Mastoiditis in Children

Ear infections are a common part of childhood — but when they do not heal properly, they can sometimes lead to more serious complications. One such rare but potentially serious condition is mastoiditis, an infection of the mastoid bone, located just behind the ear. While mastoiditis is not as common today thanks to antibiotics, it remains important for parents to recognize the warning signs early.

What Is Mastoiditis?

Mastoiditis is an infection of the mastoid process, the bony area behind the ear that is filled with small air spaces. These air spaces can become infected if a middle ear infection (otitis media) spreads beyond the ear drum.

This condition typically affects children under the age of 2 but can occur at any age.

What Causes Mastoiditis?

The most common cause is untreated or severe middle ear infections. When bacteria spread from the middle ear into the mastoid bone, it can cause inflammation, swelling, and sometimes even bone destruction or abscess formation.

The most common bacteria involved include:

• • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Streptococcus pyogenes

Signs and Symptoms to Watch For

Symptoms of mastoiditis often appear after or during an ear infection and may include:

• • Persistent or worsening ear pain
  • Redness, tenderness, or swelling behind the ear
  • Ear protrusion (the ear may stick out due to swelling behind it)
  • Fever, often high and persistent
  • Irritability or excessive crying in infants
  • Drainage from the ear (may indicate a ruptured eardrum)
  • Hearing loss on the affected side

If your child has had an ear infection and starts showing any of these signs, it is important to seek medical attention promptly.

How Is Mastoiditis Diagnosed?

A pediatrician or ENT (ear, nose, and throat) specialist will examine your child’s ear and the area behind it. Diagnosis may include:

• • Physical examination
  • Ear exam with otoscope
  • CT scan or imaging to assess the extent of infection
  • In some cases, blood tests or cultures of ear drainage

Treatment Options

Treatment depends on the severity of the infection but typically involves:

• • Antibiotics: Strong intravenous (IV) antibiotics are often given initially, especially in hospital settings.
  • Ear drainage: If fluid is trapped behind the eardrum, a myringotomy (small incision in the eardrum) may be needed to release pressure and drain pus.
  • Surgery: In rare or severe cases, surgery called a mastoidectomy may be required to remove infected parts of the mastoid bone.

Prompt treatment is key to preventing complications, which can include abscess formation, hearing loss, meningitis, or bone damage.

Can Mastoiditis Be Prevented?

The best prevention is prompt and appropriate treatment for middle ear infections. Follow your pediatrician’s guidance on:

• • Using antibiotics when indicated
  • Completing the full course of treatment
  • Following up if symptoms persist or worsen

Maintaining routine well-child visits and vaccinations, especially pneumococcal and flu vaccines, also helps reduce the risk of ear infections and complications like mastoiditis.

Please book a telemedicine appointment with one of our pediatricians when offices are closed if you have questions.