Acute and chronic mastoiditis
Acute mastoiditis is a bacterial infection within the mastoid. The mastoid bone contains a series of air spaces that connect to the middle ear space. The mastoid receives its ventilation via the eustachian tube since air circulates through the middle ear into the mastoid air spaces. An acute infection of the mastoid bone is considered an urgent situation as life-threatening complications can develop.
What causes it?
Mastoiditis usually occurs secondary to an acute ear infection. Although there is always a degree of inflammation within the mastoid when an ear infection occurs, in patients with acute mastoiditis, this infection is much more severe and begins to spread outside of the mastoid bone.
How does acute mastoiditis present?
Children with acute mastoiditis typically present with the affected ear sticking somewhat out and appearing to be pushed slightly down. This is due to a degree of swelling of the skin and soft tissues behind the ear over the mastoid area. There may be obvious redness and tenderness behind the ear. The child may be irritable or complain of pain. Sometimes there is pus draining from the ear canal.
If acute mastoiditis causes complications such as meningitis or abscess affecting the brain, the child may appear gravely ill.
How is it diagnosed?
The diagnosis of acute mastoiditis usually can be made based on examination. Often, a CT scan will be requested in order to confirm the diagnosis and to look for spread of infection.
Treatment
Most children with acute mastoiditis require hospital admission, IV antibiotics and drainage of the middle ear. If an abscess is present behind the ear, this must be surgically drained. If the mastoid infection does not improve, a surgical procedure to clean out the infection, known as a mastoidectomy, will need to be done.
The treatment described will usually prevent spread of infection into the brain. However, if serious complications are suspected or have occurred, additional treatment and procedures may be necessary.
Chronic mastoiditis
This is also called chronic suppurative mastoiditis. It is a chronic infection of the middle ear and mastoid.
How is it diagnosed?
Children with chronic mastoiditis have persistent drainage from their mastoid and middle ear coming through a hole within the eardrum. These patient's often have a history of frequent ear infections in the past. The drainage is often painless and may continue for months to years. Treatment with antibiotics by mouth and ear drops may temporarily improve the situation, or may have no effect. Diagnoses of chronic mastoiditis is made based on a patient's history and ear examination. A CT scan of the temporal bone (the ear) is often requested to confirm the diagnosis and to look for evidence of other problems that may also cause persistent drainage from the ear.
Treatment
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. If this is not successful, IV antibiotics and/or mastoid surgery will be needed.
Complications of chronic mastoiditis
Chronic infection can damage the entire eardrum and ossicles (small bones of hearing) leading to conductive hearing loss that will persist unless reconstructive surgery is performed. Chronic ear disease can also lead to development of cholesteatoma, a benign but destructive tumor of the ear.
Eventually chronic mastoiditis can spread to areas near the ear including the brain, and cause serious complications.