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Q
Chronic Mastoiditis: Troublesome Adult Ear Infection?

What can be done to treat chronic mastoiditis in an adult?

A
Answer (Published 4/10/2009)

Chronic mastoiditis is an inflammation and infection of the middle ear space that involves the mastoid bone, which is located just behind the outer ear. I know of no alternative therapies to treat mastoiditis, and checked with Chicago ear, nose and throat specialist Howard S. Kotler, M.D. about this condition and its treatment. He noted that chronic mastoiditis is a leading cause of hearing loss following chronic ear infections. The unique architecture and anatomic relationship of the mastoid bone to other ear structures make it particularly susceptible to inflammatory conditions, including repeated infections, Dr. Kotler explained.

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The mastoid bone is composed of many thousands of interconnected air chambers. When an infection reaches these chambers, they can become filled with fluid - an ideal environment for rapid growth of dangerous bacteria. The initiating infection may arise from earlier acute infections or cyst development inside the ear and is often associated with a perforated eardrum. Chronic mastoiditis usually follows a pus-producing infection of the middle ear that blocks normal drainage and aeration of the mastoid bone.

Treatment begins with antibiotic ear drops and oral medications. Dr. Kotler says that when the infection and inflammatory process have been sufficiently controlled, surgery is usually necessary to remove the infected portion of the mastoid and when indicated, the eardrum and middle ear bones as well. The extent of the disease dictates the extent of surgery, he explained. While the long-term objective is to preserve or re-create the anatomy of the ear and retain hearing, the ultimate surgical goal is to create a "safe ear" that is free of disease and associated complications. Secondary operations are often performed later to reconstruct the hearing mechanism.

As with any effective medical and surgical treatment plan, definitive treatment of chronic mastoiditis requires good communication between patient and doctor, Dr. Kotler emphasized. Evaluation and treatment is an ongoing process that requires a supportive working relationship.

Andrew Weil, M.D.

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