Mastoid air cells are open, air-containing spaces in one of the skull bones.

An infection of the mastoid air cells that cannot be controlled with antibiotics may call for surgical treatment.

A mastoidectomy is the surgical removal of these mastoid air cells; the surgery may extend into the middle ear.

Review Date: 08/03/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Mastoiditis is an infection of the mastoid bone of the skull. The mastoid is located just behind the outside ear.

Mastoiditis is usually caused by a middle ear infection (acute otitis media). The infection may spread from the ear to the mastoid bone of the skull. The mastoid bone fills with infected materials and its honeycomb-like structure may deteriorate.

Mastoiditis usually affects children. Before antibiotics, mastoiditis was one of the leading causes of death in children. Now it is a relatively uncommon and much less dangerous condition.

• Drainage from the ear
• Ear pain or discomfort
• Fever, may be high or suddenly increase
• Headache
• Hearing loss
• Redness of the ear or behind the ear
• Swelling behind ear, may cause ear to stick out

An examination of the head may reveal signs of mastoiditis. The following tests may show an abnormality of the mastoid bone:

• CTscan of the ear
• Head CT scan
• Skull x-ray

A culture of drainage from the ear may show bacteria.

Mastoiditis may be difficult to treat because medications may not reach deep enough into the mastoid bone. It may require repeated or long-term treatment. The infection is treated with antibiotics by injection, then antibiotics by mouth.

Surgery to remove part of the bone and drain the mastoid (mastoidectomy) may be needed if antibiotic therapy is not successful. Surgery to drain the middle ear through the eardrum (myringotomy) may be needed to treat the middle ear infection.

Mastoiditis is curable with treatment. However, it may be hard to treat and may come back.

• Destruction of the mastoid bone
• Dizziness or vertigo
• Epidural abscess
• Facial paralysis
• Meningitis
• Partial or complete hearing loss
• Spread of infection to the brain or throughout the body

Call your health care provider if you have symptoms of mastoiditis.

Call for an appointment with your health care provider if:

• You have an ear infection that does not respond to treatment or is followed by new symptoms
• Your symptoms do not respond to treatment

Promptly and completely treating ear infections reduces the risk of mastoiditis.

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005:3019-3020.

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. London: Churchill Livingstone; 2005:771.

A mastoidectomy is surgery to remove cells in the hollow, air-filled spaces in the skull behind the ear. These cells are called mastoid air cells.

The surgery used to be a common way to treat an infection in the mastoid air cells. Such infection usually resulted from an ear infection that spread to the nearby bone in the skull.

Mastoidectomy is now rarely needed, because infections are commonly treated with antibiotics.

However, this surgery may be used to treat other problems, such as:

• Cholesteatoma
• Complications of an ear infection (otitis media)
• To place a cochlear implant

• Changes in taste
• Dizziness
• Hearing loss
• Infection that persists or keeps returning
• Noises in the ear (tinnitus)
• Weakness of the face

Bennett M. Indications and technique in mastoidectomy. Otolaryngol Clin North Am. Dec 2006; 39(6): 1095-113.

Connell SS. Cochlear implants. Clin Geriatr Med. Aug 2006; 22(3): 677-86.