Understanding Mastoiditis: Causes, Symptoms, and Treatment
Mastoiditis is an infection of the mastoid bone, which is located just behind the ear. This condition is often a result of a middle ear infection (otitis media) that has spread to the mastoid bone. Although it is less common today due to the widespread use of antibiotics, mastoiditis remains a serious condition that requires prompt medical attention.
B. Welleschik, CC BY-SA 3.0, via Wikimedia Commons
Incidence of Acute Mastoiditis
Acute mastoiditis is a significant complication of acute otitis media (AOM), particularly in pediatric populations. Here are some key points about its incidence:
Acute mastoiditis occurs in approximately 1 in 400 cases of AOM, which translates to a prevalence of 0.24%⁽¹⁾.
The incidence can vary based on geographical location, healthcare practices, and other factors.
Mastoiditis is more common in children than in adults primarily due to anatomical and immunological differences. While mastoiditis typically affects children under 2, with most cases around 1 year old, it can strike people of all ages⁽²⁾. Here are some key factors:
Anatomical Differences
Eustachian Tube: In children, the eustachian tube, which connects the middle ear to the nasopharynx, is shorter, more horizontal, and narrower than in adults. This structure makes it easier for infections to travel from the throat to the middle ear and then to the mastoid process.
Mastoid Air Cells: The mastoid bone in children is less well-developed and contains smaller, more closely packed air cells, making it easier for infections to spread.
Developing Immune System: Children's immune systems are still developing, making them more susceptible to infections, including those that can lead to mastoiditis.
Frequency of Ear Infections: Children are more prone to otitis media (middle ear infections), which can lead to mastoiditis if not adequately treated. Recurrent ear infections are more common in children due to their frequent exposure to respiratory infections and other communicable diseases in settings like daycare or school.
Causes of Mastoiditis
The primary cause of mastoiditis is a bacterial infection that originates in the middle ear. When a middle ear infection is left untreated or is not fully eradicated by antibiotics, the infection can spread to the air cells within the mastoid bone. This can lead to the formation of pus and inflammation, which can destroy the bone structure⁽²⁾⁽³⁾.
Common bacteria that cause mastoiditis include:
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Symptoms of Mastoiditis
The symptoms of mastoiditis can vary but typically include⁽²⁾:
Pain and tenderness behind the ear
Swelling and redness behind the ear
Fever
Ear discharge (otorrhea)
Hearing loss in the affected ear
Headache
Irritability and lethargy in children
In severe cases, mastoiditis can lead to more serious complications, such as the formation of abscesses, facial nerve paralysis, or even meningitis.
Diagnosis of Mastoiditis
Diagnosing mastoiditis usually involves a combination of a physical examination and imaging studies. An otolaryngologist (ENT specialist) will examine the ear and look for signs of infection or swelling behind the ear. Imaging studies, such as a CT scan or MRI, can help confirm the diagnosis by providing detailed images of the mastoid bone and surrounding structures.
Treatment of Mastoiditis
The treatment of mastoiditis often involves a combination of antibiotics and, in some cases, surgery⁽³⁾.
Antibiotics: High-dose intravenous (IV) antibiotics are typically the first line of treatment. These antibiotics are often administered in a hospital setting to ensure that the infection is effectively targeted.
Myringotomy: This procedure involves making a small incision in the eardrum to drain pus and relieve pressure. In some cases, a tympanostomy tube may be placed to facilitate ongoing drainage and ventilation.
Mastoidectomy: In severe or unresponsive cases, surgery may be necessary to remove infected mastoid air cells. This procedure, known as a mastoidectomy, helps to prevent the spread of infection and reduce the risk of complications.
REFERENCES
[1] Cassano P, Ciprandi G, Passali D. Acute mastoiditis in children. Acta Biomed. 2020 Feb 17;91(1-S):54-59. doi: 10.23750/abm.v91i1-S.9259. PMID: 32073562; PMCID: PMC7947742.
[2] Devan, PP., & Donaldson, J. (2024, March 28). Mastoiditis. Practice Essentials, Etiology, Epidemiology. https://emedicine.medscape.com/article/2056657-overview#a6
[3] Boston Children’s Hospital. (n.d.). Mastoiditis. Mastoiditis | Boston Children’s Hospital. https://www.childrenshospital.org/conditions/mastoiditis
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