Mastoiditis
Mastoiditis is the inflammation of a portion of the temporal bone. This bone is located right behind the ear. It contains tiny cavities called mastoid air cells which are connected with the middle ear cavity. Normally, the air cells and middle air contain only moisturizing fluid produced by epithelial cells. But if there is an infection of the ear, the bacteria may crawl into the air cells and start mastoiditis. In rare cases the infection starts in the air cells without causing ear infection.
In this article:
- Mastoiditis Treatments
- Does vaccine prevent mastoiditis?
- Antibiotics
- Surgery
- Ear tubes
- Mastoidectomy
- After surgery
- References
Mastoiditis Treatments
Mastoiditis treatment is urgent and needs to be done under a medical professional guidance. In many situations acute mastoiditis requires a visit to the ER and hospitalization. An intravenous antibiotic is the first line of treatment, together with IV fluids and pain medications.
Fast treatment brings usually good recovery without further complications or need for surgery. In a complicated situation with the abscess, a surgery to drain the abscess is done.
In the situations with chronic ear infections an ear tube placement is offered. This creates an opening to the middle ear through the tympanic membrane.
It is important to address an overall health of a child or an adult who developed a mastoiditis, which is considered a rare infection. An immunologist should be involved to check if there is no immunodeficiency.
Does vaccine prevent mastoiditis?
The introduction of the pneumococcal conjugate vaccine (PCV7) in 2000, subsequently replaced by a polyvalent version (PCV13), has certainly reduced the incidence of pneumococcal infections and consequently of an ear infection. Surprisingly, no decrease has been reported in the incidence of acute mastoiditis after vaccination, probably due to a different pneumococcal bacteria. However, pneumococcal vaccination is always recommended in young children to avoid at least recurrent ear infections, which lead to mastoiditis development.
Conservative treatment is recommended even in some cases of more serious neurological or vascular complications (intracranial abscesses or lateral sinus thrombosis), in which the medical treatment with broad-spectrum intravenous antibiotic agents, anticoagulants and/or corticosteroids are often effective.
Antibiotics
In the uncomplicated forms of AM, antibiotic therapy is the main treatment. Mastoiditis necessitates a middle ear culture for a more specific choice of antibiotic. Considering the high incidence of S. pneumoniae and its specific sensitivity to cephalosporins (less frequently to penicillins), this antibiotic, in particular, Ceftriaxone sodium, is widely used in the treatment of AM, always administered intravenously in hospitalized patients.
The treatment with different antibiotics (amoxicillin, amoxicillin-clavulanate, erythromycin, etc), orally administrated, often proves to be ineffective and may even predispose to complications.
Surgery
Ear tubes
Many specialists agree on the need for an ear tube placement(myringotomy ± tympanostomy). Such procedure should be considered in the cases of AM without spontaneous TM perforation (most often verified in children < 24 months) or AM of children with recurrent ear infections and chronic ear infections
Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy.
Mastoidectomy
Mastoidectomy is a surgical procedure of the temporal bone that opens postauricular air cells by removing the thin bony partitions between them. Each mastoidectomy is unique because of the variable pneumatization patterns of the temporal bone. Pathology can also limit the pneumatization of the mastoid cells and further complicate the mastoidectomy procedure.
ENT surgeons suggest that more aggressive surgical procedures, such as mastoidectomy, neurosurgical procedures, etc, are undoubtedly indicated in more severe complications, in particular when intratemporal, endocranial or vascular structures are seriously involved. Here are some complications that will almost always warrant surgical treatment:
- Extracranial (subperiosteal abscess, Bezold’s abscess)
- Intratemporal (facial nerve palsy, labyrinthitis)
- Intracranial (subdural abscess)
Surgical procedures are also performed in all cases in which CT scan showed a serious impairment of the mastoid bone, and to cure a chronic infection.
After surgery
The timing and success of recovery depends on the extent of the surgery. The ear tubes is an ambulatory procedure with almost no need for any postsurgical observation. The mastoidectomy is a complicated scull surgery that affects many important structures of the head and neck. It requires general anesthesia, and will have longer recovery.
You should expect postsurgical recovery to be under observation of the medical staff in the hospital. Dependent on the severity of the infection, it may require the hospitalization in the intensive care unit (ICU or PICU).
After mastoiditis is treated, you will need to establish follow-up visits with the ENT surgeon and hearing specialist to make sure complications do not develop. Hearing test will show if there are any hearing loss following an ear infection with mastoiditis.
References
Antibiotic therapy for children with acute otitis media. Sakulchit T, Goldman RD.Can Fam Physician. 2017 Sep;63(9):685-687.PMID: 28904032 Free PMC article. Review.
Pneumococcal Disease in the Era of Pneumococcal Conjugate Vaccine. Yildirim I, Shea KM, Pelton SI.Infect Dis Clin North Am. 2015 Dec;29(4):679-97. doi: 10.1016/j.idc.2015.07.009.PMID: 26610421 Free PMC article. Review.
Acute mastoiditis in children. Cassano P, Ciprandi G, Passali D.Acta Biomed. 2020 Feb 17;91(1-S):54-59. doi: 10.23750/abm.v91i1-S.9259.PMID: 32073562 Free PMC article. Review.
Panel 7: Otitis Media: Treatment and Complications. Schilder AG, Marom T, Bhutta MF, Casselbrant ML, Coates H, Gisselsson-Solén M, Hall AJ, Marchisio P, Ruohola A, Venekamp RP, Mandel EM.Otolaryngol Head Neck Surg. 2017 Apr;156(4_suppl):S88-S105. doi: 10.1177/0194599816633697.PMID: 28372534 Free article. Review.
Mastoidectomy. Kennedy KL, Lin JW.2021 Jul 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 32644579 Free Books & Documents. Review.
Indications and technique in mastoidectomy. Bennett M, Warren F, Haynes D.. Otolaryngol Clin North Am. 2006 Dec;39(6):1095-113. – PubMed