Mastoiditis is an inflammatory infectious disease of the mastoid process, which is the most common complication of otitis media acuta (acute middle ear infection) due to inadequate treatment. Mastoiditis is usually well treatable if therapy is started early.
What is mastoiditis?
Mastoiditis can cause severe ear pain. Mastoiditis is an inflammation of the mucous membrane in the air-containing cells of the mastoid process of the temporal bone caused by bacteria. In most cases, mastoiditis is a sequelae of otitis media acuta (acute middle ear infection) that has not been completely cured. If the mastoiditis in a young child or infant is due to latent (hidden or undetected) otitis media, it is referred to as occult mastoiditis. Symptomatically, mastoiditis is characterized by prolonged fever in the acute stage of the disease, ear discharge (otorrhea), tenderness over the mastoid process, retroauricular (behind the ear) swelling with protruding ear, and restlessness, sleep disturbances, loss of hunger, and progressive hearing loss. If young children are affected by mastoiditis, they may also suffer from diarrhea and/or vomiting.
Causes
Usually, mastoiditis is caused by bacterial infection with pneumococcus, streptococcus, Haemophilus influenzae type B, and in infants, staphylococcus. In some cases, the bacterial one is preceded by a viral infection with rhinoviruses, influenza viruses, coxsackieviruses and adenoviruses, which can cause rhinitis and inflammation of the throat area and lead to a weakened immune system. As a result of the weakened immune system, the affected organism is more susceptible to bacterial pathogens. Bacteria invade the structures in the nasopharynx, from where they can enter the middle ear and cause otitis media. If mistreated or not treated, the bacteria can colonize adjacent structures such as the air-containing bone cells of the mastoid process and cause mastoiditis.
Symptoms, complaints, and signs
If an acute middle ear infection persists for more than two to three weeks, mastoiditis may develop. Characteristic of the disease are increasing ear pain, often associated with a decrease in hearing performance and an unusual tapping in the ear. In addition, there is a poor general condition or even a prolonged fever with chills, vomiting and fatigue. Also typical of acute mastoiditis are the swellings that usually occur behind the auricle and are filled with a light-colored tissue fluid. The swollen area hurts with pressure or touch. In some patients, secretions drain from the ear as the disease progresses. The swelling also causes the ear to become misaligned. 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 further symptoms. Thus, there is loss of appetite, headache, fatigue and gastrointestinal complaints, but also chronic ear pain and a gradual decrease in hearing. Mastoiditis usually occurs over the course of several days or weeks and initially increases in intensity before the individual symptoms slowly subside.
Diagnosis and course
Mastoiditis can be diagnosed by otoscopy (ear examination), during which the external auditory canals and eardrum are examined with an otoscope. A sunken posterior ear canal wall and a thickened, opaque eardrum that may have a protrusion and/or perforation (tear) with purulent ear secretions (ear discharge) may indicate mastoiditis. The diagnosis is confirmed by a Schüller temporal bone x-ray (special x-ray according to Schüller), which shows a shadowing of the mastoid cells (cells of the mastoid process) and a dissolution of the bone follicles. A computer tomography or magnetic resonance imaging allows conclusions to be drawn about the extent of the mastoiditis.An elevated leukocyte count, elevated CRP (C-reactive protein), and elevated erythrocyte sedimentation rate are inflammatory markers that indicate the inflammatory reactions resulting from mastoiditis. Hearing testing may reveal conductive hearing loss in mastoiditis. If diagnosed early and therapy is started early, mastoiditis is usually well treatable and heals without consequences such as hearing loss.
Complications
Mastoiditis is itself a complication of otitis media. Without appropriate medical treatment, it can in turn have serious consequences. Among the most common complications of mastoiditis is the development of abscesses under the periosteum at the mastoid process. An abscess is an encapsulated collection of pus. If the pus breaks into the lateral muscles of the neck and throat, doctors refer to it as a bezoid abscess. Also possible is abscess formation in the temporal lobes or cerebellum. Another sequelae is cystomaticitis. In this case, pus accumulates below the zygomatic arch, which in turn becomes 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 headaches, damage to the cranial nerves and meningitis. Furthermore, the pus can reach the parts of the sternocleidomastoid muscle (head nodder). As a result, the neck becomes crooked towards the healthy side and it swells on the diseased side, causing pressure pain. Complications can also arise if the pathogens spread, as they can reach other parts of the body via the bloodstream. Therefore, there is a risk of sinus thrombosis, labyrinthitis (infection in the inner ear labyrinth), paralysis of the face (facial paresis), and life-threatening blood poisoning (sepsis).
When should you see a doctor?
Because mastoiditis can cause complete hearing loss, the condition should always be examined and treated by a physician. There is no self-healing in this case, and without treatment, the symptoms will worsen. 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. Also, there may be pain in the head or general weakness and general poor well-being. In some cases, fever, vomiting or chills also indicate mastoiditis and should be examined by a doctor. On the ear, the disease is noticeable by swelling, which can also lead to hearing loss. The quality of life of the affected person is considerably limited and reduced by the disease. Not infrequently, loss of appetite or fatigue also indicates this complaint. Mastoiditis can be treated relatively well by a general practitioner or by an ENT specialist. Early treatment in this case increases the chances of complete healing.
Treatment and therapy
Mastoiditis is treated depending on the extent of inflammation. In the presence of occult mastoiditis or a very early stage of disease, decongestant nasal drops and intravenous therapy with high-dose antibiotics in combination with paracentesis (incision of the tympanic membrane) may be successful. If the bony structures are involved or the therapy is unsuccessful, mastoiditis is usually treated surgically and with antibiotic therapy. For this purpose, in the course 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 burs. In addition, a high-dose antibiotic is infused intravenously to kill the bacteria remaining in the organism. In some cases, fever reducers and painkillers (paracetamol, ibuprofen) are used to reduce the often severe ear pain, but these should only be used for a short time in young children.With regard to the success of antibiotic therapy, it is crucial in mastoiditis, as in other bacterial infectious diseases, 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), brain abscess, or deafness can result from mastoiditis.
Outlook and prognosis
With early diagnosis and prompt initiation of therapy, mastoiditis has a favorable prognosis. There is an inflammation of the mucosa that is readily treatable with current medical options. The disease triggers are bacteria, which die through the administration of medication and are subsequently removed from the organism. The patient is usually discharged from treatment within a few weeks as recovered. At an advanced stage of the disease or without medical care, the risks for complications are increased. Pain occurs, decreased hearing is present, and interference with locomotion is possible. As pus develops, life-threatening sequelae may develop in severe cases. Blood poisoning can develop, which must be treated with intensive care, otherwise the affected person will die prematurely. If the affected person seeks medical care in time, surgery is performed in these cases. This is associated with risks. If the operation proceeds without any problems, medication is administered afterwards to ensure a complete recovery. If the conditions are unfavorable, the inflammation may spread. In addition, there is a possibility that the affected person may experience permanent hearing impairments, including deafness.
Prevention
Mastoiditis cannot be prevented directly. Rather, colds, rhinitis, or otitis media should be prevented by maintaining a healthy, endogenous defense system (healthy diet, plenty of exercise) and adequate clothing in cold, damp weather conditions. In addition, therapy of existing infectious diseases and inflammations in the area of the ears should not be discontinued prematurely to prevent mastoiditis.
Aftercare
Because mastoiditis is highly treatable, follow-up care focuses on increasing long-term healthy lifestyle habits to avoid weakening the immune system. This includes sufficient exercise as well as a balanced diet with fresh ingredients. Yoga or Nordic walking are easy sports that are easy to integrate into everyday life and can increase well-being enormously. If expected complaints arise after the completed treatment, this should be clarified immediately with the attending physician.
What you can do yourself
If mastoiditis is suspected, a physician should be consulted promptly. If the first signs such as earache or fever occur at night or on weekends, mild symptoms can initially be treated with over-the-counter painkillers. If the earache subsides overnight, there may only have been a temporary tube ventilation disorder. This is a restricted or absent equalization of pressure between the middle ear and the nasopharynx. If the earache recurs as soon as the effect of the painkiller wears off, this reinforces the suspicion of a middle ear infection, which should definitely be presented to the doctor. Ear drops should not be administered in this situation without a doctor’s prescription. Provided the eardrum is still undamaged, the drops cannot reach the middle ear anyway. If the eardrum is already ruptured, the drops may cause damage to the inner ear. On the other hand, it makes sense to apply heat treatment, which promotes healing and has a pain-relieving effect. A red light, heating pad or 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, homeopathy uses regular doses of chamomilla, aconitum and belladonna in low potencies. Purulent discharge from the ear should be removed regularly with an alcohol-soaked paper handkerchief or a cotton pad.On the other hand, do not close the ear canal with absorbent cotton or other substances, as this could promote the multiplication of pathogens.