The condition of mastoiditis, often mimic the signs and symptoms of ear infection. Affected individuals, especially children often experience the following signs:

• Discharge and drainage from the affected ear
• Localized pain in the ear
• Development of fever accompanied by headache
• Hearing loss of the affected ear
• Development of tenderness and swelling of the affected ear
• Redness of the ear
• In more severe cases, mastoiditis may favor the development of brain abscess. In addition, it can also cause more complications that can involve the skull. In such cases, the affected individuals may suffer from headaches and papilledema [7].

• Pain

  A 20-year-old white male presented to the family practice department with a 1-month history of right ear pain and loss of hearing. During the month, he had been seen in emergency rooms twice and also by his dentist. [ncbi.nlm.nih.gov]

  Over-the-counter (OTC) pain relievers and fever reducers such as acetaminophen ( Tylenol ) or ibuprofen ( Advil, Motrin ) may be taken for pain and inflammation. [medicinenet.com]

  An 8-year-old girl was seen with a chief complaint of increasing left ear pain of 7 days' duration. The pain was severe, awakening the patient at night. There were no systemic symptoms, and the patient had no fever. [jamanetwork.com]

  Nitricum acidum Difficult hearing, very sensitive to noise Chronic pain and inflammation in the right ear. Ear pains extending upward from the throat on swallowing. Severe pain ; stitching ear pains. Ears cracking when person chews. [homeopathyforwomen.org]

• Fever

  Case Two: A 23-month-old female presents to the emergency department with five days of fever, cheek swelling, and not allowing family to touch her face or ears. She was seen three days prior with complaints of fever and left ear pain... [epmonthly.com]

  In this report, we describe a pediatric case of sigmoid sinus thrombosis following mastoiditis, presenting with nonspecific symptoms such as fever, otalgia, and headache. Diagnosis was based on magnetic resonance imaging. [ncbi.nlm.nih.gov]

  Sigmoid sinus occlusion causes severe fevers and headache, commonly in association with meningitis. Mastoid infection may spread into the neck causing marked swelling on the side of the neck along with fever and exquisite tenderness. [tampabayhearing.com]

  Symptoms of acute mastoiditis: 1) Fever and malaise: Fever is persistent, in spite of adequate antibiotics. It can be as high as 40 degree C 2) Pain: It is usually post-aural. [specialist-ent.com]

• Inflammation

  […] of temporal bone inflammation edit English mastoiditis middle ear disease characterized by an inflammation of the mucosal lining of the mastoid antrum and the mastoid air cell system inside the mastoid process mastoid process of temporal boneitis mastoid [wikidata.org]

  OME is a chronic inflammatory condition without acute inflammation, which often follows a slowly resolving AOM. There is an effusion of glue-like fluid behind an intact tympanic membrane in the absence of signs and symptoms of acute inflammation. [patient.info]

  We speculate that removal of the infectious granulation within the middle ears and mastoids ameliorated the acute inflammation. The etiology remains unknown in this case. [ncbi.nlm.nih.gov]

  See Mastoid. mas·toi·di·tis ( mas'toy-dī'tis ) Inflammation of any part of the mastoid process. mastoiditis Inflammation of the mastoid air cells from infection usually spread from an OTITIS MEDIA. [medical-dictionary.thefreedictionary.com]

• Surgical Procedure

  If the mastoid infection does not respond to antibiotic treatment, a surgical procedure may be performed. Surgical procedures are likely to include a myringotomy, in which a small incision is made in the eardrum to relieve pressure and drain fluid. [everydayhearing.com]

  The authors show different courses of both presented complications and imaging techniques and surgical procedures performed in these children. [ncbi.nlm.nih.gov]

  In severe infections which do not respond to the aforementioned treatments, a surgical procedure to remove the entire mastoid process may be performed; this is referred to as mastoidectomy. [ent-surgery.com.au]

  Surgical procedures to remove the part of the mastoid bone are done in order to drain the infection. [symptoma.com]

  In addition, a mastoidectomy may be needed in surgical procedures of the ear to allow access to areas of the middle ear for removal of tumors, reconstruction of the hearing mechanism or other similar therapeutic purposes. [californiaearinstitute.com]

• Crying

  Infants may present with irritability, intractable crying and feeding problems. Swelling, redness or a boggy, tender mass behind the ear. [patient.info]

  This is a difficult test to perform in younger children because the child needs to sit very still and not be crying, talking, or moving. [stanfordchildrens.org]

• Pharyngitis

  Grommets Ear: Mastoidectomy & tympanoplasty Ear: Myringoplasty Ear: Stapedectomy Ear: Ossiculoplasty Nose: Septoplasty Nose: Septorhinoplasty Nose: Functional endoscopic sinus surgery H&N: Microlaryngoscopy H&N: Pharyngo- oesophagoscopy H&N: Stapling of pharyngeal [entsho.com]

  […] and retropharyngeal abscess • Case in literature due to spread of the infection along the EU tube and spreading into the Retropharyngeal and Para pharyngeal spaces 32. [de.slideshare.net]

• Rhinitis

  Clear rhinitis ("cold") followed by thick discharge, then earache. Ear: More often affecting the right ear. Pain, discharge, hearing loss. Yellow-green offensive discharge from ear with difficulty hearing. Inflammation of external ear canal. [homeopathyforwomen.org]

• Loss of Appetite

  Signs and Symptoms Common signs and symptoms of mastoiditis include: Pain, tenderness, erythema and swelling behind the ear Fever Headaches Earache/ear pain Hearing loss – the sensation of having a blocked ear Irritability Loss of appetite Discharge from [ent-surgery.com.au]

  The other non-specific features accompanying mastoiditis can include fever, headache, irritability, loss of appetite and generalized weakness. [healthhype.com]

• Thrombosis

  The clinical picture of mastoiditis, sigmoid sinus thrombosis and brain abscess has changed with the advent of antibiotics. [ncbi.nlm.nih.gov]

  Cerebral venous sinus thrombosis is a rare condition that is generally associated with acute processes, one of the most important being mastoiditis. [neurologia.com]

• Erythema

  On presentation to the clinic, his right mastoid area showed erythema, tenderness, and swelling that displaced the pinna. He was immediately referred to the otolaryngology department. [ncbi.nlm.nih.gov]

  According to a recent meta-analysis, the three most common local findings associated with mastoiditis are post-auricular changes (e.g., erythema, tenderness, edema, fluctuance), abnormal TM findings (e.g., erythema, dullness, bulging), and external auditory [epmonthly.com]

  However, acute mastoiditis for the EP involves clinical evidence of mastoid inflammation such as erythema, tenderness to palpation, bogginess, and swelling over the mastoid bone. [emdocs.net]

  Bottom, There is marked erythema and swelling over the mastoid process plus loss of the postauricular skinfolds. postauricular cellulitis over the mastoid process in which the initial diagnosis was incorrect. [jamanetwork.com]

  If you have AOM and postauricular edema or erythema than you have just made the diagnosis. Is CT necessary to routinely rule out further complications of Mastoiditis? Simple answer = NO But your exam needs to be thorough. [pedemmorsels.com]

• Otalgia

  She was found to have an ear wick in place as part of the treatment of otalgia. She was subsequently diagnosed with mastoiditis and meningitis. [ncbi.nlm.nih.gov]

  Fever, irritability, otalgia, and hearing loss are also often present. Infection can be serious and may lead to sepsis, sigmoid sinus thrombosis, and intracranial abscess if not treated appropriately. [oxfordmedicine.com]

• Ear Discharge

  We report one such case of a patient who presented to us with trismus, jaw pain, and ear discharge. Imaging of the jaws revealed classical features of osteoradionecrosis and mastoiditis. [ncbi.nlm.nih.gov]

  Clear rhinitis ("cold") followed by thick discharge, then earache. Ear: More often affecting the right ear. Pain, discharge, hearing loss. Yellow-green offensive discharge from ear with difficulty hearing. Inflammation of external ear canal. [homeopathyforwomen.org]

  Clinical diagnosis of mastoiditis includes: Medical history of ear infections. Patient symptom presentations like headaches and ear discharge. Physical examination to look for redness, tenderness and swelling behind the ear. [medindia.net]

  Symptoms of acute mastoiditis include: Pain in or behind the ear Swelling of the area behind the ear Ear discharge Fever Headache The most common cause of mastoiditis is an untreated inner ear infection ( otitis media ). [medicinenet.com]

  The presence of unilateral headache is suggestive of impending intracranial complications 3) Ear discharge: The discharge is purulent, profuse and foul smelling. [specialist-ent.com]

• Tinnitus

  Role of maskers in tinnitus management Role of middle ear muscles shambaugh's criteria to identify sensorinueral deafness due to otosclerosis Siegel's pneumatic speculum Sudden sensorineural hearing loss by drtbalu Susac syndrome Tests of eustachean [sites.google.com]

  The presenting symptoms were varied-tinnitus, hearing loss, and cranial nerve palsies. All three cases showed a dense lymphoplasmacytic infiltrate, storiform type fibrosis as well as elevated numbers of IgG4 positive plasma cells. [ncbi.nlm.nih.gov]

  Abbas et al (2018) reported that 5.8% of individuals who underwent MRI for asymmetrical hearing loss or tinnitus had mastoiditis. [dizziness-and-balance.com]

  Medical Director, Balance Center John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus [emedicine.medscape.com]

• Meningism

  She was subsequently diagnosed with mastoiditis and meningitis. [ncbi.nlm.nih.gov]

  If you don’t treat it, or if the infection doesn’t respond to treatment (which is incredibly rare), meningitis could develop. Meningitis is an infection of the meninges, which are the membranes surrounding your brain and spinal cord. [thesinusdoctor.com]

  Meningitis and facial nerve paralysis are possible in mastoiditis. Approximately 7% of patients may develop intracranial complications related to acute mastoiditis. [emedicine.medscape.com]

• Headache

  Here we describe the case of a 10-year-old-male presenting with nausea, vomiting, and headache who developed intracranial complications of actinomycotic mastoiditis. [ncbi.nlm.nih.gov]

  In such cases, the affected individuals may suffer from headaches and papilledema. [symptoma.com]

  You have a headache that does not go away with treatment. You have weakness in your face. You have a headache, fever, and a stiff neck. When should I contact my healthcare provider? You think your medicine is not working. [drugs.com]

  Experience of mild fever or headaches. Infants generally show nonspecific symptoms, such as loose bowels, anorexia or irritability. Drainage from the ear appears in more complex conditions. [streetdirectory.com]

• Vertigo

  Abstract We describe the case history of a 70-year-old female patient presenting with bilateral hearing disturbance, facial paralysis, and vertigo. [ncbi.nlm.nih.gov]

  […] newer stronger generation of antibiotics this disease was treated with a wide myringotomy ( surgically creating a large hole in the eardrum ) and IV antibiotics, reserving mastoidectomy for those cases with a cholesteatoma, intracranial complications, vertigo [entusa.com]

  The vertigo and nystagmus result from sudden loss of the healthy tonic neural impulses from the involved labyrinth, without any change in the input from the healthy side. [otologytextbook.net]

  Possible Complications Complications may include: Destruction of the mastoid bone Dizziness or vertigo Epidural abscess Facial paralysis Meningitis Partial or complete hearing loss Spread of infection to the brain or throughout the body When to Contact [m.ufhealth.org]

  Some of the possible complications of mastoiditis include: Meningitis Sepsis Hearing loss Vertigo Paralysis of parts of the face If you have any other questions about ear infections and mastoiditis make an appointment to see our ear nose and throat specialist [ent-surgery.com.au]

• Dizziness

  Mastoiditis Chronic otitis media Acute otitis externa Complications of Otitis Externa Pinna perichondritis Facial nerve palsy Ramsay Hunt syndrome Sudden hearing loss Foreign body in ear Pinna haematoma Temporal bone fracture Traumatic TM perforation Dizziness [entsho.com]

  It has been our observation that in our dizziness and hearing practice in Chicago, at least 1/100 of our patients has mastoid fluid (i.e. about 1%). [dizziness-and-balance.com]

  Full recovery will take 3-4 weeks with possibly bouts of dizziness and headaches during this time. Over time the headaches and dizziness should diminish. [hearingcentral.com]

• Cranial Nerve Involvement

  Cranial nerve involvement. Gradenigo’s syndrome – Facial nerve paralysis, deep facial pain and otitis media. Meningitis (inflammation of membranes of the brain). Brain abscess. [medindia.net]

  When the patient has clinical signs of CNS involvement (ex. stupor, altered mental status). When there is evidence of cranial nerve involvement (ie. Gradeningo’s Syndrome ). When there is a history of cholesteatoma. [pedemmorsels.com]

  The involvement of the sixth cranial nerve is seen as a reaction caused by the adjacent inflammation, as the nerve passes through Dorello´s canal under the petroclinoid ligament [ 2 ]. The full triad of symptoms in GS may not always be present. [bmcearnosethroatdisord.biomedcentral.com]

  […] and/or labyrinth Complications Complications of mastoiditis include the following: Hearing loss Facial nerve palsy Cranial nerve involvement Osteomyelitis Petrositis Gradenigo syndrome - Otitis media, retro-orbital pain, and abducens palsy Intracranial [emedicine.medscape.com]

In cases, when individuals show signs of ear infection, then ear examination will be done in order to determine whether the infection has spread from the ear to the mastoid bone. In addition, the following tests may also be done to further diagnose the condition of mastoiditis:

• Blood tests: Complete blood count would be done to analyze the white blood cells to determine signs of infection. Sedimentation rate should also be determined which would help in deciding the plan of treatment.
• Imaging studies such as CT scan of the temporal bone and MRI of the brain and ear are indicated. In situations, when these are not available then X-ray of the skull is carried out for diagnosing the condition. This test would reveal bone destruction along with clouding of air cells in the mastoid region [8].
• Spinal tap tests: In this test, lumbar puncture would be performed to analyze the fluid contained in the spinal cord. This is helpful in determining the spread of the infection to these areas [9].

• Pseudomonas

  Several recent studies demonstrated the predominance of Pseudomonas aeruginosa in this infection. However, because P. aeruginosa colonizes the ear canal it can contaminate specimens obtained through the non-sterile ear canal. [ncbi.nlm.nih.gov]

  Pseudomonas aeruginosa and Streptococcus pneumoniae were the most frequently isolated agents. This review showed a significant increase (150%) in the number of patients with acute mastoiditis. Nadol JB Jr, Eavey RA. [doi.org]

  Both children were treated with oral antibiotics that are considered fairly active against the typical otopathogens, but with no activity at all against Pseudomonas or MRSA. [healio.com]

  […] factors OM extension (most common) Cholesteatome (chronic), leukemia, mononucleosis, kawasaki, temporal bone sarcoma (uncommon) Etiologies Streptococcus pneumoniae (22%) Streptococcus pyogenes (16%) Staphylococcus aureus (7%) Hemophilus inflenzae(4%) Pseudomonas [sites-test.uclouvain.be]

Long term treatment would be required for effective management of the condition. Often oral antibiotics would not be sufficient to effectively eradicate the infection. Therefore, in such cases antibiotics would be administered through the intravenous route [10].

Surgery is often the preferred method when antibiotics do not work. Surgical procedures are employed to remove part of the mastoid bone. This is done so the infection can be successfully drained. It would also be required to drain the infection from the middle ear in case the infection has spread to this area.

Mastoiditis can be successfully treated with appropriate management. However, in many instances, the condition can recur and in such cases treating it may become difficult [6]. It is therefore advised that such individuals should get regularly checked for signs of middle ear infection.

Acute otitis media is the most common cause of mastoiditis. The infection may gradually spread to the mastoid bone in the skull. Untreated infection causes inflammation of the mucosal lining. With such a phenomenon, the mastoid bone gets accumulated with various infected materials; due to which, the honey-comb like structure of the mastoid bone undergoes gradual deterioration. The condition of mastoiditis most commonly strikes the children. It has been reported that children who are less than 2 years of age and are affected by the condition, usually do not present with history of otitis media.

In addition to otitis media, bacterial infections are also the common cause for mastoiditis. Various pathogens known to play foul include Staphylococcus aureus, Streptococcus pyrogenes, Streptococcus pneumoniae and Moraxella catarrhalis [2].

In the US, mastoiditis is reported to occur in about 0.004% population. The incidence of acute mastoiditis as a result of untreated otitis media is higher amongst young children and in the developing nations. It was reported that the incidence of this disease significantly reduced from 61 per 100,000 children to about 37 per 100,000 children [3].

The pathophysiology of mastoiditis involves 2 phenomenons, onset of infection, which causes the bacteria to spread from the middle ear to the mastoid cells followed by an inflammatory response of the mastoid bone. Various pathogenic microorganisms are known to cause the development of mastoiditis. The organisms that have a rare association with this condition are mycobacterium species. In some instances, mastoiditis can also be caused by cholesteatoma, which is a sac like structure in the middle ear [4] [5].

Effective treatment of all kinds of ear infection would help in preventing the spread of the infection to the mastoid bone. Individuals should be advised to promptly seek medical intervention to treat the condition. Taking full course of oral antibiotics would be necessary to effectively treat the bacterial infection [11].

Mastoiditis is a condition caracterized by infection of the mastoid bone. It is an inflammatory disease of the mucosal lining of the mastoid bone. The condition majorly occurs due to untreated otitis media and is one of the leading causes of childhood mortality. However, with the advent of antibiotics, incidences of mastoiditis have undergone significant decline. Infections of the middle ear when left untreated can pose serious health risks and favor the development of serious complications. Mastoiditis is a common occurrence amongst children; but adults too can get affected [1].

• Definition: Mastoiditis is a condition, characterized by inflammation of the mastoid bone. Children are more susceptible to contract this condition than adults. The mastoid is situated behind the ear and therefore infections of the middle ear can predispose an individual to develop mastoiditis if the former condition is not effectively treated.
• Cause: Acute otitis media which if left untreated can favor the development of mastoiditis. In addition, various pathogens such as staphylococcus aureus, streprococcus pyrogenes, streprococcus pneumoniae, haemophillus influenza and moraxella catarrhalis can also cause mastoiditis.
• Symptoms: Symptoms of mastoiditis include discharge and pain from the affected ear, followed by tenderness and swelling of the affected area, headache and discomfort. Individuals would also suffer from sudden onset of high fever and swelling behind the ear.
• Diagnosis: A careful examination of the ear forms the preliminary basis of the diagnostic procedure. Ear discharge would also be tested for signs of infections. Spinal tap test which includes testing of spinal fluid is also done to analyze infection. Blood tests and imaging studies would be required for further diagnosing the condition.
• Treatment: Antibiotics form the basis of the treatment regime. Administration of antibiotics through the intravenous route is done at the primary level. This is then followed by oral antibiotics for a specified period. Surgery is the last resort and is employed when antibiotics don’t work. Surgical procedures to remove the part of the mastoid bone are done in order to drain the infection.

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8. National Cancer Institute. Radiation Risks and Pediatric Computed Tomography (CT): A Guide for Health Care Providers. National Institutes of Health. 
9. Acuin, J. Chronic Suppurative otitis media. Burden of Illness and Management Options. World Health Organization. Geneva, Switzerland, 2004. 
10. Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, et al. Acute mastoiditis--the antibiotic era: a multicenter study. Int J Pediatr Otorhinolaryngol. Jan 2001;57(1):1-9.
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