Otalgia (Earache)

The mastoid bone is the back part of the temporal bone of the skull located just behind the inner ear. Mastoiditis is infection of the mastoid bone. The mastoid bone is made up of a honeycomb-like structure, which is full of mastoid air cells. The mastoid air cells can become infected or inflamed, often as a result of an inner ear infection (otitis media). If infection spreads outside the mastoid air cells into the mastoid bone (coalescent mastoiditis), serious health problems can arise.

Mastoiditis is more common in children, but it can affect adults as well.

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The most common cause of mastoiditis is an untreated inner ear infection (acute otitis media).

Less frequently, a condition called cholesteatoma can cause mastoiditis. Cholesteatoma is an abnormal growing collection of skin cells inside the ear that can prevent the ear from draining, which can lead to mastoiditis.

If mastoiditis is treated promptly with antibiotics, it can often be cured. In some people, the infection comes back and another course of antibiotics is required.

If the infection spreads, serious and even life-threatening complications can occur such as:

  • Hearing loss that may be permanent
  • Facial nerve palsy (facial paralysis)
  • Bone infection (osteomyelitis)
  • Inflammation of the inner ear nerves (labyrinthitis)
  • Blood clots, including sinus thrombosis, which is a blood clot in the sinuses that drains blood from the brain
  • Brain abscess (epidural abscess or subperiosteal abscess) or other intracranial complications
  • Meningitis

Kids under 5 years old are particularly at risk, especially following upper respiratory illnesses when ear infections often occur. A number of things can cause ear pain. Some of the most common include ear infections, airplane pressure, a perforated eardrum, excess earwax, and dental problems.

  • Pain or discomfort in or behind the ear (otalgia)
  • Redness or tenderness behind the ear
  • Swelling of the area behind the ear (this may cause the ear to stick out)
  • Ear discharge (otorrhea)
  • Fever
  • Headache
  • Hearing loss in the affected ear
  • Swelling behind the eyes
  • Irritability
  • Tiredness
  • Dizziness or spinning sensation (vertigo) (uncommon)
  • Weakened facial muscles (uncommon)

A doctor will do an examination of the ear canal with an otoscope to see inside the ear canal and visualize the eardrum (tympanic membrane) and structures within the middle ear if possible. Other tests may be ordered to confirm a diagnosis. These tests include:

  • CT scan of the temporal bone
  • MRI scan of the ear and head
  • X-ray of the skull
  • Blood tests, including a white blood cell count and complete blood count (CBC)
  • Culture of any fluids drained from the ear (via tympanocentesis, tympanostomy, or myringotomy)
  • Hearing test (audiometry)
  • Lumbar puncture or "spinal tap"

Mastoiditis cannot be treated at home. It requires medical treatment as the infection can spread and cause serious complications. Most of the home treatments are aimed at reducing symptoms of an ear infection, which is the most common cause of mastoiditis.

  • Wear earplugs when swimming or showering to keep water out of the ears and keep an ear infection from worsening.
  • Over-the-counter (OTC) pain relievers and fever reducers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be taken for pain and inflammation. Do not give aspirin to children or teenagers as it has been linked with Reye’s syndrome, a rare but serious disease.
  • A warm compress held over the ear may help relieve some pain.
  • Stay hydrated.
  • Rest.
  • Avoid air travel if possible, as flying may aggravate ear pain.

Early diagnosis and treatment with antibiotics is needed to avoid complications. In some cases, intravenous (IV) antibiotics in a hospital may be required.

If antibiotics alone do not cure the infection, surgery may be needed. A myringotomy may be performed to drain the middle ear, and in more serious cases a mastoidectomy may be needed to remove part of the infected mastoid bone.


The best way to prevent mastoiditis is to prevent ear infections (otitis media) and treat any ear infection you have with antibiotic therapy.

Ways to prevent acute middle ear infections include:

  • Wash hands frequently to prevent the spread of cold and flu viruses.
  • Keep children away from secondhand smoke. Studies have shown children who are around smokers get more ear infections than children not exposed to smoke.
  • Be sure your child gets the flu vaccine yearly. Vaccinated children get fewer ear infections than non-vaccinated children.
  • Limit your child's exposure to other children who have a cold or the flu.

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