| 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