When Ear Infections Get Serious: What Is Mastoiditis?

ear infection
Doctor looking in child's ear. sdominick/E+/Getty Images

Mastoiditis is an infection of the mastoid bone, which is the bone in the skull just behind the outer ear. It is most common in children, although it is rare even in this age group. Before antibiotics were discovered, mastoiditis was one of the leading causes of death in children.

Causes of Mastoiditis

Mastoiditis usually occurs when an otitis media (middle ear infection) spreads to the mastoid bone in the skull.

This bone fills with bacteria and its structure can be destroyed. These infections are rare but can occur when severe ear infections go untreated. 

Symptoms of Mastoiditis

People with mastoiditis may suffer from several symptoms. They can include:

  • Ear drainage
  • Ear pain or discomfort
  • Fever
  • Headache
  • Hearing loss
  • Redness or swelling behind the ear (one of the most significant and telltale signs of mastoiditis)

An exam by a healthcare professional is necessary if mastoiditis, or most any other ear infection, is suspected. For definite diagnosis, you may need a CT scan of the ear or head, an x-ray of the skull, a culture of any ear drainage or a combination of these tests. The pain, redness and swelling associated with mastoiditis are often severe. 

Mastoiditis Treatment Options

Depending on the severity of the infection, treatment may include injected or IV antibiotics followed by oral antibiotics. If it is not responsive to these treatments or the infection is too deep in the bone, surgery may be needed to drain the fluid and/or remove part of the mastoid bone.

Many children that are diagnosed with mastoiditis have to be hospitalized. 

Complications of Mastoiditis

Mastoiditis can cause severe complications if it is not treated promptly. They may include:

  • Destruction of the mastoid bone
  • Permanent hearing loss (complete or partial)
  • Dizziness or vertigo
  • Facial paralysis
  • Meningitis
  • Infection or abscess in the space covering the brain or spinal cord (epidural abscess)
  • Infection that can spread to the brain or throughout the body

Fortunately, most of these complications are rare. Typically, mastoiditis is treated successfully and most children recover fully without any further complications. But they can occur and just show how important it is to seek prompt treatment.

If you are concerned your child may have an ear infection or has been diagnosed with an ear infection that seems to be getting worse instead of better, contact her health care provider. If you notice redness or swelling of the skin behind the ear or you notice one ear appears to be "sticking out", seek medical attention as these are significant signs of mastoiditis. 

Although this infection is not as common or life threatening as it once was, it's important to seek medical care if you are concerned that you or your child may have it. 


”Mastoiditis.” Medical Encyclopedia 10 Oct 08. Medline Plus. National Institutes of Health. 19 Feb 09.

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