Ear, Nose & Throat Everything You Need to Know About Mastoiditis By Aubrey Bailey, PT, DPT, CHT Published on June 21, 2023 Medically reviewed by John Carew, MD Print Table of Contents View All Table of Contents Causes Symptoms Complications Diagnosis Treatment Mastoiditis is a serious bacterial infection that develops in the mastoid process (bony projection behind the earlobe), which contains bone and air cells surrounding the middle ear. This condition most often affects children but can also occur in adults. Left untreated, infection caused by mastoiditis can continue to spread and become life-threatening. This article discusses mastoiditis—symptoms, complications, diagnosis, and treatment options. simarik / Getty Images What Causes Mastoiditis? The mastoid is the lower part of the temporal bones on each side of your skull. Mastoiditis is often a rare complication when a middle ear infection spreads to the nearby mastoid process. A blockage of pus and fluid forms in the eustachian tube (auditory tube responsible for controlling ear pressure) and prevents air cells in the mastoid from properly draining the middle ear. Mastoiditis can be acute (lasting less than one month) or chronic (lasting for months or years). Chronic mastoiditis causes persistent ear drainage and often occurs from a ruptured eardrum. Can Mastoiditis Develop Without an Ear Infection? Although rare, mastoiditis can occur without an ear infection. A cholesteatoma (skin growth) can develop in the middle ear, behind the eardrum, which can become infected. Mastoiditis Symptoms Mastoiditis is rare, but children are the most affected population. If you notice the following symptoms in your child, follow up with a healthcare provider for additional testing: Pain at the mastoid processPain in the earRedness and swelling at the mastoid processEar drainageSwollen ear lobeRecent ear infectionHeadacheLoss of hearingFeverIrritabilityNeck painChillsFacial weakness or paralysis Mastoiditis Complications Mastoiditis can lead to severe complications, even with treatment, and can include the following: Meningitis (inflammation of brain and spinal cord fluid) Loss of hearing Brain infection Sepsis (infection moves to the bloodstream) Facial paralysis Blood clots An abscess (mass filled with pus) Labyrinthitis (inflammation of the inner ear) Bezold's abscess (pocket of pus deep in the neck) Complications of mastoiditis are also more likely to occur in older adults or those with preexisting health conditions. Can Mastoiditis Go Away on Its Own? Mastoiditis will not go away without treatment. The infection will continue to spread, which can ultimately be life-threatening. Even with proper treatment, the condition can return, leading to chronic mastoiditis. How to Diagnose Mastoiditis A healthcare provider, such as an otolaryngologist, also referred to as an ear, nose, and throat doctor (ENT), will conduct a physical exam to begin the diagnosis process. They will use a handheld tool called an otoscope to look at the inside of the ear. Some symptoms of mastoiditis, such as redness, swelling, and drainage, are easy to spot but are also shared with other medical conditions. A provider might also use tympanometry, a procedure to assess middle ear functioning. Additional testing can include: Blood work A culture of infected fluid to determine the type of bacteria present Head X-rays Computed tomography (CT scan) Magnetic resonance imaging (MRI) How Do Healthcare Providers Treat Mastoiditis? The primary treatment for mastoiditis is antibiotic medications. A healthcare provider administers these medications intravenously (through an IV) in a hospital setting. In some cases, depending on the type of bacteria present, they provide additional antibiotics. Sometimes, medications are unsuccessful in treating mastoiditis, in which case a healthcare provider will recommend surgical treatment. During the procedure, a provider makes a small hole in the eardrum to relieve pressure in the middle ear and help drain excess fluid. They may place a tiny tube in this opening to help keep fluid from building up. These tubes are temporary and typically fall out independently in about six to 12 months. Severe cases of mastoiditis might require a mastoidectomy—surgical removal of air cells in the mastoid, which poses additional risks, including: Hearing loss Dizziness Altered sense of taste Tinnitus (ringing in the ears) Weakness in facial muscles Ongoing infection Leaking of cerebrospinal fluid Can Mastoiditis Be Prevented? The best way to help prevent mastoiditis is early recognition and proper treatment of ear infections. Pneumococcal vaccines may benefit in preventing ear infections caused by certain types of bacteria that lead to mastoiditis. Summary Mastoiditis is a bacterial infection affecting the mastoid part of the temporal skull bones behind the ears. This condition can cause pain, swelling, ear drainage, headaches, fever, chills, and additional symptoms. It most often develops after an ear infection and typically occurs in children. Mastoiditis can lead to severe complications, including meningitis and hearing loss. A healthcare provider can diagnose it through a physical exam, a culture, blood work, and imaging. The primary treatment for mastoiditis is IV antibiotics, but more severe cases might require surgery. 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Mierzwiński J, Tyra J, Haber K, et al. Therapeutic approach to pediatric acute mastoiditis – an update. Braz J Otorhinolaryngol. 2018;85(6):724-732. doi:10.1016%2Fj.bjorl.2018.06.002 Infectious Disease Management Program at UCSF. Mastoiditis. Johns Hopkins Medicine. Cholesteatoma. Cassano P, Ciprandi G, Passali D. Acute mastoiditis in children. Acta Biomed. 2020;91(Suppl 1):54-59. doi:10.23750%2Fabm.v91i1-S.9259 Mansour S, Magnan J, Nicolas K, Haidar H. Acute otitis media and acute coalescent mastoiditis. Middle Ear Diseases. 85-113. doi:10.1007%2F978-3-319-72962-6_2 Children's Hospital of Philadelphia. Mastoiditis. National Library of Medicine. Mastoidectomy. Dagan RD, Pelton SP, Bakaletz L, Cohen R. Prevention of early episodes of otitis media by pneumococcal vaccines might reduce progression to complex disease. The Lancet Infectious Diseases. 2016;16(4):480-492. doi:10.1016/S1473-3099(15)00549-6 By Aubrey Bailey, PT, DPT, CHT Aubrey Bailey is a physical therapist and professor of anatomy and physiology with over a decade of experience providing in-person and online education for medical personnel and the general public. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit