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.