Last Updated on by frcemuser

The tympanic cavity of the middle ear is in communication with the mastoid antrum via a small canal that runs through the petrous temporal bone. Mastoiditis typically occurs when suppurative infection extends from a middle ear affected by otitis media to the mastoid air cells. The mastoid air cells are related superiorly to the middle cranial fossa and posteriorly to the posterior cranial fossa. This means that infection of the mastoid can, rarely spread to cause intracranial infection e.g. meningitis or cerebral abscess.

Mastoiditis is more common in young children (peak incidence at age 6 – 13 months) and in patients with immunocompromise. The most common isolated organism is Streptococcus pneumoniae. Other implicated organisms include: Streptococcus pyogenes, Staphylococcus spp., Haemophilus influenzae, Pseudomonas aeruginosa and Moraxella catarrhalis.

Patients may present with a history of acute or recurrent otitis media, intense otalgia and pain behind the ear, fever, irritability, intractable crying and feeding problems in infants and systemic illness. On examination there may be swelling, redness or a boggy, tender mass behind the ear, the external ear may protrude forwards, and there are features of otitis media on otoscopy (a distinctly red, yellow or cloudy tympanic membrane, moderate to severe bulging of the tympanic membrane with loss of normal landmarks, an air-fluid level behind the tympanic membrane and perforation of the tympanic membrane +/- discharge into the external auditory canal).

Patients should be urgently referred to ENT and managed as an inpatient with high dose broad spectrum intravenous antibiotics.


  • Hearing loss Facial nerve palsy
  • Cranial nerve involvement Osteomyelitis
  • Petrositis Labyrinthitis
  • Venous sinus thrombosis
  • Intracranial extension – Meningitis, cerebral abscess, epidural abscess, subdural empyema

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