By | June 8, 2022

Mastoiditis is an inflammatory infectious disease of the mastoid process, which is the most common complication of acute otitis media (acute middle ear infection ) as a result of inadequate treatment. Mastoiditis is usually treatable if treatment is started early.

What is mastoiditis?

Mastoiditis is a bacterial inflammation of the mucous membrane in the air-containing cells of the mastoid process (Processus mastoideus) of the temporal bone. In most cases, mastoiditis is a secondary disease of acute otitis media (acute middle ear infection) that has not fully recovered. If the mastoiditis in a small child or infant is due to latent (hidden or undetected) otitis media, it is referred to as occult mastoiditis. For acute urinary retention – aur, please visit

Symptoms of mastoiditis are long-lasting fever in the acute stage of the disease, discharge in the ears (otorrhoea), tenderness over the mastoid process, retroauricular (located behind the ear) swelling with a protruding ear, restlessness, sleep disorders, loss of hunger and progressive hearing loss.

If young children are affected by mastoiditis, they can also suffer from diarrhea and/or vomiting.


Usually, mastoiditis is caused by bacterial infection with pneumococci, streptococci, Haemophilus influenzae type B, and also staphylococci in infants. In some cases, the bacterial infection is preceded by a viral infection with rhinoviruses, influenza viruses, coxsackie viruses and adenoviruses, which can cause a runny nose and sore throat and weaken the immune system.

As a result of the weakened defense system, the affected organism is more susceptible to bacterial pathogens. Bacteria invade the structures in the nasopharynx, from where they reach the middle ear and can cause otitis media. If treated incorrectly or not at all, the bacteria can colonize neighboring structures such as the air-containing bone cells of the mastoid process and cause mastoiditis.

Symptoms, Ailments & Signs

If an acute middle ear infection persists for more than two to three weeks, mastoiditis can develop. The disease is characterized by increasing ear pain, which is often associated with a decrease in hearing and an unusual pounding in the ear. In addition, there is a poor general condition or even a long-lasting fever with chills, vomiting and exhaustion.

The swellings that usually develop behind the auricle and are filled with a light-colored tissue fluid are also typical of acute mastoiditis . The swollen area hurts when pressed or touched. In some patients, secretions drain from the ear as the disease progresses. The swelling also causes a misalignment of the ear. Especially in children, the auricle protrudes slightly and is reddened.

As a result of a long-lasting middle ear infection, chronic mastoiditis can develop, which is accompanied by other symptoms. This leads to loss of appetite, headaches, exhaustion and gastrointestinal complaints, but also to chronic earache and a gradual decrease in hearing. Mastoiditis usually occurs over the course of several days or weeks and initially increases in intensity before individual symptoms slowly subside.

Diagnosis & History

Mastoiditis can be diagnosed by an otoscopy ( earscopy ), which examines the external auditory canals and eardrum with an otoscope. A sunken posterior wall of the auditory canal and a thickened, opaque eardrum that may bulge and/or perforate (tear) with purulent ear discharge (ear discharge) can indicate mastoiditis.

The diagnosis is secured by means of a Schüller temporal bone image (special X-ray according to Schüller), which shows a shadowing of the mastoid cells (cells of the mastoid process or mastoid process) and a dissolution of the bony trabeculae. Computed tomography or magnetic resonance imaging allow statements to be made about the severity of the mastoiditis. An increased number of leukocytes, an increased CRP value (C-reactive protein) and an increased blood sedimentation rate indicate the inflammatory reactions as a result of mastoiditis as inflammatory markers.

A hearing test can detect conductive hearing loss in mastoiditis. With early diagnosis and early start of therapy, mastoiditis can usually be treated well and heals without consequences such as hearing loss.


Mastoiditis is itself a complication of otitis media. Without appropriate medical treatment, it can itself have serious consequences. One of the most common complications of mastoiditis is the development of abscesses under the periosteum on the mastoid process. An abscess is an encapsulated collection of pus.

If the pus breaks into the lateral muscles of the neck and neck, the doctors speak of a Bezoid abscess. An abscess can also form in the temporal lobes or in the cerebellum. Another consequence is cystomaticitis. This leads to an accumulation of pus below the zygomatic arch, which in turn is noticeable through pressure pain.

Other possible symptoms are restricted movement of the jaw, swelling and eyelid edema. If the pus penetrates into the pars petrosa of the temporal bone, there is a risk of symptoms such as headaches, damage to the cranial nerves and meningitis.

Furthermore, the pus can reach the parts of the sternocleidomastoid muscle (head nod). The consequences of this are a crooked position of the neck in the direction of the healthy side and its swelling on the diseased side, which causes pressure pain.

Complications can also arise when the pathogens spread, since they can reach other parts of the body via the bloodstream. There is therefore a risk of sinus thrombosis, labyrinthitis (infection in the labyrinth of the inner ear), paralysis of the face (facial paralysis) and life-threatening blood poisoning (sepsis).

When should you go to the doctor?

Since mastoiditis can cause complete hearing loss, the condition should always be evaluated and treated by a doctor. Self-healing does not occur and the symptoms worsen without treatment. A doctor should be consulted for mastoiditis if the affected person suffers from severe ear pain that occurs without any particular reason and does not go away on its own. It can also lead to headaches or general weakness and a generally poor sense of well-being.

In some cases, fever, vomiting, or chills also indicate mastoiditis and should be evaluated by a doctor. In the ear, the disease becomes noticeable through swelling, which can also lead to hearing loss. The quality of life of those affected is significantly restricted and reduced by the disease. It is not uncommon for a lack of appetite or fatigue to indicate this complaint. Mastoiditis can be treated relatively well by a general practitioner or an ENT doctor. Early treatment increases the chances of complete recovery.

Treatment & Therapy

Mastoiditis is treated depending on the extent of the inflammation. In the presence of occult mastoiditis or in a very early stage of the disease, decongestant nasal drops and intravenous therapy with high-dose antibiotics in combination with paracentesis (incision of the eardrum) can be successful.

If the bony structures are involved or if the therapy is unsuccessful, the mastoiditis is usually treated surgically and with antibiotic therapy. For this purpose, as part of a so-called mastoidectomy, the pus and fluid accumulations (exudate) are drained via an incision (cut) behind the auricle and the infected mastoid cells (cells of the mastoid process) are removed with the help of special milling tools.

In addition, a high-dose antibiotic is infused intravenously to kill the bacteria remaining in the body. In some cases, fever reducers and painkillers (paracetamol, ibuprofen) are used to reduce the often severe earache, but these should only be used for a short time in small children.

With regard to the success of antibiotic therapy in mastoiditis, as in other bacterial infectious diseases, it is crucial that the antibiotics are not discontinued too early in order to avoid resistance on the part of the pathogen. If the pathogen can no longer be killed due to antibiotic resistance, serious complications such as sepsis ( blood poisoning ), meningitis ( meningitis ), a brain abscess or deafness can result from mastoiditis.

Outlook & Forecast

With an early diagnosis and an immediate start of therapy, mastoiditis has a favorable prognosis. There is an inflammation of the mucous membrane, which can be easily treated with today’s medical options. The disease triggers are bacteria that die off as a result of the administration of medication and are then removed from the organism. The patient is usually discharged from treatment within a few weeks as recovered.

If the disease is in an advanced stage or without medical care, the risk of complications is increased. Pain occurs, hearing loss is present and movement disorders are possible. As pus develops, life-threatening complications can develop in severe cases. Blood poisoning can develop, which must be treated in intensive care, otherwise the affected person will die prematurely. If the person concerned goes to medical care in good time, an operation is carried out in these cases. This is associated with risks. If the procedure goes smoothly, medication is then administered to ensure full recovery.

In unfavorable conditions, the spread of inflammation can develop. In addition, there is the possibility that the affected person will experience permanent impairment of hearing ability up to deafness.


Mastoiditis cannot be prevented directly. Rather, colds, runny noses or a middle ear infection should be prevented by a healthy, endogenous defense system (healthy diet, lots of exercise) and appropriate clothing in damp and cold weather conditions. In addition, the therapy of existing infectious diseases and inflammations in the ear area should not be stopped prematurely in order to prevent mastoiditis.


Since mastoiditis is easily treatable, follow-up care focuses on increasing a healthy lifestyle over the long term to avoid weakening the immune system. This includes sufficient exercise and a balanced diet with fresh ingredients. Yoga or Nordic walking are light sports that can be easily integrated into everyday life and can increase your well-being enormously. If the expected symptoms appear after the treatment has been completed, this should be clarified immediately with the doctor treating you.

You can do that yourself

If mastoiditis is suspected, a doctor should be consulted promptly. If the first signs such as earache or fever appear at night or at the weekend, mild symptoms can initially be treated with over-the-counter painkillers. If the earache subsides overnight, there may only be a temporary problem with the ventilation of the tubes. This is a limited or missing pressure equalization of the middle ear with the nose and throat area. If the earache comes back as soon as the painkiller wears off, this raises the suspicion of an otitis media, which should definitely be brought to the doctor’s attention.

Ear drops should not be administered in this situation without a doctor’s prescription. If the eardrum is still undamaged, the drops cannot reach the middle ear anyway. If the eardrum is already ruptured, the drops can damage the inner ear. On the other hand, a heat treatment that promotes healing and has a pain-relieving effect is useful. A red light, a heating pad or a hot -water bottle can be used for this purpose. In naturopathy, the application of hot potatoes wrapped in a towel is recommended. For supportive treatment of acute mastoiditis come in homeopathyregular doses of chamomilla, aconite and belladonna in low potencies are used.

Purulent discharge from the ear should be removed regularly with an alcohol-soaked tissue or cotton pad. On the other hand, the auditory canal must not be closed with cotton wool or other substances, as this could promote the proliferation of pathogens.