Inflammation of the mastoid bone behind the ear


  • Usually a complication of suppurative otitis media

Clinical features

  • Severe pain felt over the mastoid bone
  • Swelling in post auricular area (pinna is pushed down and
  • Current or history of pus discharge from the ear
  • Fever
  • Mental confusion is a grave sign of intracranial spread of
    infection (Refer to ENT surgeon immediately)

Differential diagnosis

  • Inflamed lymph node behind ear


  • Diagnosis mainly by clinical features
  • X-ray: Useful in chronic mastoiditis
  • Blood: Full blood count, shows leucocytosis
  • Examine ear with otoscope


  • Admit urgently; give emergency treatment
  • Ceftriaxone 2-4 g by IV or deep IM once daily for 10-14 days
    Child: 50-80 mg/kg once daily

    • Divide IM doses over 1 g between 2 sites
  • Plus metronidazole 400 mg every 8 hours for 10-14 days
    Child: 7.5 mg/kg per dose
  • Surgical drainage may be necessary to remove pus

if an abscess has formed

    • Refer urgently for specialist care