Surgery for Acute Mastoiditis

QUESTION: Back when I was a youth, there was a serious operation that lopped
off a bit of the bone behind the ear. It was viewed with great alarm, but I
can remember several schoolmates displaying that peculiar dimple that resulted
from the surgery. I tried to explain this to my daughter, but can no longer
remember what the illness was, or why the operation was so dreaded. Do you
recall and can you tell me?
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ANSWER: Yes, of course I do, but there are few in this generation that have
experienced the tribulations of a once very serious condition known as "acute
Mastoiditis". The mastoid bone is really a round bump (from the Greek
"mastos" = breast, "eidos" = resembling) on the temporal bone, one of the
bones that forms the skull. It lies just behind the ear, and is easily seen
and palpated. The inner structure of the mastoid is a series of spaces in the
bone, honey-comb-like air cells which connect to the inner ear. The spaces
are lined with a thin layer of cells, the mucous membrane. They may become
infected following a serious infection of the inner ear that goes untreated.
About two weeks after the beginning of the middle ear infection, the
clinical symptoms of mastoiditis begin. An ear ache develops, and the mastoid
area behind the ear becomes red, painful and swollen. Pus may discharge from
the ear (otorrhea), and hearing is lost progressively as the infection
continues. The air cells become filled with purulent fluid, and gradually the
infection eats away at and destroys some of the bony tissue. This can lead
to further complications as the infection, now an abscess, proceeds inward
towards the brain.
In the days of which you write, it was necessary to provide an exit for
the abscess and the pus to prevent a brain abscess from developing. And so
the mastoid bone was opened, and as much of the infected bone was removed as
possible and the pus drained away. This operation is called a "mastoidectomy"
(Now, it all comes back to you now). Today, however, we live in the era of
very potent antibiotics, that have dramatically changed the picture. High
doses of penicillin are continued over a period of several weeks, until all of
the bacterial invaders are killed. In some cases surgery may still be
necessary if the antibiotic therapy is not successful, but the need for this
procedure is relatively infrequent.