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Mastoiditis is an infection of the mastoid bone of the skull. It is usually a serious complication that occurs following inadequate treatment of an acute middle ear infection (otitis media). The prevalence of mastoiditis has decreased with the advent of a wide variety of antibiotics. It is now a relatively uncommon and much less dangerous (but still serious) disorder that occurs when medical treatment has not been sought for an acute middle ear infection or when treatment has failed to eliminate the infection.
The infections spread from the affected middle ear to a projection of the temporal bone located behind the ear (the mastoid process) through hollow spaces of various sizes and shapes (mastoid cells) connecting the two areas. Causes of failed treatment for acute middle ear infection that lead to mastoiditis include poor compliance with antibiotic therapy, the presence of an antibiotic-resistant organism, or a weakened immune system that cannot fight infection adequately. The most common organisms (pathogens) causing mastoiditis are Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes.
Chronic mastoiditis is a serious infection that can destroy the mastoid bone and the structures of the middle ear and lead to a number of intracranial complications, some of them life-threatening.
Risk: Individuals with a weakened immune system are more susceptible to mastoiditis. The condition is more prevalent in children. Incidence and Prevalence: Mastoiditis that develops from acute otitis media occurs in about 0.004% of the population in the US (Young). Developing countries have a higher incidence of mastoiditis. |
Source: Medical Disability Advisor
| History: The individual with acute mastoiditis usually relates a recent history of severe pain behind the ear (retroauricular), high fever, recent history of middle ear infection, decrease in hearing, headache, a purulent drainage from the ear, ringing in the ear, and dizziness. Physical exam: The exam reveals tenderness, redness (erythema), and swelling over the mastoid area behind the ear. If the infection is very severe, neurological symptoms may be present (signs of increased intracranial pressure, facial paralysis, or meningitis). When examined through a microscope, the eardrum associated with mastoiditis may be perforated, scarred, or completely eroded, and drainage from the middle ear may be present in the ear canal. Tests: A sample of the purulent ear drainage is sent to the laboratory for culture and sensitivity testing to determine the responsible organism and the specific type of antibiotic needed to treat the infection. MRI or CT may reveal temporal bone destruction, absence of the bones (ossicles) of the middle ear, or a cyst-like mass (cholesteatoma) in the ear canal or mastoid area. If neurological symptoms are present, MRI or CT may reveal inflammation of the lining of the brain and spinal cord (meningitis). Audiometric studies may be performed to test the diminished degree of transmission of sound waves through the ossicles of the middle ear (conductive hearing loss). |
Source: Medical Disability Advisor
| The goal of treatment for mastoiditis is to clear the middle ear, mastoid cells, and mastoid bone of infection before permanent damage occurs or serious intracranial complications arise. Because of the high incidence of intracranial complications in individuals with acute mastoiditis, prompt admission to the hospital is usually required to administer intravenous antibiotic therapy and perform surgical drainage of the infection through an incision (myringotomy) in the eardrum (tympanic membrane) or mastoidectomy, depending on the extent of disease.
When persistent purulent discharge is found despite antibiotic therapy and surgical drainage, chronic mastoiditis should be suspected. Chronic mastoiditis requires urgent surgical intervention involving drainage and evacuation of the infection and removal of the mastoid process (mastoidectomy). The extent of surgery required depends on the extent of destruction caused by the infection. Surgery is followed by a prolonged course of antibiotic therapy, 4 to 6 weeks or longer.
When the infection is completely resolved, surgery (myringoplasty or tympanoplasty) is usually required to repair any residual perforation in the eardrum. |
Source: Medical Disability Advisor
| The outcome is generally good following antibiotic therapy and surgical treatment of mastoiditis. Infection is usually eliminated in individuals who are otherwise healthy. Treatment of mastoiditis in individuals with weakened immune systems (immunosuppression) is more difficult and may require extensive surgery and treatment with several different antibiotics before the infection resolves. It may also recur. In any case, full recovery is dependent on completion of a full course of antibiotic therapy. Disruption in antibiotic therapy before the prescription is completed can result in a recurrence of the infection and contributes to the growth of antibiotic-resistant organisms.
Surgical procedures for treatment of mastoiditis (myringotomy and mastoidectomy) should result in the removal of infection from the middle ear and mastoid area. The structures of the middle ear are preserved as much as possible. |
Source: Medical Disability Advisor
| Rehabilitation is generally not required for this condition, except in the case of hearing loss or facial nerve paralysis. Individuals with permanent conductive hearing loss or facial nerve paralysis may require vocational or occupational therapy to help them prepare for a different job. |
Source: Medical Disability Advisor
| If treatment of acute or chronic mastoiditis fails, the infection can spread to other areas of the head and neck and cause serious, even life-threatening complications such as meningitis, subdural infection, brain abscess, infection of the petrous bone (petrous apicitis) situated between the inner and middle ear, infection of the temporal bone (osteomyelitis), facial paralysis caused by inflammation of the facial nerve, and facial palsy caused by chronic pressure on the facial nerve. Thrombosis of the sigmoid sinus can lead to sepsis and increased intracranial pressure, must be treated with intravenous antibiotics or surgical drainage, and may even require tying off the internal jugular vein in the neck. Permanent hearing loss can be a complication of chronic mastoiditis or a consequence of the mastoidectomy procedure. |
Source: Medical Disability Advisor
| Work restrictions and accommodations for individuals with acute or chronic mastoiditis are related to the degree of hearing loss the individual experiences. Because the structures of the middle ear are often destroyed by the infection or surgical intervention, individuals with chronic mastoiditis may experience long-term or permanent hearing loss. This may require a long-term or permanent accommodation in the workplace and the use of hearing aids. Balance disorders can result from ear infections and may require work restrictions for the safety of the individual and coworkers. Persistent facial paralysis or palsy may also require accommodations if the individual's job requires distinct speech. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual report a recent history of severe pain behind the ear and high fever? Has individual had a middle ear infection recently? Was there a decrease in hearing, tinnitus, or dizziness?
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Has drainage from the ear occurred?
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On physical exam, were tenderness, erythema, and swelling over the mastoid area observed? Is purulent drainage present? Facial paralysis? Meningitis?
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Is the eardrum perforated, scarred, or completely eroded?
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Is drainage from the middle ear present in the ear canal?
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Has individual had a culture and sensitivity done on the drainage? Was CT or MRI performed? Were audiometric studies done?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Was individual admitted to the hospital for intravenous antibiotic therapy?
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Has surgical drainage of the area been done?
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Has individual developed chronic mastoiditis? Is this being treated with surgical drainage and a prolonged course of antibiotics?
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Does individual need additional surgery to repair a residual perforation?
Regarding prognosis:
- Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to recover?
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Have any complications developed such as the infection spreading to other areas of the head and neck? Facial paralysis? Thrombosis of the sigmoid sinus? Hearing loss?
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Source: Medical Disability Advisor
| Young, Tesfa, N. Ewen Wang, and Joan Burg. "Mastoiditis." eMedicine. Eds. Eric Kardon, et al. 15 Oct. 2001. Medscape. 10 Nov. 2004 <http://emedicine.com/emerg/topic306.htm>. |
Source: Medical Disability Advisor