. In addition, the ear secretion can be examined for the inflammation-causing bacteria.
Sometimes one will X-ray-, MRT– or CT scan created to better assess the extent of the inflammation.
Mastoiditis: how is bone inflammation treated?
As with many other bacterial infections, treatment with antibiotics is indicated for mastoiditis. Ideally, the triggering pathogen is first determined in order to use a suitable drug. In most cases, treatment begins intravenously (i.e. as an infusion) and can then be continued at home using tablets. It is important that the antibiotic is taken for the entire recommended period, even if the symptoms have already subsided.
If antibiotic treatment does not work, if a bone abscess has formed, or if the infection has become chronic, surgery may be necessary. In this so-called mastoidectomy, the inflamed part of the bone is surgically removed. At the same time, a thin tube (drainage) is placed through which the fluid can drain from the ear.
Mastoiditis: course and prognosis
If mastoiditis is treated immediately with antibiotics, it heals quickly and without consequences in most cases. The longer it goes untreated (for example, in chronic mastoiditis), the more time the bacteria have to spread to neighboring areas of the body. A further spread of germs is mainly due to the close proximity to the Brain very dangerous. Then there is a risk of serious complications such as:
- Inflammation of the meninges or periosteum
- Facial paralysis
- permanent hearing loss
- Brain abscess (an encapsulated collection of pus in the brain)
If the pathogens get into the bloodstream, it can become life-threatening Sepsis (Blood poisoning) coming.
Prevention of mastoiditis
The best way to prevent the development of mastoiditis is to consistently treat middle ear infections. If this has not completely subsided after two weeks or if the symptoms suddenly flare up again, a visit to the ENT practice is strongly recommended. Prescribed antibiotics must not be discontinued prematurely – even if the symptoms subside – since surviving bacteria can lead to a new outbreak of the disease.
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