Mastoiditis

The mastoid bone is connected to the middle ear through the roof of the middle ear (called "antrum"). The mastoid bone has hollow spaces that are lined similar to sinus cavities with a mucous membrane lining.

When the middle ear space is infected, the infection can spread into these "mastoid cells" and the area can wall itself off leading to an abscess that can turn life threatening.

Symptoms

The patient has a high fever, looks sick and complains about an excruciating ear pain. The bone behind the ear lobe is also painful to touch. There may even be a lot of redness of the skin of this area and excruciating pain when it is touched or tapped. At the same time the physician likely will see an acute otitis media. Three of the problem bacteria are Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus.

Treatment

A patient who is that sick needs to be hospitalized and treated with intravenous antibiotics to prevent the development of septicemia (which otherwise could lead to shock).

An otolaryngologist needs to carefully examine and possibly order emergency CT or MRI scans to rule out a mastoid abscess. It this is the case, the surgeon will do a mastoidectomy (drainage of the abscess by opening the abscess cavity in the bone). Without this procedure there is a danger that the infection spreads upwards into the temporal lobe of the brain and forms meningitis or a brain abscess and septic shock (Ref. 6, p. 674).

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Disclaimer

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References

1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 84.

2. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001, Mosby Inc.

3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 85.

4. Rakel: Conn's Current Therapy 2001, 53rd ed.,2001, W. B. Saunders Company

5. Goldman: Cecil Textbook of Medicine, 21st ed.,2000, W. B. Saunders Company

6. Mandell: Principles and Practice of Infectious Diseases, 5th ed.,2000, Churchill Livingstone, Inc.

7. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 265.

8. MF Williams: Otolaryngol Clin North Am; Oct1999; 32(5): 819-834.

9. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 106.

Last Modified: Dec. 23, 2007