Mastoiditis: Symptoms, causes, and diagnosis

Symptoms of mastoiditis include swelling behind the ear, pus coming out of the ear, throbbing pain, and difficulty hearing.

Ear infections that do not receive treatment, as well as antibiotic-resistant ear infections, sometimes spread. When this happens, the bacteria travel to surrounding structures, including bones such as the mastoid process.

Without antibiotic treatment, the bacteria can continue spreading to the bones of the skull. They may also travel to the blood and organs, including the brain.

Middle ear infections, which doctors call acute otitis media, and mastoiditis are most common in children younger than 2 years of age.

Symptoms of mastoiditis

Mastoiditis can begin after symptoms of an ear infection seem to have cleared up. It may also appear as a progressively worsening ear infection.

When a person develops new symptoms within a few weeks of an ear infection, a doctor may assess them to see if they have mastoiditis.

Symptoms include:

  • intense throbbing pain in or around the ear
  • pus or other fluids coming out of the ear
  • fever or chills
  • swelling behind or under the ear
  • redness behind the ear
  • a bad smell coming from the ear
  • an ear that appears to be sticking out or pushed forward
  • hearing problems or ringing in the ears

People should look out for the following signs in very young children who might be unable to describe their symptoms:

  • mood changes
  • frequent crying
  • hitting the side of the head
  • pulling on the ears

In some people, the swelling that mastoiditis causes is intermittent or gets better and then worse. It is important not to assume that an infection is healing just because symptoms improve slightly.

Without treatment, mastoiditis can cause infections in the skull, the blood, or the organs. People can also develop a life-threatening blood infection called sepsis.

A person with mastoiditis or an ear infection who has confusion, a high fever, is very weak, or who has swelling around their head should go to the emergency room.

Ear infections are the most common cause of mastoiditis.

When a person does not receive antibiotics for mastoiditis, the bacteria can spread. If people stop taking antibiotics too soon, this can also allow the infection to spread.

Some people can develop antibiotic-resistant infections that spread even with antibiotic treatment.

A person may, less commonly, have an abnormal growth of skin cells in the middle ear called a cholesteatoma.

This skin growth can cause a blockage in the ear that allows bacteria to multiply, causing mastoiditis. Cholesteatomas can also cause ear polyps that may result in further obstruction.

A doctor can usually diagnose mastoiditis, depending on symptoms and by looking at the swelling. Sometimes blood work or imaging scans of the ear can help rule out other causes.

Antibiotics can usually treat mastoiditis. In most cases, a person needs intravenous antibiotics, typically requiring hospitalization.

If the first antibiotic treatment does not work, a doctor may take a culture of the infection to determine the type of bacteria and find a different course of antibiotics.

In some cases, a doctor may need to perform a mastoidectomy. This operation involves the removal of the portion of the mastoid process that has the infection.

If there is an abscess, which is a swollen mass of infected fluid, a doctor may need to drain it surgically or with a needle.

The most effective option for preventing mastoiditis is to treat ear infections promptly.

It is essential to see a doctor for symptoms of an ear infection that are not improving. This is true even if a person has previously had a successful recovery from an ear infection without needing antibiotics.

When a doctor prescribes antibiotics for an ear infection, people should take all of the antibiotics even if symptoms disappear. Taking a partial dose of antibiotics makes it easier for the infection to return.

People should not take older antibiotics that are lying around the house from a previous illness. Taking the appropriate antibiotics for the infection is critical.

Regular hand-washing and avoiding people who are unwell can help reduce the risk of contracting an ear infection.

People with a weakened immune system due to HIV or AIDS, diabetes, or certain medications are more vulnerable to serious complications. It is vital to immediately see a doctor for signs of infection in a person with a compromised immune system.


With prompt, aggressive treatment, the outlook for mastoiditis is good in most cases.

A 2014 study followed 32 people younger than 16 years old who were in the hospital for mastoiditis. Most of the children had a successful recovery, though 54 percent required surgery. Three of the children with weak immune systems developed mastoiditis again and had to have further surgery.


People who experience intense ear pain and swelling must treat these symptoms seriously. Parents should suspect mastoiditis in children with a recent ear infection who complain of pain or swelling around the ear.

Although ear infections are a common childhood ailment, they can also cause serious complications, including mastoiditis. People may wish to see a doctor for advice about the best course of treatment.

A person should see the doctor again or ask for a second opinion if symptoms do not improve within a few days.

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