Mastoiditis is the infection of the mastoid cells inside the bone behind the ear lobe. The mastoid bone cells are connected to the middle ear through the roof of the middle ear (called “antrum”).
The mastoid bone has hollow spaces that are lined similar to sinus cavities with a mucous membrane lining.
When the middle ear space is infected, the infection can spread into these “mastoid cells” (shown here with bone chiseled open behind the ear canal, thanks to chestofbooks.com for this image) and the area can wall itself off leading to an abscess that can turn life threatening.
The patient has a high fever, looks sick and complains about an excruciating ear pain. The bone behind the ear lobe (thanks to commons.wikimedia.org for this image) is also painful to touch. There may even be a lot of redness of the skin of this area and excruciating pain when it is touched or tapped. At the same time the physician likely will see an acute otitis media. Three of the problem bacteria are Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus.
A patient who is that sick needs to be hospitalized and treated with intravenous antibiotics to prevent the development of septicemia (which otherwise could lead to shock).
An otolaryngologist needs to carefully examine and possibly order emergency CT or MRI scans to rule out a mastoid abscess. It this is the case, the surgeon will do a mastoidectomy (drainage of the abscess by opening the abscess cavity in the bone). Without this procedure there is a danger that the infection spreads upwards into the temporal lobe of the brain and forms meningitis or a brain abscess and septic shock (Ref. 6, p. 674).
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