Mastoiditis is a bacterial infection of the mastoid bone behind the ear, usually a complication of acute otitis media. It is most common in young children and can spread inside the skull if treatment is late.
Key symptoms
- Pain, redness and swelling behind the ear
- Fever and irritability
- Ear pain and discharge
- Recent or untreated ear infection
What you find on exam
- Tender, red, boggy swelling over the mastoid
- Ear pushed forward and outward
- Bulging or perforated eardrum on otoscopy
- Neurological exam: neck stiffness, cranial nerve palsy
Tests
- CT of the temporal bones with contrast
- Blood count, CRP and blood cultures
- Culture of ear fluid
- MRI if spread inside the skull is suspected
Treatment basics
- IV antibiotics such as ceftriaxone, plus vancomycin if severe
- Urgent ENT referral
- Ear tube placement (myringotomy) to drain the middle ear
- Mastoidectomy for an abscess or failure to improve
Red flags
- Severe headache, neck stiffness or confusion
- Facial weakness
- Persistent or spiking fevers despite antibiotics (possible venous sinus thrombosis)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.