What is chronic mastoiditis?

Chronic mastoiditis occurs when this infection of the mastoid bone behind the ear does not respond to initial treatment or recurs. The mastoid is affected by a chronic inflammatory process that lasts more than three months. Chronic mastoiditis is often caused by infectious disease in the middle ear and a perforated tympanic membrane, or benign ear cysts. Although mastoiditis is usually curable, it can be difficult to treat due to the location and density of the bone. As a result, the infection may recur or become chronic and require long-term treatment.

The mastoid is located just behind the external ear and looks like a bone-covered honeycomb that is filled with air. It is lined with a mucous membrane that communicates with the space behind the eardrum. As a result of this link, inflammation and infection in the middle ear can lead to mastoid infection, or mastoiditis.

Mastoiditis is acute or chronic. An untreated or ineffectively treated acute ear infection is often the cause of acute mastoiditis. This results in a direct bacterial infection in the mastoid which inflames the skin behind the external ear. If the infection is left untreated for more than two weeks, the bony walls inside the mastoid will begin to deteriorate.

The acute form can develop into chronic mastoiditis and cause many complications, such as facial paralysis, deafness, and vertigo. This is usually exacerbated by chronic otitis media, a middle ear infection that results in a perforated eardrum through which infected material periodically drains. A benign cyst of the ear that blocks the connection between the middle ear and the mastoid can also be a factor. The bone does not deteriorate in cases of chronic mastoiditis as it does in the acute form. Instead, the mucous membrane lining becomes inflamed and thickens over time.

While patients with acute mastoiditis may develop swelling of the skin behind the affected ear, those with chronic mastoiditis may be almost symptom-free. A typical patient with chronic mastoiditis will experience pain and increased drainage from the ear when ear disease involving the mastoid erupts. If left undiagnosed and untreated, chronic mastoiditis can lead to scarring of the lining of the mastoid mucous membrane and conductive hearing loss.

The diagnosis of chronic mastoiditis usually begins with an examination of the head. There will usually be a hole in the eardrum through which the infected fluid will drain. As a result of this perforation, the individual may have some hearing loss. The lining of the middle ear may appear red and swollen. Additional tests such as a CT scan of the head and ear, a skull X-ray, or a cultural drain of the ear can help confirm a diagnosis.

Treatment is usually directed at the underlying infection that is affecting the mastoid. Antibiotics are injected or taken by mouth. If antibiotic treatment is unsuccessful, surgery may be recommended. The surgery involves removing and draining the mastoid or draining the middle ear through the eardrum. Ventilation tubes may be inserted to bypass Eustachian tubes that are not working well.

A person who has some hearing loss with a recurring draining ear should consider seeing an ear specialist. The need to see a specialist can be acute if the affected ear has not responded to home care or other treatment such as antibiotic ear drops. Any bacterial ear infection should be treated as soon as possible to prevent complications such as chronic mastoiditis.

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