Mastoiditis - Symptoms and Treatment

Mastoiditis is an infection of the mastoid process , the portion of the temporal bone of the skull that is behind the ear . The mastoid consists of air cells that drain the middle ear. Mastoiditis can be a mild infection or can develop into life-threatening complications. Mastoiditis is usually a complication of acute otitis media (middle ear infection). Other symptoms are fever, pain around and within the ear, and a creamy, profuse discharge from the ear. The pain tends to be persistent and throbbing. Hearing loss is progressive. Computed tomography (CT) shows that the air cells (spaces in bone that normally contain air) in the mastoid process are filled with fluid. As mastoiditis progresses, the spaces enlarge. Inadequately treated mastoiditis can result in deafness, blood poisoning (sepsis), infection of the tissues covering the brain (meningitis), brain abscess, or death.

Treatment is with intravenous antibiotics. A sample of ear discharge is examined to identify the organism causing the infection and to determine the antibiotics most likely to eliminate the bacteria. Antibiotics may be given by mouth once the person starts to recover and are continued for at least 2 weeks. If an abscess has formed in the bone, surgical drainage (mastoidectomy) is required.

Mastoiditis is a bacterial infection and inflammation of the air cells of the mastoid antrum. Although the prognosis is good with early treatment, possible complications include meningitis, facial paralysis, brain abscess, and suppurative labyrinthitis. It is hollow, like the sinuses of the face, and is connected to the middle ear cavity. Infection may spread from the ear into the mastoid bone. Since the structures involved with hearing are contained in the bone immediately in front of the mastoid, they may be damaged by mastoiditis. In addition, the facial nerve passes through this bone and can be damaged leading to weakness or paralysis of the facial muscles. If the infection destroys the bone, it may spread into the overlying brain. In acute purulent otitis media, inflammation often extends into the mastoid antrum and air cells, resulting in fluid accumulation. In a few patients, bacterial infection develops in the collected fluid, typically with the same organism causing the otitis media; pneumococcus is most common.

Mastoid infection can produce osteitis of the septae, leading to coalescence of the air cells. The infection may decompress through a perforation in the tympanic membrane or extend through the lateral mastoid cortex, forming a postauricular subperiosteal abscess. Rarely, it extends centrally, causing a temporal lobe abscess or septic thrombosis of the lateral sinus.

Causes of Mastoiditis

Bacteria that cause mastoiditis include pneumococcus (usually in children under age 6), Hemophilus influenzae, beta-hemolytic streptococci, staphylococci, and gram-negative organisms.Mastoiditis is usually a complication of chronic otitis media; less frequently, it develops after acute otitis media. An accumulation of pus under pressure in the middle ear cavity results in necrosis of adjacent tissue and extension of the infection into the mastoid cells. Chronic systemic diseases or immunosuppression may also lead to mastoiditis. While pneumococcal mastoiditis is usually not symptomatic, it can be very destructive. Coalescence of the mastoid air cells may precede rupture of the tympanic membrane. Streptococcal mastoiditis is generally preceded by early rupture of the tympanic membrane and copious otorrhea.

• Streptococcus Group A.
• Histiocytosis X.
• Pneumococcus.

Signs and Symptoms of Mastoiditis

Sign and symptoms may include the following :

• Headache.
• Redness of the ear.
• Swelling of the ear lobe .
• Fever.
• Discomfort .
• Ear pain .
• Irritability.

Treatment for Mastoiditis

Treatment of mastoiditis consists of intense parenteral (intravenous or intramuscular) antibiotic therapy. I.V. penicillin is the initial drug of choice for at least a 2-week duration. If bone damage is minimal, myringotomy drains purulent fluid and provides a specimen of discharge for culture and sensitivity testing. Recurrent or persistent infection or signs of intracranial complications necessitate simple mastoidectomy. This procedure involves removal of the diseased bone and cleaning of the affected area, after which a draill is inserted.

A chronically inflamed mastoid requires radical mastoidectomy (excision of the posterior wall of the ear canal, remnants of the tympanic membrane, and the malleus and incus, although these bones are usually destroyed by infection before surgery). The stapes and facial nerve remain intact. Radical mastoidectomy, which is seldom necessary because of antibiotic therapy, does not drastically affect the patient's hearing because significant hearing loss precedes surgery. With either surgical procedure, the patient continues oral antibiotic therapy for several weeks after surgery and hospital discharge.

• The primary treatment for mastoiditis is administration of intravenous antibiotics. Initially, broad-spectrum antibiotics are given, such as ticarcillin, clavulanate plus gentamicin, or ciprofloxacin (Cipro).
• Surgery to remove part of the bone and drain the mastoid may be needed if antibiotic therapy is not successful. Surgical drainage of the middle ear through the eardrum may be needed to treat the underlying middle ear infection.
• I.V. penicillin is the initial drug of choice for at least a 2-week duration.
• The first line of treatment is frequent cleanings of the ear in the office by an ear specialist combined with use of topical therapy (ear drops or irrigations) at home .