Mastoiditis

Infection spreading into the bone behind the ear. A pushed-forward ear with a red swollen mastoid is a same-day emergency.

What it is

Infection of the mastoid bone behind the ear, almost always spreading from a middle ear infection. See otitis media.

It is uncommon, mainly affects young children, and it is the reason ear infections are not entirely trivial.

The recognisable sign is anatomical: swelling and tenderness over the bone behind the ear, redness there, and the ear itself being pushed forwards and outwards away from the head. In a young child the ear sticking out where it did not before is what parents notice.

It matters because the infection can spread inwards to cause meningitis, a brain abscess, or a clot in one of the brain's draining veins. Those complications are why this is a same-day hospital matter rather than a GP appointment.

Treatment is intravenous antibiotics, and often surgery to drain the mastoid or insert a grommet.

Most children with ear infections do not need antibiotics, and mastoiditis remains rare even so; the answer is not routine antibiotics but knowing what to watch for.

In adults it is rarer, and more often associated with cholesteatoma or a long-standing ear problem.

Signs you might notice

Redness, swelling and tenderness of the bone behind the ear.

The ear being pushed forwards or downwards, sticking out compared with the other side.

Persistent or worsening earache, often after an ear infection that seemed to be settling.

Fever, and being generally unwell.

Discharge from the ear.

Hearing loss on that side.

**999 or A and E the same day** for any of these; and immediately for headache, neck stiffness, drowsiness, confusion, a squint or double vision, or facial weakness, which suggest spread.

An ear infection that is not improving after 48 to 72 hours of antibiotics needs reassessment rather than another few days.

How it can affect day-to-day life

The photograph test is useful: compare the ears in a photograph from the front and from behind, and from above looking down. An ear that has changed position is a real finding.

Parents are often the ones who notice, and it is worth telling them what to look for when a child is sent home with an ear infection.

Repeated ear infections in a child should be counted and taken to the GP, because the number in a year drives referral.

For anybody with a long-standing discharging ear, particularly an adult, ENT assessment is needed rather than repeated drops; cholesteatoma erodes bone slowly and silently.

Hearing should be tested after recovery, because middle ear damage can persist.

Supporting someone well

Look behind the ear. Redness, swelling, tenderness, or the ear pushed forward is a same-day hospital matter.

Go back if an ear infection is not improving after two to three days, or is getting worse.

Do not delay for a routine GP appointment; use urgent care or A and E.

Say mastoiditis; it prompts the right examination.

Watch for the danger signs of spread: headache, neck stiffness, drowsiness, double vision, facial weakness.

Get chronic ear discharge in an adult assessed by ENT.

Have hearing tested afterwards.

Count and report recurrent ear infections in a child.

Where to get help

A and E or urgent care the same day; 999 for signs of spread.

ENT services for treatment and for chronic ear disease.

ENT UK publish patient information on ear infections and their complications.