Mastoiditis is an infection of the bone behind the ear, usually a complication of an ear infection and most common in young children, and it needs same-day medical care; any ear noise is the least important part.
Most of what is written about tinnitus concerns a sound you are going to live with, where the useful timescale is weeks to years and the honest advice is rarely urgent. This page is the exception, and the framing is deliberately different.
What it is
The mastoid is the bone you can feel as a bump behind the earlobe. It is not solid — it is honeycombed with air cells connected to the middle ear. Acute mastoiditis is a suppurative infection of those air cells: pus in a sealed bony space with the brain on one side of it.
It is most often a complication of ear infection, and the bacteria usually involved are Streptococcus and Staphylococcus. It affects children far more than adults — across the surgical studies pooled in a 2019 systematic review, the mean age was 2.8 years.
A 2024 review in the American Journal of Emergency Medicine opens by describing it as a serious condition carrying a high rate of morbidity and mortality. That sentence is the reason this article exists on a tinnitus site. The complications it lists include abscesses inside the skull and in the neck, facial nerve palsy, meningitis or encephalitis, venous sinus thrombosis, and seizures.
Where tinnitus fits, which is not where you would expect
Ear noise and muffled hearing can accompany mastoiditis, in the way they accompany most middle-ear infection — fluid and inflammation between the eardrum and the inner ear change how sound is conducted, and ringing is a common companion of that.
But tinnitus is not the signal here, and this page will not pretend otherwise. Nobody identifies mastoiditis from ringing in one ear. What identifies it is pain, fever, and the ear being pushed away from the head.
There is a more specific reason for a tinnitus site to carry this page, and it belongs to the complication list rather than the infection itself. Among the complications the emergency review names is venous sinus thrombosis — a clot in one of the large veins draining the brain, which run directly against the mastoid bone. Those are the same vessels this site covers elsewhere for a different reason: sigmoid sinus wall abnormalities and venous sinus stenosis generate pulsatile tinnitus precisely because disturbed flow there is audible from the ear beside it.
Be careful about how far that connection is pushed. What is established in the sources here is that mastoiditis can cause thrombosis in those veins. That a mastoiditis-related clot commonly announces itself as whooshing is not something the evidence on this page demonstrates, and it is not how these children are found. They are found by fever, neurological signs and imaging.
What it looks like
The emergency medicine review lists the findings that should raise it:
- Redness of the eardrum
- The outer ear protruding — pushed forward and outward by swelling behind it
- Redness behind the ear, and tenderness over the mastoid bone on pressing
- Swelling of the ear canal
- Discharge from the ear
- Fever and malaise
And the circumstance that should raise it hardest: an otitis media that has not responded to treatment. An ear infection that is not settling is the ordinary route in.
The finding most worth carrying away
The review states it directly, and it runs against a common instinct:
A normal white blood cell count and normal inflammatory markers should not be used to exclude the diagnosis.
Bloods that come back reassuring are not a clearance. If the examination and the story point at mastoiditis, normal inflammatory markers do not undo that. Where the diagnosis is uncertain, the recommended imaging is CT of the temporal bones with intravenous contrast, which has the second advantage of showing complications if they are present.
Treatment is antibiotics — the review names ampicillin-sulbactam or ceftriaxone — together with an ear, nose and throat consultation.
What the treatment evidence shows
A 2019 systematic review in The Laryngoscope screened 310 articles, included 55, and separated medical from surgical management.
Medical therapy — 19 studies, 990 patients. Average cure rate 71.7% (median 70%, range 26.3–100%), with an estimated success of 72.9% (95% CI 60.5–82.5) by meta-analysis.
Surgical options — 33 studies, 2,930 patients:
- Myringotomy, with or without a tube — 94% (95% CI 84.5–97.8)
- Drainage of a subperiosteal abscess with myringotomy — 86.5% (66.4–95.4)
- Mastoidectomy — 99.7% (77.5–100)
Two things are worth reading carefully there. The confidence intervals on the surgical figures are wide — mastoidectomy's runs from 77.5% to 100%, which is not the precision the 99.7% suggests on its own. And the review's own conclusion declines to convert these into a rule: management should rest on the surgeon's experience and judgement, the patient's characteristics, and the severity of the disease.
The useful summary is not "surgery is better". It is that roughly seven in ten children are cured with antibiotics alone, that the surgical options have higher success rates, and that which applies to a given child is a clinical decision made with the child in front of you.
The thrombosis complication, and what predicts it
A 2025 retrospective review in the European Journal of Pediatrics looked specifically at children whose mastoiditis was complicated by cerebral sinus venous thrombosis, and identified what marks them out:
- Abnormal neurological signs
- Prolonged fever
- Elevated CRP
- Recent antibiotic use
Its conclusions are that early imaging and timely anticoagulation contribute to favourable outcomes, that routine thrombophilia screening may have limited utility, and that these signals can help a general paediatrician decide who needs prompt referral for neuroimaging.
On the anticoagulation question itself, a 2023 systematic review in the Indian Journal of Otolaryngology and Head and Neck Surgery gathered 16 articles covering 113 patients with otogenic sigmoid sinus thrombosis. Comparing those who received anticoagulation against those who did not:
- Recanalisation of the vein: 76.67% with anticoagulation against 39.13% without — close to double.
- Complications: 23.33% against 21.74% — very slightly higher in the anticoagulated group.
That is a large difference in the outcome being aimed at, against a difference in complications small enough to sit inside the noise of 113 patients across 16 studies. It is not a decision anyone reading this page will be making themselves; it is included because "should they be on blood thinners" is a question families are asked to consent to, and the shape of the evidence behind it is worth seeing.
What to do with this
- If you or your child has an ear infection that is not settling, and there is pain behind the ear, fever, swelling, or the ear starting to stick out — that is a same-day medical problem, not a tinnitus question.
- Do not let normal blood tests reassure you out of an examination that pointed the other way. The review says so explicitly.
- If ringing is your only symptom, with no pain, no fever and no swelling, mastoiditis is not what this is. What the whole range of causes looks like is the more useful place to start.
- If pulsatile, whooshing tinnitus is the symptom, the pulsatile tinnitus article linked above covers why that specific quality is assessed rather than waited out — for vascular reasons that are mostly unrelated to infection.