Mastoid
Infection (Mastoiditis)
© 2004-2008 Hearing Central LLC
The mastoid is part of the skull
and is made up of spongy bone just
behind the ear.
Mastoiditis is an
infection of the bony air cells in the
mastoid bone. In fact the middle
ear and the inner ear (cochlea) are
embedded in the mastoid bone.
Indications of a mastoid infection
are reddening and swelling behind the
ear. The cause is usually from an
untreated middle ear infection (See
Otitis Media), so otitis media
symptoms are often present. An untreated
middle ear infection can slowly spread
into the mastoid cells. When infection
becomes trapped in the mastoid bone areait is
known as mastoiditis.
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Note the mastoid bone swelling
behind the ear |
Another example showing a child's
right ear being pushed forward by
the mastoid infection |
Symptoms of the mild form of
mastoiditis show a reddening behind the
ear and swelling and sensitivity to
touch. An acute case of mastoiditis
shows a pronounce bulbous swelling that
can push the ear forward.
Mastoiditis treatment:
Treatment for Mild Mastoiditis
Antibiotics are the normal treatment
for the mild form of mastoiditis. There
are a number of antibiotics available to
treat mastoiditis (and coincidentally,
any otitis media that is present). Because there are few
blood vessels permeating the mastoid
area, a normal 10 day protocol of
antibiotics may be extended to 14 days
to make sure the medicine penetrates the
bony mass. This protocol should also
clear up any otitis media present .
Treatment for Acute Mastoiditis
Acute mastoiditis is quite visually
apparent - a large swelling behind the
ear accompanied by high fever, ear pain,
sensitivity to touch, and hearing loss.
In serious cases, the facial nerves may
become paralyzed.
Diagnostic Procedures for Mastoiditis
A number of procedures will usually
be performed in a hospital setting to
ascertain the extent of the disease's
progress and to rule out any
complications. A CT/PET/ scan
and/or X-rays will be used to assess the
extent of the infection.
Immediately upon entering the hospital
antibiotics will be administered,
usually by IV. If, and that's a big "if"
it is seen that the antibiotics are seen
to kill the bacteria causing the
infection, then no surgery may be
performed. But this situation rarely
occurs, and antibiotics will be
administered during and after any
surgery.
To assist with diagnostic procedures
and antibiotic therapy, and if the
eardrum has not burst, a small incision
will be made in the eardrum (myringotomy)
to allow drainage of the infection.
Mastoid Surgery
(Mastoidectomy)
If the
antibiotic protocols do not appear to
work, or appear to be too slow in
counteracting the infection,
a
mastoidectomy may be indicated. A
mastoidectomy is done under general
surgery. It involves drilling away
the infected bone. This aims to remove
all the infected bone. An incision is
made behind the ear and the flap is
lifted forward.
Photo Courtesy of The Internet Journal of
Otorhinolaryngology
A circle is cut out of
the bone covering the the mastoid and
showing the infected area. The spongy
mass that is infected is then cut away
and removed (it looks like pieces of
coral or hard sponge). The remaining
cavity is cleaned, coated with
antibiotics and if possible the bone cover is "sewn"
back to the rest of the skull, and the
flap of skin stitched back together. An
outer pressure dressing is then worn for
1-2 days after surgery.
If too
much mastoid material has been removed,
and it is not possible to reattach the bone
covering, it is left off and the skin
flap is stitched back to the surrounding
tissue. After
healing, there will be depression
behind the ear.
Mastoid Surgery
Recovery
The stay
in the hospital is usually 1-3 days.
After discharged from the hospital, a
full regimen of antibiotics will be
given (10-14 day regimen).
The
stitches will be removed after about 2
weeks. Full recovery will take 3-4 weeks
with possibly bouts of dizziness and
headaches during this time. Over time
the headaches and dizziness should
diminish.
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