Introduction:
Acute mastoiditis is a very common complication of middle ear infection known as acute otitis media. This is a rare disease and affects young children, which can further cause some serious complications. In acute otitis media, the infection occurs in the area behind the eardrum called the middle ear. It causes inflammation and pain, and the inflammatory ear effusion (fluid) in the middle ear can freely move into the mastoid air cells present in the mastoid bone, causing acute mastoiditis. It has been found that patients with acute otitis media always have a mild form of acute mastoiditis, however, it does not affect the condition.
What Is Mastoiditis?
Mastoiditis is the inflammation of a part of the temporal bone referred to as mastoid air cells. Children are more susceptible to middle ear infections and at higher risk of developing acute mastoiditis than adults. Most commonly, acute mastoiditis is a complication of acute otitis media, however other conditions that can lead to mastoiditis include infection of mastoid air cells (incipient mastoiditis) and subacute ear infections.
What Are the Types of Acute Mastoiditis?
Mastoiditis can be divided into three different categories depending upon the mechanism of action, which are mentioned below -
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Incipient Mastoiditis - Isolated infection of the mastoid cells only, without involving the middle ear cavity (middle ear infection).
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Acute Coalescent Mastoiditis - This is the most common type in which inflammation of the epithelial lining, along with the erosion of the bony septations (septum dividing the cavity) of the mastoid air cells, occurs. The erosion can progress into an intracavity abscess extending to adjacent structures.
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Subacute Mastoiditis - It occurs when recurrent acute otitis media with inadequate antimicrobial therapy can lead to non-ending infection of the middle ear and mastoid ear cells.
What Is the Etiology of Acute Mastoiditis?
The mastoid bone has a structure like a honeycomb that contains air spaces called mastoid cells. Mastoiditis occurs when these mastoid cells become infected or inflamed, followed by persistent middle ear infections (otitis media). Bacterial infections most frequently cause this, and the pathogen responsible for it are -
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Streptococcus pneumoniae (most common).
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Haemophilus influenzae (less common but more aggressive).
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Aspergillus (mostly seen in older patients).
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Tuberculous otomastoiditis (more commonly seen in immunocompromised patients).
Cholesteatoma is an abnormal collection of skin cells behind the eardrum preventing the ear from draining properly, causing mastoiditis.
What Is the Epidemiology of Acute Mastoiditis?
Mastoiditis can occur at any age, but pediatric age is most prone to mastoiditis. Most of the patients affected by this are less than two years of age, with an average of 12 months. This occurs due to anatomical, immunological, and infectious conditions in the first years of life. Therefore younger patients have a more rapid evolution of acute mastoiditis at different ages and can have more serious symptoms than adults.
According to various studies, around 20 percent of cases of acute otitis media get complicated by acute mastoiditis and can be associated with severe intracranial complications.
What Are the Symptoms of Acute Mastoiditis?
The symptoms of mastoiditis may appear after an ear infection has resolved, or it may seem as if the ear infection has worsened. Some of the common symptoms include -
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Throbbing pain inside or around the ear.
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Discharge of pus or other fluids from the ear.
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Fever or chills.
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Swelling behind the ear.
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Bad smell coming from the ear.
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Redness behind the ear.
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Hearing problems such as ringing in the ears.
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The ear appears to stick out more than normal.
Some of the signs of mastoiditis in young children include -
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Frequent crying.
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Pulling on their ears.
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Mood changes.
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Hitting the side of their head.
Without any treatment, mastoiditis can develop into sepsis which can be life-threatening. Therefore anyone with mastoiditis with symptoms such as high fever, weakness, or swelling around their head needs emergency medical care.
How to Diagnose Mastoiditis?
Generally, the patient with mastoiditis would be a child under the age of two years showing signs such as irritability, fussiness, fever, ear pain, and ear pulling. In contrast, the adult patient will complain of severe ear pain, headache, and high fever.
Physical Examination -
Upon physical examination, redness and swelling behind the ear, along with tenderness and warmth of the affected area, can be noticed.
An otoscope can be used to see the inside of the ear, which may reveal the bulging of the posterosuperior wall of the external auditory canal. Tympanic membrane (eardrum) and pus can also be seen there. In some cases, this can lead to rupturing of the tympanic membrane and drainage of pus.
Diagnostic Tests -
Mastoiditis can be diagnosed only upon clinical examination. Therefore along with physical examination, some laboratory tests can also be performed to confirm the diagnosis, which includes -
CBC (Complete Blood Count) - This test will show the elevated levels of white blood cells in case of mastoiditis.
CT Scan (Computed Tomography) - This imaging test will reveal the disruption of bony septation in mastoid air cells, and the presence of infection can also be seen. Some of the things that can be seen on the scan include the following -
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Presence of fluid in the middle ear.
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Mucosal thickening in the middle ear.
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Destruction or irregularity of the mastoid process.
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Thickening or disruption of the periosteum (membrane covering the bones).
What Is the Treatment for Acute Mastoiditis?
Antibiotic therapy is an essential tool to eliminate mastoiditis. In most cases, the antibiotics must be administered via IV (intravenous), which requires hospitalization. The majority of the patients get treated by this method. However, if this does not work, then the doctor will take a sample to identify the causative organism.
Surgery may also be needed in severe cases, and the most commonly done surgical procedure is a myringotomy.
Myringotomy - In this procedure, a hole is made in the eardrum to drain the pus or fluid. In children, the procedure can be done, by placing the tubes into the eardrum so that the pus can be drained. After the surgery, the patient is prescribed oral or IV (intravenous) antibiotics.
Mastoidectomy - In cases of any complication, such as a blood clot or abscess, the patient might need a mastoidectomy. In this procedure, the infected part of the mastoid is removed.
What Are the Complications of Acute Mastoiditis?
The complications involved in acute mastoiditis include -
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Hearing loss.
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Facial nerve palsy (sudden weakness on one side of the face).
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Osteomyelitis (infection in the bone).
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Petrositis (infection of the petrous part of the temporal bone).
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Cranial nerve involvement.
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Labyrinthitis (inflammation of the inner ear or nerves).
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Gradenigo syndrome (the clinical triad of otitis media, retro-orbital pain, and abducens palsy).
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Abscess formation (pus formation due to bacterial infection).
Conclusion:
Ear infections are a common childhood condition that may cause serious complications. Parents should be aware of the symptoms related to mastoiditis and should report to the doctor as soon as possible if any of the symptoms are reported. In addition, parents should look for any swelling near the ear, pain, or change in behavior of the child and should consult the medical professional accordingly.
