A mastoiditis is a purulent inflammation of the bone behind the ear. Mastoiditis usually develops as a result of not or too briefly treated middle ear infection. Triggers of inflammation are different types of bacteria. With timely and consistent treatment, the mastoiditis has a good prognosis. Untreated, however, complications can occur that can be life-threatening. Read all important information about mastoiditis here.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. H70ArtikelübersichtMastoiditis

  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Mastoiditis: description

Mastoiditis (also called mastoiditis) is a purulent inflammation of the cooking that is behind the ear. This bone (referred to medically as Os mastoideum) has an oblong, tapering shape that remotely resembles a wart, hence its name as a mastoid (Pars mastoidea). The inside of the mastoid is not completely filled with bone, its interior is partially filled with mucous cells lined cavities. Mastoiditis is characterized by inflammation.

The mastoid is behind the ear, he is palpable behind there as a bead. He is directly connected to the tympanic cavity (Cavum tympani). The tympanic cavity is the part of the middle ear where the ossicles are located. If inflammation takes place there, this is known as "middle ear inflammation". Due to the close proximity, the mastoiditis is usually always a secondary disease or complication of otitis media.

Mastoiditis is the most common complication of otitis media today. Children and adolescents are especially affected by otitis media, but adults are less likely to get sick. Therefore, the mastoiditis occurs more often in childhood. Nevertheless, it is due to the good treatability of otitis media a rare disease. 1.2 to 1.4 children of 100,000 children are considered to be affected by this complication.

Chronic mastoiditis

To distinguish from acute mastoiditis is chronic mastoiditis. Chronic mastoiditis is less common than acute mastoiditis, but more dangerous. Chronic mastoiditis also causes the mastoid process to become inflamed. However, this inflammation is not noticeable by the symptoms that traditionally occur with mastoiditis (fever or pain). That's why it can go undetected for many weeks and even months. Physicians call this form therefore also masked mastoiditis. If chronic mastoiditis persists for a long time, the bacteria continue to multiply. You also have plenty of time to continue to expand your body and invade other areas. Chronic mastoiditis often causes considerable consequential damage.

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Mastoiditis: symptoms

The symptoms of mastoiditis occur about two to four weeks after the onset of acute otitis media. Most of their symptoms are already subsiding again and then suddenly flare up again. Reason may be a mastoiditis.

In general, the symptoms of mastoiditis resemble those of otitis media. For a layman, it is therefore very difficult to distinguish the two diseases from each other. Either way, they should be treated as quickly as possible. In general, therefore, a precautionary doctor should be consulted if one or more of the following symptoms occur:

  • Pain in and around the ear. Typical is a constant, throbbing pain.
  • Longer lasting fever
  • Hearing deteriorates
  • Restlessness, insomnia, violent screaming
  • fatigue

In addition, mastoiditis results in externally palpable swelling and hypersensitivity over the mastoid, which does not occur in middle ear inflammation. If the swelling is severe, push the ear sideways down. As a result, the auricle is clearly off. In addition, the ear often empties large quantities of a milky fluid. It may be that the patient refuses to eat and is apathetic.

In infants, it is difficult to determine which complaints exist exactly. One symptom of otitis media and mastoiditis is when children often touch their ears or shake their heads. Many infants also suffer from nausea and vomiting. In babies, mastoiditis is often less severe than in older children. Parents should therefore pay close attention to the smallest changes in their child's behavior.

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Mastoiditis: causes and risk factors

The causative agents of mastoiditis in babies and children are mostly bacteria such as pneumococci, streptococci and Haemophilus influenzae type b, in babies often also staphylococci. Since there is no way from the outside that leads directly into the mastoid, mastoiditis is usually a result of other diseases.

In most cases, mastoiditis is preceded by a veritable chain of infection. Children become infected quickly and frequently with various types of viruses, which then cause inflammation of the throat and throat area. The viral infection lowers the body's defenses. So easily creates an additional infection with bacteria (superinfection). Bacteria can enter the middle ear directly from the pharynx via the Eustachian tube (which connects the pharynx and middle ear), triggering inflammation as well. Mastoiditis often develops on the basis of late or not treated otitis media. Also, if a middle ear infection is treated too short, bacteria can spread from the middle ear into the mastoid.

Complicated discharge of secretions in infections favors mastoiditis. This can happen, for example, with a heavily swollen nose or stuffy ears. Even a weakened immune system favors infections. A weakening of the immune defense occurs, for example, in the context of a therapy with antibiotics or corticosteroids (for example cortisone) as well as in certain chronic diseases (for example HIV or diabetes mellitus).

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Mastoiditis: examinations and diagnosis

If a mastoiditis is suspected, an ear, nose and throat doctor is the right person to contact. In an initial conversation, the latter will record the medical history (anamnesis). You have the opportunity to describe your complaints exactly. For children, parents usually provide information. The doctor can ask questions like:

  • Have you (or your child) been suffering from an infection recently?
  • Since when do the complaints exist?
  • Did you notice discharge from the ear?

Following the anamnesis, a physical examination is carried out. At first, the doctor looks for external changes. For example, he may notice redness as well as pain and pressure sensations above or behind the ear. An ear mirror (otoscope) is used to examine the eardrum and the inner auditory canal. This examination is also called ear reflexology (otoscopy). If there is a swelling of the eardrum, this is determined inter alia by a light reflex, which is elsewhere on the eardrum than a healthy ear. In addition, the ear is red from the inside.

The further diagnosis is made in case of a reasonable suspicion of mastoiditis in a hospital. This makes sense, as the therapy should start as soon as possible and under certain circumstances an operative intervention may be necessary. If the doctor has not done that yet, a blood count will be made here first. Inflammation in the body increases certain levels of blood testing. These include, among others, the number of white blood cells (leukocytes), the value of the C-reactive protein and the rate of blood cell killing. To determine the causative agent of inflammation, a smear is taken from the ear. In the laboratory, a culture is created from it. The result is available within one to two weeks. As a rule, the treatment of mastoiditis is started before the final result is available.

An X-ray or computed tomography will further confirm the diagnosis. On the resulting images, the doctor can detect any complications - for example, if pus has accumulated in surrounding areas. In small children, making an X-ray and computed tomography can be difficult. In case of clear findings that support the suspicion of mastoiditis, physicians in some cases refrain from these additional examinations.