What Is Chronic Mastoiditis?

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  • Written By: C. K. Lanz
  • Edited By: Melissa Wiley
  • Last Modified Date: 15 January 2019
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Chronic mastoiditis results when this infection of the mastoid bone behind the ear does not respond to initial treatment or reoccurs. The mastoid is affected by a chronic inflammatory process that lasts more than three months. This condition is often caused by an infectious disease in the middle ear and a perforated tympanic membrane, or benign ear cysts. Although mastoiditis is generally curable, it can be difficult to treat due to the bone’s location and density. As a result, the infection can reoccur or become chronic and require long-term treatment.

The mastoid is located just behind the outer ear and looks like a honeycomb encased in bone 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 an infection of the mastoid itself or mastoiditis.

Mastoiditis is either acute or chronic. An untreated or ineffectually treated acute ear infection is usually the cause of acute mastoiditis. This results in a direct bacterial infection in the mastoid that inflames the skin behind the outer ear. If the infection is left untreated for more than two weeks, the bony walls within the mastoid will begin to deteriorate.


The acute form can become chronic and lead to many complications, including facial paralysis, deafness, and vertigo. This is usually exasperated by chronic otitis media, a middle ear infection that results in a perforated eardrum through which infected material drains periodically. A benign ear cyst blocking the connection between the mastoid and middle ear may 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 this condition may be nearly symptom-free. A typical patient with chronic mastoiditis will experience pain and increased ear drainage when the ear disease affecting the mastoid flares up. If left undiagnosed and untreated, it can result in the scarring of the mastoid mucous membrane lining and conductive hearing loss.

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

Treatment usually targets the underlying infection that is affecting the mastoid. Antibiotics are either injected or taken orally. If the antibiotic treatment is not successful, then surgery may be recommended. Surgery involves removing and draining the mastoid or draining the middle ear via the eardrum. Ventilation tubes can be inserted to bypass Eustachian tubes that are not functioning well.

An individual who has some hearing loss with a recurrently draining ear should consider consulting an ear specialist. The need to see a specialist may be acute if the affected ear has not responded to home care or other treatment like antibiotic ear drops. Any bacterial ear infection should be treated as soon as possible to prevent complications like chronic mastoiditis.


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