Mastoiditis: Symptoms, Urgent Care and Treatment

01The mastoid

Where the mastoid bone is

The mastoid bone is part of the skull located just behind the ear. MedlinePlus explains that it has a honeycomb-like structure made of small air spaces. It is connected to the middle ear, the space behind the eardrum.

Because of this connection, an infection in the middle ear can extend into the mastoid. When that happens, MedlinePlus says the honeycomb spaces fill with infected material and the bone may start to break down. This is why mastoiditis is treated as a serious condition.

02Cause

How infection can spread from the middle ear

MedlinePlus explains that mastoiditis is most often caused by a middle ear infection (acute otitis media) that spreads from the ear to the mastoid bone. The NHS notes that you are more likely to get mastoiditis if you have a severe ear infection or get lots of ear infections.

Before antibiotics, MedlinePlus says mastoiditis was one of the leading causes of death in children. It is much less common and much less dangerous today, but it can still happen, sometimes in people who have already started treatment for an ear infection. Developing mastoiditis does not necessarily mean an ear infection was badly managed.

03Symptoms

Signs behind the ear and hearing changes

The NHS and MedlinePlus list these symptoms:

• pain, soreness or tenderness behind the ear
• redness behind the ear, which can be harder to see on brown or black skin
• swelling behind the ear, which can make the ear stick out
• discharge from the ear
• a high temperature, which may rise suddenly
• headache, tiredness and irritability
• hearing loss in the affected ear

Not every pain behind the ear is mastoiditis. Our guides on pain behind the ear and a lump behind the ear cover other, more common causes. What makes mastoiditis more likely is the combination of these signs with a recent or ongoing ear infection.

04Children and adults

Presentation in children and adults

Both sources say mastoiditis is more common in children, but it can affect adults too. In young children, signs may be less specific: the NHS mentions tiredness and irritability alongside fever and the signs behind the ear, and the NHS advises calling 111 for help with a child under 5. Our guide on ear infections in babies explains the usual signs of the underlying infection.

Online, the “three-finger test” is sometimes mentioned as a way to check for mastoiditis. Neither of the sources used here describes it, and it is not a reliable home test. Pressing behind the ear cannot rule mastoiditis in or out: if the symptoms above are present, seek medical help rather than examining the area yourself.

06Diagnosis

Examination and selected tests

The NHS explains that a GP uses an otoscope, a small magnifying instrument with a light, to look for infection inside the ear. If mastoiditis is suspected, you are referred to an ear, nose and throat (ENT) specialist in hospital for further tests, including blood tests.

MedlinePlus explains that an examination of the head may show signs of mastoiditis, and that a CT scan of the ear or head, or an MRI scan, may show changes in the mastoid bone. A sample of discharge from the ear can be sent for culture to identify the bacteria. Not everyone needs a scan; the NHS says one may sometimes be needed to show the bone in more detail.

07Antibiotics

Hospital antibiotic treatment

The NHS explains that mastoiditis is treated by an ear specialist in hospital, and that the main treatment is antibiotics given directly into a vein through a drip. People usually stay in hospital for a short time to make sure the antibiotics are working, and if symptoms improve, antibiotic tablets may be continued at home.

MedlinePlus explains that mastoiditis can be hard to treat because medicine may not reach deep into the bone, so repeated or long-term treatment is sometimes needed. The type and length of antibiotic treatment are decided by the hospital team, and how long each person stays depends on how they respond.

08Surgery

When drainage or surgery is needed

If antibiotics do not work or the infection gets worse, the NHS says further treatment may be needed:

• draining pus from the ear with a needle or through a small cut in or behind the ear
• ear surgery, including removing part of the mastoid bone (mastoidectomy)

MedlinePlus adds that a small opening in the eardrum to drain the middle ear (myringotomy) may be needed to treat the middle ear infection. Which procedure is needed depends on how the infection responds and on what the specialist finds.

09Sources

Where the sources differ

The NHS and MedlinePlus agree on the main symptoms and on antibiotics as the first treatment. They differ in some details:

• Hospital stay. The NHS says you will usually stay in hospital for 1 or 2 days to check that the antibiotics are working. MedlinePlus describes antibiotic injections followed by antibiotics by mouth, without giving a stay. The real length of stay depends on the person.
• Outlook. MedlinePlus says mastoiditis can be cured but may be hard to treat and may come back. The NHS focuses on getting treatment quickly to avoid complications.
• Complications. MedlinePlus lists destruction of the mastoid bone, dizziness or vertigo, an abscess around the brain, facial paralysis, meningitis, partial or complete hearing loss and spread of infection to the brain or throughout the body. The NHS mentions permanent hearing loss and meningitis.
• Prevention. MedlinePlus says prompt and thorough treatment of ear infections reduces the risk. This does not mean every ear infection needs antibiotics; that decision is made by a doctor.

10Summary

In summary

Mastoiditis is a rare but serious infection of the bone behind the ear, usually spreading from a middle ear infection and more common in children. Pain, redness and swelling behind the ear, a sticking-out ear, discharge, fever and hearing loss are the key signs. It needs urgent medical assessment and is treated in hospital with antibiotics through a drip, with drainage or surgery if needed.

On discharge, it helps to write down the treatment you have been given, when your follow-up is and which changes mean you should go back: fever returning, swelling or pain behind the ear increasing, new discharge, a severe headache, a stiff neck, dizziness or weakness of the face. Symptoms can return, so keep follow-up appointments and seek help quickly if things get worse.