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Mastoiditis: bone infection that starts in the ear

Mastoiditis is a serious bone infection that begins in the mastoid bone behind the ear, often resulting from untreated middle ear infections. Early diagnosis and treatment are crucial to prevent complications such as hearing loss, abscess formation, or spread of infection to nearby structures.

What is mastoiditis?

Mastoiditis is an infection of part of the bone behind your ear — the mastoid or “mastoid process” of the temporal bone. In most cases, it stems from a middle ear infection (otitis media). The middle ear shares tissue with the mastoids, making it possible for the infection to spread, causing inflammation and possibly damage to the bone. Because children are more prone to ear infections, it’s more common for them to develop mastoiditis.

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Key takeaways

  • Mastoiditis is an infection of the mastoid process, which is a bony projection of the skull’s temporal bone.
  • Mastoiditis is typically caused by a middle ear infection that was not treated soon enough, leading it to spread to the temporal bone, which surrounds the middle ear.
  • Because children are more prone to middle ear infections, they’re also the most likely to develop mastoiditis.
  • Acute mastoiditis lasts less than a month, while chronic mastoiditis lasts longer than a month and/or comes back.
  • Mastoiditis typically happens on just one side of the head.
  • Mastoiditis is treated first with antibiotics. More serious cases may require minor surgery that helps drainage, or more invasive surgery to remove infected portions of the bone.
  • Mastoiditis can lead to serious complications if not treated quickly.

What are mastoids?

To understand mastoiditis, it helps to also understand where the mastoid bone is located and a bit about the anatomy of the ear.

Your skull is made up of multiple bones held together by fibrous tissue. Mastoids (or mastoid processes) are part of the skull’s temporal bone, which surrounds the middle ear. The mastoids are cone-shaped projections at the bottom of the temporal bone — you can easily feel them where they curve behind your ears.

Mastoids are not solid bones. They have a structure similar to honeycomb, with pockets of air called “mastoid air cells.” As mentioned above, there is tissue that lines both the middle ear and the mastoids — specifically the mastoid air cells.1 With that connection in mind, it’s easy to understand how infection can spread from the middle ear to the mastoids. While middle ear infections can spread to the mastoidsnot every ear infection will result in mastoiditis. With prompt medical treatment, middle ear infections can be cured before they spread.  

No, but mastoid effusion and mastoiditis can be related. Mastoid effusion refers to the presence of fluid in the mastoid air cells. Mastoiditis, as a complication of a middle ear infection, can be a cause of mastoid effusion. The inflammation from the infection can weaken the barriers between the mastoid air cells, causing them to erode and collapse, forming larger cells. In mastoid effusion, those cells then fill up with fluid or pus that overflows from the infection in the middle ear.

Types of mastoiditis

There are two types of mastoiditis, and the main difference is how long each lasts.

This is the most common form of mastoiditis, and is linked to or follows middle ear infection. It typically lasts a month or less and doesn’t come back

Chronic mastoiditis is related to an ongoing, longstanding or recurring ear infection that lasts longer than a month
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Right or left location of mastoiditis

Mastoiditis can happen on either the left or right side of your head; the location doesn’t change anything about how it’s treated. It can happen on one side at a time, but can also be bilateral, meaning it occurs on both sides at the same time. However, bilateral mastoiditis is relatively rare, and in adults, is mostly found in people with diabetes or compromised immune systems.2

Signs and symptoms of mastoiditis

Mastoiditis symptoms usually show up after a middle ear infection, typically within a few days or a week. If you have a middle ear infection, it’s important to get that treated by a medical professional, but it’s still a good idea to keep an eye out for signs of the early stages of mastoiditis, which include

Mastoiditis symptoms in adults

  • Ear pain
  • Redness or swelling behind the ear
  • One ear sticking out more than the other
  • Fever
  • Drainage containing pus
  • Headache
  • Hearing loss

Mastoiditis symptoms in children

  • Redness or swelling behind the ear
  • Signs of ear pain like tugging at the ears
  • One ear sticking out more than the other
  • Irritability
  • Fever
  • Drainage containing pus
  • Hearing loss
Man experiencing ear pain

Any of those symptoms sound familiar?

If you or a loved one is experiencing mastoiditis, visit us for a free hearing test.

Causes of mastoiditis

The most common cause of mastoiditis is a middle ear infection, particularly one that goes untreated for too long or is completely untreated. These infections can be either viral or bacterial — a doctor will need to make the specific diagnosis to treat it appropriately.

While it’s far less common, mastoiditis without ear infection is possible. It can potentially be caused by cholesteatoma, which is an abnormal growth of skin in the middle ear. That extra skin can prevent proper drainage of fluids from the middle ear and lead to mastoiditis.

Diagnosis and tests for mastoiditis

Mastoiditis diagnosis is usually done through an examination. Your physician will talk to you about your symptoms, do a physical exam and look in your ears. Other tests and scans will help give your doctor information about the spread or complications of the infection. Ear cultures (testing fluid extracted from the ear) are sometimes used to help find out the exact bacteria that’s causing the infection. This helps your physician understand which medications can be used to treat it.

An otoscope enables your doctor to look further into your ear than what’s visible on the outside. They’ll use it to examine the condition of your eardrum and look for other signs of infection

In cases of mastoiditis, radiology is especially useful because it gives physicians a visual of what’s happening behind the eardrum. A couple of types of scans might be used:

CT  scan: “Computerized axial tomography,” better known as a CT or CAT scan, is a type of complex X-ray that shows bones, soft tissues and blood vessels. For mastoiditis, CT scans of the ear and/or the head are usually the first choice.

MRI : “Magnetic resonance imaging” uses radio waves and powerful magnets to create detailed images of soft tissues. In the case of mastoiditis, MRI can help show the spread of fluid. It’s also an option that avoids exposing patients to radiation, but it takes much longer than a CT scan. 

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Treatment for mastoiditis

Mastoiditis treatments start with medicines to help knock out the infection. If there are complications, or in the case of chronic mastoiditis, additional treatment might be necessary. 

Medication: drug therapy

Drug therapy used in the treatment of mastoiditis includes a variety of antibiotics, depending on the exact nature of the infection. Doctors may move quickly to get you started on antibiotics and make adjustments once results from an ear culture identify the specific bacteria causing the problem.

For mastoiditis, antibiotics might be used in a couple of ways. Intravenous antibiotics are often a first choice because of their power to fight the infection fast. If the case is not very severe, oral antibiotics might be used as an alternative. 

Antibiotic eardrops for mastoiditis are typically prescribed after surgery to help prevent additional infection. Over-the-counter eardrops should not be used to treat a potentially serious condition like mastoiditis. 

Medical procedure: surgery

For treating mastoiditis, medical procedures might be relatively minor or more intensive, depending on how severe the infection is and how much it has spread.

To help mastoiditis drainage, two types of surgery can be done. Myringotomy is a tiny incision in the ear drum that allows fluid to drain. In a tympanostomy (also known as ear tubes), an incision is also made, but a small tube is placed in the ear drum to help drainage

In more severe cases, if there is pus in the mastoid air cells or if antibiotics don’t work, the affected part of the mastoid may need to be removed in a surgery known as a mastoidectomy. The surgery involves making an incision, using a drill to access the mastoid bone, removing the infected air cells and then stitching up the incision. It is done under general anesthesia. A drain may be placed to help prevent fluid buildup at the site.
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Care for your ears

One of the best ways to care for your ears and prevent hearing loss is to get them properly examined by a hearing professional. Find your nearest Miracle-Ear store to get started on your journey to better hearing.

What kind of doctor treats mastoiditis?

An otolaryngologist, also known as an ENT, who specializes in ear, nose and throat conditions, should treat mastoiditis. An ENT surgeon would perform a mastoidectomy.

When to see a healthcare professional

If you see signs of a middle ear infection, it’s important to go to a healthcare professional quickly. Getting it treated quickly can prevent mastoiditis from developing. However, if you have been treated for a middle ear infection and still develop symptoms of mastoiditis, you should be seen again as soon as possible, as the complications can be serious.

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FAQs on mastoiditis

Mastoiditis is not contagious. However, it can be serious. If left untreated, it can lead to complications including partial or complete hearing loss, facial paralysis, meningitis and the infection spreading to other parts of the body or the brain. 

It is unlikely that mastoiditis will spread from one ear to the other. It’s only in extremely severe or untreated cases that the infection spreads to other parts of the body. 

You should avoid flying with a severe infection affecting the ear, like mastoiditis. The pressure changes, along with the effects of the infection, can affect the Eustachian tubes and put strain on the eardrum or even lead to rupture.

Sources

Sahi D, Callender KD. Mastoiditis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560877/.

Samantha Honner, Raphael M. Kudela, Ethan Handler. Bilateral Mastoiditis from Red Tide Exposure. The Journal of Emergency Medicine,Volume 43, Issue 4, 2012, Pages 663-666. ISSN 0736-4679. https://doi.org/10.1016/j.jemermed.2010.06.007.

 

Dr. Tom Tedeschi

Our experts

Dr. Thomas Tedeschi, Au.D.

Chief Audiology Officer, Miracle-Ear

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