Mastoiditis is inflammation of the mastoid bone behind the ear. It is the hard lump which you can feel if you put your hand behind your ear. It is full of air cells which communicate with the space in the middle ear. Mastoiditis often follows a long middle ear infection. If this has not been treated properly then infection can become chronic and spread to the mastoid bone. Incomplete treatment may include a course of antibiotics which is not long enough or does not include the right type of antibiotic.
Mastoiditis may present with pain or tenderness behind the ear and redness or swelling over the area. Sometimes people may show signs of systemic sepsis with a raised temperature and high breathing rate. There may also be a fast pulse, drowsiness or vomiting. Blood tests may show an elevated CRP and white cell count. These are signs of bacteria or inflammatory mediators in the blood.
Mastoiditis needs treatment with a course of the correct antibiotics. These may need to be continued for several weeks in order to get the problem under control. The diagnosis is often missed and may require an ear, nose and throat specialist to diagnose and treat the problem adequately. Sometimes antibiotics are not enough to get it under control and an operation may be required to remove the damaged and infected cells.
If an operation is required then the surgeon may perform this under a general anaesthetic. An anaesthetist will put the patient to sleep and then the surgeon makes a cut in the skin overlying the mastoid bone. The bone is revealed and a hole made to access the air cells within. These are scraped out and the skin closed over the top. Stitches may be used to hold it closed. The skin and surrounding area may be sore for a few days or even weeks after the operation. It is important that the surgeon prescribes good analgesia for pain. They should also arrange a follow-up within a couple of weeks to make sure that the problem is settling down and that no infection occurs.
Dr Toby Bateson, MD of ZenPlugs