What is Mastoiditis?: Understanding the signs and why prompt treatment matters

Mastoiditis

What you need to know about this serious ear infection

Overview    |    What's actually happening    |    Symptoms to watch out for   |    When to seek help    |    Diagnosis and treatment options    |    Prevention and key takeaways    |    Conclusion 

Last Hearing Aid UK Update:  13/01/2026

Overview

If you've been experiencing persistent ear pain that isn't shifting, or you're wondering whether your ear infection has turned into something more serious, it's worth understanding mastoiditis.

This is a bacterial infection that affects the mastoid bone, which is the prominent bone you can feel behind your ear.

Mastoiditis is genuinely rare in the UK these days, largely thanks to antibiotics and widespread vaccination programmes, and most ear infections clear up without ever developing into mastoiditis.

But when it does happen, it needs prompt medical attention, as mastoiditis typically develops when middle ear infections go untreated or don't respond properly to initial treatment. The good news is that with early diagnosis and appropriate treatment, outcomes are excellent.

What's actually happening

Mastoiditis typically starts as a middle ear infection (otitis media) that spreads into the mastoid bone behind your ear. The mastoid bone isn't solid, as it's filled with air cells that look rather like a honeycomb.

When infection spreads from the middle ear into these spaces, inflammation and pus build up, causing the characteristic symptoms. There are two types you should know about:

• Acute mastoiditis appears quickly, usually within days of an ear infection. It responds well to treatment and doesn't recur once it's cleared up.
• Chronic mastoiditis is associated with prolonged ear infections that have been present for at least a month. This version is more persistent and may require more intensive treatment.

Occasionally, mastoiditis develops without a preceding ear infection. This happens when something called a cholesteatoma, which is an abnormal skin growth in the middle ear, blocks fluid drainage and creates conditions ripe for infection.

Cholesteatomas can develop if you've had repeated ear infections over the years or chronic eustachian tube problems.

Related reading:  Earache and pain

Symptoms to watch out for

The symptoms of mastoiditis usually appear days or weeks after a middle ear infection. The challenge is that they can develop gradually, making them easy to dismiss as just a lingering ear infection that's taking its time to clear up. The main warning signs are:

• Persistent, throbbing ear pain that doesn't improve with standard pain relief. This isn't the mild discomfort of a typical ear infection, but more of a pain that demands attention and stops you from sleeping or concentrating on anything else.
• Your ear appears to stick out more than usual, as if it's being pushed forward. 
• Swelling or redness in and around the skin behind your ear. The bone behind your ear should feel firm, and if it feels soft or squishy when you press on it, that's a warning sign that shouldn't be ignored.
• Discharge from your ear containing pus, which might be yellow, green, or even containing blood. Any ear discharge needs to be seen by a GP, but thick, smelly discharge particularly so.
• Worsening hearing loss, such as if your hearing was already affected by the ear infection and it's getting worse rather than better, or if you're experiencing sudden hearing loss, that's significant.
• Persistent fever that doesn't respond to paracetamol or ibuprofen, persistent headache (particularly if it's getting worse), vertigo, which is an unpleasant sensation that the room is spinning around you, confusion or difficulty concentrating, or double vision.

When to seek help

Contact your GP promptly if you have ear pain that isn't improving after a few days of treatment, or if you notice any or a combination of the warning signs listed above. 

Mastoiditis requires proper medical attention, and untreated mastoiditis can lead to serious complications, including permanent hearing loss, facial paralysis, meningitis, or, in very rare cases, life-threatening infections.

Seek emergency medical care if you're experiencing severe symptoms like confusion, double vision, severe headache alongside ear problems, facial weakness or drooping, or severe dizziness that makes it difficult to walk.

These could indicate that the infection has spread beyond the mastoid bone and requires immediate attention.

Related reading:  Dizziness and hearing loss

Diagnosis and what to expect

Your GP will examine your ear using an otoscope, which is a small torch-like device that lets them see inside your ear canal and check your eardrum. They'll also examine the area behind your ear for swelling, tenderness, and the soft, doughy feeling that suggests mastoiditis.

If mastoiditis is suspected, you'll be referred urgently to an ear, nose and throat (ENT) specialist for further assessment. This might include:

• Blood tests to check for signs of infection or inflammation:  High white blood cell counts and raised inflammatory markers help confirm infection and assess its severity.
• An ear culture:  Where a sample of any drainage from your ear is tested to identify the specific bacteria causing the infection. This helps doctors choose the most effective antibiotic, particularly if you've already tried one course that hasn't worked.
• CT scan:  Which creates detailed images of the inside of your skull, showing exactly where the infection is, how far it's spread, and whether any abscesses have formed.
• MRI scan:  In some cases, particularly if there's concern about complications or if the infection appears to be affecting surrounding structures.

These tests aren't just about confirming mastoiditis but are essential for ruling out complications and planning the most effective treatment approach, and preventing serious problems later.

Treatment options

Treatment for mastoiditis typically involves antibiotics, often administered intravenously (through a drip) initially if the infection is severe. Most people need to be admitted to the hospital, at least for the first few days of treatment, as intravenous antibiotics work faster and more effectively than oral ones for serious infections.

Antibiotics and drainage

The standard approach combines strong antibiotics with ensuring the infected fluid can drain properly from your middle ear. If your ear isn't draining naturally, your ENT specialist may perform a myringotomy. This is a minor procedure where a tiny hole is made in your eardrum to allow infected fluid to escape.

This small perforation usually closes up on its own once the infection clears. Sometimes, tiny tubes (grommets) are inserted into the hole to keep it open and allow ongoing drainage, and usually fall out naturally within six months to a year.

When surgery is needed

If antibiotics and drainage don't resolve the infection within a few days, or if there's an abscess in the mastoid bone, you may need surgery called a mastoidectomy. This involves removing the infected portion of the mastoid bone.

The surgery is typically performed under general anaesthetic, and whilst you'll need a few weeks to recover fully, most people experience significant relief from symptoms almost immediately.

Surgery is also necessary if a cholesteatoma is causing mastoiditis, as these abnormal growths need to be physically removed, and they won't respond to antibiotics alone.

Steroids may also be prescribed to reduce inflammation and help the antibiotics work more effectively. The combination of antibiotics, steroids, and drainage gives your body the best chance to fight off the infection quickly.

Prevention

The best approach to mastoiditis is to prevent it from developing in the first place, and largely comes down to taking middle ear infections seriously and ensuring they're properly treated.

• Seek prompt treatment for ear infections:  If you have ear pain, discharge, or hearing loss, see your GP within a few days if symptoms don't improve. Most ear infections in adults do clear up naturally, but if symptoms persist beyond three or four days, or if they're severe from the beginning, medical assessment is worthwhile.
• Complete antibiotic courses as prescribed:  If you're prescribed antibiotics for an ear infection, take the full course even if you feel better after a few days. This isn't just about your current infection, as incomplete antibiotic courses contribute to antibiotic resistance, making infections harder to treat for everyone.
• Manage chronic conditions:  If you have allergies, chronic sinusitis, or other conditions that make you prone to ear infections, work with your GP to manage them effectively. Persistent inflammation in your nasal passages and eustachian tubes creates conditions ripe for ear infections.
• Don't smoke:  Smoking damages the delicate linings of your nose, throat, and ears, making infections more likely and harder to shake off. 
• Be cautious with cotton buds:  Never stick cotton buds or anything else into your ear canal, as they can push wax deeper, damage your eardrum, and introduce bacteria. 

Key takeaways

✔️ Mastoiditis is a bacterial infection of the mastoid bone behind your ear that develops when middle ear infections spread. It's rare thanks to modern antibiotics, but it requires prompt medical attention.

✔️ Key warning signs include: persistent throbbing ear pain, an ear that sticks out more than usual, swelling or softness behind the ear, worsening hearing loss, or discharge containing pus.

✔️ Contact your GP within a day or two if you suspect mastoiditis - don't wait to see if it improves. Severe symptoms like confusion, double vision, or a severe headache require emergency care.

✔️ Treatment typically involves hospital admission for intravenous antibiotics and possibly drainage or surgery. Complete the full course of treatment to prevent the infection from returning in a resistant form.

✔️ Prevention means taking ear infections seriously. Seek prompt treatment, complete prescribed antibiotics, manage chronic conditions like allergies, avoid smoking, and never put cotton buds in your ears.

✔️ Most people recover completely with appropriate treatment. Follow-up appointments check for hearing issues - if hearing loss occurs, modern hearing aids provide excellent support.

Conclusion

Mastoiditis is a serious condition, but it's also highly treatable when caught early. The key is recognising that persistent ear pain or other worrying symptoms warrant medical attention rather than hoping they'll improve with time.

If you're diagnosed with mastoiditis, the treatment pathway is well-established and effective. It might mean a hospital stay and possibly surgery, but the alternative, leaving it untreated, carries risks of permanent hearing loss and potentially life-threatening complications.

Follow your GP's advice carefully and take all antibiotics as prescribed, attend all follow-up appointments, and don't hesitate to contact your doctor if symptoms worsen or new ones develop.

For most people, mastoiditis resolves completely with appropriate treatment, with no lasting effects. Some people experience temporary hearing changes that improve as the infection clears, whilst others may need hearing tests to check for any longer-term impact.