Advice intended for parents/carers taking their child home after seeing a hospital based healthcare professional

Mastoiditis is a serious bacterial infection that affects the mastoid bone behind the ear.


  • Redness, tenderness and pain behind the ear
  • Swelling behind the ear, that can cause the ear to stick out
  • Fever, misery and tiredness
  • Headache
  • Discharge from the ear


Mastoiditis can develop if the mastoid bone becomes infected or inflamed, often as a result of a chronic middle ear infection (otitis media). The bacteria from the middle ear spread to the mastoid cells and this can cause the bone to break down.

When to seek further help:

If your child has any of the following:

  • Becomes pale, mottled and feels abnormally cold to touch
  • Has blue lips
  • Severe breathing difficulty - too breathless to talk / eat or drink
  • Has a fit / seizure
  • Becomes extremely agitated, confused or very lethargic (difficult to wake)

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Develops a continous headache despite regular painkillers (paracetamol and ibuprofen)
  • Continues to vomit repeatedly
  • Develops a severe pain behind their eyes
  • Develops a squint (eyes pointing in different directions) or starts complaining about double vision or needs to cover up one eye to see or complaining of blurred vision
  • Coordination issues or finding it hard to balance
  • Develops weakness in an arm or leg
  • Is finding it hard to breathe
  • Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) – especially if they remain drowsy or irritable despite their fever coming down
  • Has extreme shivering or complains of muscle pain
  • Continues to have a fever of 38.0°C or above for more than 5 days
  • Is getting worse or if you are worried

You need to contact the discharging ward urgently

  • If none of the above features are present

Self Care

Continue providing your child’s care at home using the advice below. If you are still concerned about your child, speak to your health visitorlocal pharmacist or call NHS 111– dial 111. Keep monitoring your child for red and amber features and seek help if they develop


Mastoiditis needs to be treated promptly with intravenous (given into a vein) antibiotics. Children who need intravenous antibiotics are usually admitted to hospital. Some children may be able to be at home for part, or all of, the intravenous antibiotic course. These children would come into hospital once a day for someone to look at them and for their antibiotics to be given.

The decision on when to change from intravenous to oral antibiotics (tablets or liquid) will be made by the medical team caring for you child. This will depend on how quickly your child responds to treatment (improvement in fever, pain and sometimes their blood tests) and whether your child has other health conditions. Antibiotics are usually given for a total of 10 days. You can give regular pain relief (Paracetamol or Ibuprofen) until any discomfort has improved.

In some cases it may be necessary to have an operation to treat the infection. The most common procedure is a myringotomy, where the surgeon makes a small cut in the eardrum to drain the middle ear. They may or may not put in a grommet at the same time. Sometimes a surgical approach to directly drain the mastoid cells or remove them is needed (called a mastoidectomy).


Most children recover without any complications. However, mastoiditis can very occasionally cause thrombosis (clotting of blood vessels), meningitis and brain infection (brain abscess). If any of these complications are suspected, your child may have to undergo further investigations or procedures. It is very important to have your child reviewed by a doctor if they show any signs of failure to improve or deterioration, or develop weakness, drowsiness, a worsening headache, vomiting or double vision.

If you are concerned that your child's condition is getting worse (see table above), you should contact your discharging ward.

Call 999 for an ambulance if you have serious concerns for your child.


It is difficult to prevent mastoiditis. Most ear infections in children do not need antibiotic treatment and complications such as mastoiditis are extremely rare. It is important that your child completes their course of antibiotic, to prevent it from recurring.

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