Mastoiditis is a bacterial infection of the air cells in the bony skull in the area behind the ear. The air chambers serve to lighten the skull; they communicate with the outside air via small passages that lead to the inner ear behind the eardrum. Mastoiditis almost always occurs as a complication of untreated otitis media with chronic ear drainage. Once very common (mastoidectomy was once the most common operation in the United States as late as the 1940's), the infection has all but disappeared. I have seen two cases in my career.

Parents will from time to time encounter articles in which it is stated that in certain European countries, antibiotics are not given for ear infections routinely. These articles usually fail to add that the incidence of mastoiditis, with its attendant complications of painful illness, surgery and hearing loss, are much higher in those countries. Now that the push is on to cut back antibiotic treatment of otitis media, I suppose we will have to learn about this disease again.

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