Acute Mastoiditis and Mastoid Infections

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Acute Mastoiditis and Mastoid Infections

Disease/Disorder Name: Acute Mastoiditis
ICD-9 Description: 
Acute Mastoiditis and Other Complications
ICD-9 Code Family: 383.02
Description:  Various infections and complications on the mastoid area including Gradenigo’s Syndrome.

Mastoid Infection (Mastoiditis)

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 itching, 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 expands into the mastoid bone area it is known as mastoiditis.

Note the mastoid bone swelling behind the earAnother 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 to determine the extent of the Mastoiditis

A hospital setting is usually the only facility capable of performing some of the diagnoses to understand the extent of a mastoid infection.   A CT/PET/ scan and/or X-rays will be used to assess the extent of the infection.  If the mastoiditis is readily apparent i.e. a swelling behind the ear the size of a hens egg, antibiotics will be immediately administered, usually by IV. To assist with diagnostic procedures and antibiotic therapy, and if the eardrum has not burst, a small incision will often be made in the eardrum (myringotomy) to allow drainage of the infection and to alleviate pain.

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 usually if the swelling is quite large, after the scanning sessions, antibiotic administration will be continued and surgery will be performed as soon as possible.

Mastoid Surgery (Mastoidectomy)

The operation is usually performed by an ENT (Ear Nose Throat) surgeon or a head and neck surgeon and the mastoidectomy is done under general surgery.  It involves drilling away and removing the infected bone.

Surgical Procedures

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, although when they are infected, they feel like soft mush). After the bone removal, 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, the bone covering is left off and the skin flap is stitched back to the surrounding tissue. After healing, there will be a permanent 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 continued (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.