Mastoid Pain


The mastoid, located behind the ear in the lower area of the skull, is a protruding bone with an interior that resembles a honeycomb with air-filled cavities. These mastoid cells connect to the middle ear through the mastoid antrum, which is an air filled cavity. The mastoid bone functions as a reserve air supply, allowing the eardrum to move normally. This connection, however, may allow middle ear infections to spread to the mastoid bone.


Mastoid pain is primarily caused by mastoiditis, an infection or inflammation of the mastoid bone. Mastoiditis usually occurs when the inflammation from a middle ear infection (acute otits media) moves into the mastoid air cells. Mastoiditis may be caused by several bacteria such as pneumococcus, Hemophilus influenzae, beta-hemolytic streptococci, staphylococci, and gram-negative organisms.


Mastoiditis can be diagnosed in a number of ways. Physicians use an otoscope, a lighted instrument, to examine the outer ear and eardrum. A pneumatic otoscope examines eardrum movement, by blowing a puff of air into the ear. Tympanometry is a test that measures the amount of sound reflected back, when a test tone is presented to the ear canal. Imaging tests that a physician may use include: x-rays, CT scans, and MRIs. Physicians may also draw blood or take a culture from the ailing ear.


Accounting for 40% of outpatient antibiotic use, middle ear infections are now the second leading cause of doctor’s visits. (Ref3). Children between six months and two years of age, are most likely to acquire an ear infection.


Antibiotic therapy, oral or topical, is the first phase of mastoiditis treatment. If antibiotics are not effective, surgery may be required to alleviate the pain. A mastoidectomy, the removal of the mastoid, may be performed if there is persistent infection or intracranial complications. A drain is inserted into the affected area, after it has been cleaned. A radical mastoidectomy, the removal of the posterior wall of the ear canal, may be performed if the mastoid is chronically inflamed.


If antibiotic therapy is ineffective and surgery is not undertaken, the infection may spread and cause several complications. Meningitis may occur if the membranes that cover the brain become inflamed due to infection. A bezold’s abscess, a collection of pus forms in the neck, may occur. A persistent infection may also result in the destruction of the mastoid’s delicate structures, which may further lead to hearing loss. Further possible complications include facial paralysis and labyrinitis, an infection of the inner ear chamber that controls balance and hearing.

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