The Symptoms, Causes and Treatment of Mastoiditis

Mastoiditis is a bacterial infection that invades the Mastoid bone, a porous bone that is behind the ear. This bone has air cells in it to help with air flow throughout the ear. This condition can be potentially life threatening if not discovered early or given the proper treatment but it is often manageable when it is treated early.

The symptoms of Mastoiditis usually arise days or weeks after Otisis Media occurs. This is the result of an ear infection which leaves fluid trapped behind the eardrum which can spread infection into the air cells of the Mastoid bone where pus begins to collect. After an extended period of time this can erode the bone. The outer ear behind the bone may become red, swollen and tender and it may be pushed sideways and downward. Fever, pain, lethargy , irritability, and a creamy discharge from the ear are common. Often a persistent, throbbing pain is present and some degree of hearing loss often results. Another cause of Mastoiditis is a skin cyst within the middle ear called a Cholesteatoma which can block drainage of fluid from the ear. If this is not treated in a timely manner it may cause deafness, blood poisoning, meningitis, brain abscesses and even death. Children from under one year of age on up are the most effected but adults develop Mastoiditis as well.

Treatment of this illness often involves taking blood tests and/or a culture of the fluid draining from the ear to determine what type of antibiotics may be necessary. The antibiotics are intravenously administered at a hospital for one to two days and followed up at home with oral antibiotics for up to two weeks. Before antibiotics were available children often died of this condition. If the infection reoccurs or seems to be severe a CT scan may be done to determine the extent of the fluid blockage in the Mastoid bone and if there is an abscess on the brain.

If the condition is severe a surgery called a Mastoidectomy may be performed. Basically there are three degrees of this procedure which all require an incision behind the outer ear. A simple Mastoidectomy involves removing the infected air cells by drilling or scraping out infected bone. In a radical procedure the eardrum and most of the middle ear structures are removed and the Eustachian Tube is closed. This can lead to permanent hearing loss in the effected ear. In a modified surgery the bone is cleaned of infection and any abscesses are drained but the ossicles ( the three small bones that receive sounds) and part of the eardrum is preserved.

For the most part this surgery is considered to be safe and successful. However there is no guarantee that it will permanently fix the problem. At times a person needs this operation more than once. If the infectious fluid continues to collect and cannot be stopped from accumulating then the patient may need the surgery again. When a Cholesteatoma is present there is a 30% – 50% recurrence rate so the patient is monitored carefully to watch for regrowth. This seems to be the reason for the more radical surgeries and thus complications because it invades so much of the ear. One source states that any complications from it’s removal are no worse than the effects of it not being removed. Hopefully there will be no complications but those that occur can be severe. There could be partial or complete hearing loss. Of course there is usually some loss to begin with. Dizziness and Vertigo can result but are usually temporary as well as loss of taste on the side of the tongue. Bone erosion is possible. Facial paralysis can occur because the procedure is done in close proximity to the facial nerve. If discovered that It has been damaged they will have to go back in and repair it. Meningitis is also a possibility but it may have developed before the surgery as well.

My husband,Todd, has Mastoiditis and his doctor recommended surgery. Actually, two specialist have but he is not comfortable with having an operation that close to the brain and I don’t blame him. One of them mentioned a new procedure in the Fall of 2014. It is called Balloon Dialation of the Eustachian Tubes or Balloon Eustachian Tuboplasty. It is currently available in the U.K. And other European countries. An instrument with a balloon attached is inserted up into the nostril to the opening of the Eustachian Tube and then the balloon is inflated with a saline solution. It remains at the site for usually two or three minutes. This causes the Eustachian Tubes to remain open and allow for proper fluid drainage. So far the clinical trials have shown that it has remained effective in most cases for three years. Although it may seem short lived to some my husband would like to have the procedure done because it seems to provide some relief and is far less invasive than a Mastoidectomy.

We went back to the doctor in early 2015 to discuss this treatment again and hopefully make arrangements for it. He informed us that there is no medical or(CPT) code for insurance purposes , that allows for this procedure alone. It has to be performed along with a Mastoidectomy. Ugh! Hopefully that will change in the near future. Do any of you suffer from Mastoiditis? Have you had the surgery or other successful treatments? Please let us know. Stay posted!

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