Formula Medical Group
Apple Valley, CA

James Krider, MD

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Ear abscess - Mastoiditis

Mastoiditis usually occurs from an inadequately treated middle-ear infection.

Mastoiditis usually occurs from an inadequately treated middle-ear infection.

What is an ear abscess?

An ear abscess is a serious infection, usually caused by bacteria that have invaded the area called the mastoid processes, the spongy sections


  • Renewed, severe throbbing pain during or following an ear infection.
  • Bleeding or discharge of pus from the ear.
  • Swelling and redness in and around the ear.

of the skull near the ears. It most often occurs in infants and in babies up to 3 years old, and its medical name is mastoiditis.

Acute mastoiditis occurs when bacteria from an upper respiratory infection congregate first in the middle ear, multiply, and migrate into the hollow air spaces, or sinuses, of the temporal bone. The middle-ear infection is dangerous enough in itself; it can rupture the eardrum and lead to deafness. Mastoiditis is even more serious, since infections that invade and destroy bone may be very difficult to cure.

What causes an ear abscess?

Well-known and dangerous bacteria are usually the cause. They include E. coli. Staph. aureus, Strep. pneumoniae, Hemophilus influenzae, and Group A beta-hemolytic streptococci. Inadequate treatment of a middle-ear infection from any of these microorganisms can lead to an ear abscess. The initial infection may seem to be cured, but if the bacteria are not completely eradicated, they can reemerge in 2 or 3 weeks as an even more serious infection. If the infection has spread into the mastoid process, there will be persistent, throbbing pain; redness and swelling; and a discharge from the ear. If the initial infection has not already perforated the eardrum, it may do so now.

How is an ear abscess diagnosed and treated?

A diagnosis is easy to establish by inspecting the ear and surrounding tissues. Treatment should begin immediately with a broad-spectrum antibiotic. However, your doctor also will culture the thick pus or the blood that is discharged from the ear to confirm precisely what kind of bacterium is causing the infection. In some cases, it may also be necessary for an ear specialist (an otologist) to operate on the afflicted ear(s) to hollow out the spongy bone mass. Instead of many small bone cavities, this operation leaves a single, larger cavity.

What can I do myself?
Acute mastoiditis is not a self-treatment disease. After your doctor has prescribed a course of treatment, warm compresses held against the ear may ease the discomfort.

When should I see my doctor?
If you or your child has an earache, you should see your doctor as soon as possible. This is especially important if the person is recovering from a middle-ear infection and suddenly feels new pain or shows signs of swelling or redness in or around one or both ears. If you cannot reach your doctor, go to a hospital emergency room.

What will the doctor do?
Your doctor will examine the ear(s) and take a sample of the pus and/or blood discharge for laboratory study. If the problem is mastoiditis, bed rest or perhaps hospitalization will be needed. The first-choice antibiotic is usually high-dose penicillin, given intravenously. If the patient is allergic to penicillin, an alternative antibiotic will be used. When the laboratory analysis identifies the bacteria that is causing the infection, the doctor may switch to a different drug if it is likely to be a more effective one.

Pressure of the pus behind the eardrum often will rupture the eardrum. To avoid this, the doctor may make a slit in this membrane to allow the pus to escape; the surgical cut is more likely to heal cleanly than the rip or tear that occurs in case of rupture caused by pressure.

The course of an ear abscess

Mastoiditis often comes on the heels of a middle-ear infection. Bacteria that have not been eradicated form a pus-filled pocket in the mastoid process, and from there, continue to spread to other parts of the head, including the brain. The infection also can spread through the bloodstream. Spread to the brain or in the blood can be fatal.

Antibiotic therapy almost always clears up the infection, especially if it is treated early. But any bone damage and loss of hearing that have occurred may be permanent.

Is an ear abscess dangerous?
Yes; it can cause deafness and, if allowed to spread, it can be fatal.

What can I do to avoid an ear abscess?

  • Make sure that any ear infection is adequately treated. Follow your doctor's instructions scrupulously and make sure that the entire course of antibiotics is given.
  • Following treatment of a middle-ear infection, it's a good idea to take a child back to the doctor for a checkup to make sure that the infection has, indeed, been eradicated.
  • If a child has frequent middle-ear infections, talk to your doctor about the advisability of having a special drainage tube inserted into the ear.
This article was last reviewed November 23, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.
Bacterial infection
Middle-ear infection

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