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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Assessment online. A doctor can judge by video whether your symptoms could be mastoiditis and how urgently you need care; diagnosis and treatment are in hospital.
- What it is: a bacterial infection of the mastoid bone, the bone just behind the ear, usually spreading from a middle ear infection.
- Key signs: pain, redness, swelling or tenderness behind the ear, an ear that sticks out, discharge, a high temperature and worsening hearing.
- Who gets it: it is uncommon, most common in children under 2, but it can affect people of any age.
- Emergency: call 112 for confusion, drowsiness, a severe headache with a stiff neck, facial drooping, double vision or a seizure.
Do not book a video appointment if you have confusion, drowsiness, a severe headache with a stiff neck, facial drooping, double vision, a seizure, or feel very unwell with fast breathing or blotchy skin: call 112 or go to an emergency department. If you already have a red, swollen or tender area behind the ear, or an ear that is starting to stick out, get medical advice the same day in person rather than waiting for a video call.
Can an online doctor help with mastoiditis?
No, mastoiditis cannot be treated online: it needs hospital care, usually antibiotics through a drip, and sometimes surgery. What a doctor by video can do is look at the area behind your ear on camera, go through an ear infection that is not settling, and tell you plainly whether you need hospital care now. After treatment, the doctor can help with recovery, keeping the ear dry, and when to have your hearing checked. If you already see a red swelling behind your ear, go for in-person care rather than waiting for a video call.
How an online consultation helps with possible mastoiditis
- Urgency made clear: Whether your ear needs hospital care now, and what to tell the staff when you get there.
- An ear infection that is not settling: Why it might not be getting better, and what needs checking in person.
- Other causes considered: Swollen glands, a cyst, an infected piercing or shingles around the ear can look similar.
- Help after hospital: Finishing the antibiotics, keeping the ear dry, and when to have your hearing tested.
What the doctor checks in an online assessment for mastoiditis
The doctor asks about the emergency signs first, then looks at the area behind your ear. The doctor asks about:
- Warning signs: confusion, drowsiness, a severe headache, a stiff neck, facial weakness, double vision, or feeling very unwell.
- Behind the ear: redness, swelling, tenderness or a soft, doughy feel, and whether the ear has started to stick out.
- The ear infection: when it started, how it was treated, and whether it improved and then got worse.
- The ear itself: throbbing pain, thick discharge, worsening hearing, dizziness.
- Your health: diabetes, a weakened immune system, earlier ear surgery or cholesteatoma, and the antibiotics you have taken.
Before the call, sit in good light, tie back long hair, and have someone ready to hold the camera close to the area behind the ear.
What is mastoiditis, and what is the mastoid?
The mastoid is the part of the skull you can feel just behind your ear. Inside, it has a honeycomb-like structure. Mastoiditis is a bacterial infection of that bone, usually spreading from a middle ear infection: the honeycomb can fill with infected material and the bone can start to break down, which is why it is treated as a serious infection.
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| Acute mastoiditis | Chronic mastoiditis | |
|---|---|---|
| When it starts | Days to weeks after a middle ear infection | With a long-standing ear infection, usually present for at least a month |
| Course | Usually clears within a month of treatment and does not come back | Needs longer, sometimes repeated treatment |
Mastoiditis is now uncommon, because ear infections are treated and children are vaccinated against pneumococcus, the bacterium behind most cases. It is most common in children aged 2 and under, but it can affect people of any age, including adults.
What are the symptoms of mastoiditis?
The symptoms usually appear days or weeks after a middle ear infection. They include:
- pain, soreness or tenderness behind the ear
- red, swollen skin behind the ear, which can look purple or darker on brown or black skin
- swelling that pushes the ear out, so it sticks out more than the other ear
- a persistent, throbbing pain in and around the ear
- thick, creamy discharge from the ear
- a high temperature, headache and tiredness
- hearing loss in the affected ear that gets worse
Confusion, double vision, dizziness, facial weakness or a stiff neck mean the infection may be spreading, and need emergency care.
Can you check for mastoiditis at home?
There is no reliable home test. Compare the two sides: look for redness or swelling behind one ear, an ear that sticks out more than the other, and tenderness when you press gently on the bone behind it. Any of these with an ear infection needs a doctor to see you in person, and a CT scan is usually what confirms the diagnosis.
Can you have mastoiditis without an ear infection?
Rarely. Most mastoiditis follows a middle ear infection, but a cholesteatoma, an abnormal growth of skin cells in the middle ear, can block drainage and lead to mastoiditis without an obvious ear infection first. The cholesteatoma page explains its signs.
How serious is mastoiditis?
It is serious, but curable when it is treated in time. Before antibiotics, it was a leading cause of death in young children; now it is uncommon and much less dangerous. It can be hard to treat, because medicine does not easily reach deep into the bone, and it can come back. Untreated or not treated well enough, it can lead to:
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| Complication | What it means |
|---|---|
| Hearing loss | Partial or complete, sometimes permanent |
| Facial paralysis | Weakness of the face on the affected side |
| Labyrinthitis | Infection of the inner ear, causing dizziness and vertigo |
| Meningitis | Infection of the layers around the brain |
| Brain or epidural abscess | A collection of pus inside the skull |
| Sepsis | The body’s extreme reaction to an infection spreading through the blood |
Can mastoiditis go away on its own?
It should never be left to settle by itself. Mastoiditis needs antibiotics, usually started in hospital through a drip, and sometimes surgery, and waiting risks the complications above.
What causes mastoiditis, and how is it diagnosed?
Mastoiditis usually develops when a middle ear infection that was not treated, or not treated well enough, spreads into the bone behind the ear. Most cases are caused by pneumococcus bacteria. Rarely, a cholesteatoma is the cause.
In person, the doctor looks inside the ear with an otoscope and examines the area behind it. Suspected mastoiditis is referred to an ear, nose and throat (ENT) specialist, and the diagnosis is usually confirmed with:
- a CT scan, which shows the mastoid bone in detail; sometimes an MRI scan, to check the area between the ear and the brain
- blood tests for signs of infection and inflammation
- a sample of the ear discharge, to identify the bacteria and choose the antibiotic
What might the doctor recommend for possible mastoiditis?
What happens next depends on what the doctor sees and how unwell you are. This is the framework the doctors use:
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Confusion, drowsiness, a stiff neck, facial drooping, double vision or a seizure | Emergency care | No | Call 112 now |
| Red, swollen or tender skin behind the ear, or an ear that sticks out | Hospital assessment and treatment | Only to assess | Urgently: get medical advice the same day |
| An ear infection that is not improving with treatment, or getting worse | Assessment, and an examination in person | Yes, to assess | If the doctor suspects a complication |
| Earache with a high temperature, without swelling behind the ear | Assessment for a middle ear infection | Yes | If it is not improving after 3 days, or new symptoms appear |
| Recovering after hospital treatment | Finishing antibiotics, keeping the ear dry, follow-up | Yes | If symptoms come back, and for a hearing test |
Ear infection getting worse instead of better? A doctor can tell you in one consultation how urgently you need to be seen.
See available times →How is mastoiditis treated?
Mastoiditis is treated in hospital by an ear specialist, mainly with antibiotics given through a drip. Most people stay in hospital for 1 to 2 days, then continue with antibiotic tablets at home, usually for at least 2 weeks. Symptoms usually start to improve a few days after the antibiotics begin, and the full course must be finished.
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| Treatment | What it involves | When it is used |
|---|---|---|
| Antibiotics through a drip | Given in hospital, then changed to tablets once you improve | For everyone |
| Draining the middle ear | A small cut in the eardrum (myringotomy), sometimes with a small tube that usually falls out within 6 to 12 months | If the middle ear is not draining by itself |
| Draining pus | With a needle or a small cut | If an abscess forms |
| Mastoidectomy | Surgery to remove infected bone and drain the mastoid | If antibiotics do not work, or an abscess forms |
| Antibiotic ear drops | Used for some weeks after a tube or surgery | As the specialist advises |
What you can do yourself
- Go for in-person care promptly if you notice any of the signs above.
- Finish every antibiotic prescribed, even when you feel better.
- Keep water out of the ear: use cotton wool coated in petroleum jelly when you shower or wash your hair.
- Avoid swimming until the specialist says it is safe.
- Take paracetamol or ibuprofen for pain, if they suit you.
- Contact a doctor if the ear pain is not improving.
Prescription treatment
A prescription is never issued without a consultation. Mastoiditis itself is treated in hospital, usually starting with antibiotics through a drip, and no medicine taken at home replaces that. After hospital treatment, the doctor may help you continue the antibiotic tablets or ear drops the specialist chose, and advise on pain relief. Strong opioid painkillers are never prescribed online. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Waiting at home for a swelling behind the ear to settle. Stopping antibiotics early. Swimming or getting water in the ear before it has healed.
Special situations
Diabetes or a weakened immune system
Ear infection symptoms with diabetes or a weakened immune system need prompt assessment, so the threshold for an in-person examination is lower.
Mastoiditis or something else?
A swelling behind the ear has other causes. A lump that is not red, hot or tender, without an ear infection, is covered on the lumps page; a red, sore piercing on the ear on the infected ear piercing page; and a painful rash with blisters around the ear on the Ramsay Hunt syndrome page.
Preventing mastoiditis
Get ear infections treated promptly, especially if they are not improving after 3 days. Avoid smoking and second-hand smoke, and keep allergies under control. For children, pneumococcal vaccination has made mastoiditis much less common.
Mastoiditis while travelling in Europe
If you develop swelling behind the ear on holiday, go to the nearest hospital or call 112 if you are very unwell. Keep the discharge letter and the name of your antibiotics, so the course can be completed at home.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When mastoiditis is assessed online, and when you need in-person care
Assessed online: an ear infection that is not settling, whether a swelling behind the ear needs hospital care, other likely causes, and follow-up after hospital treatment.
In-person care: any suspected mastoiditis, every examination, scan and blood test, antibiotics through a drip, drainage and surgery, and any emergency sign.
When to get in-person care
Call 112 or go to an emergency department now for:
- confusion, drowsiness or a seizure
- a severe headache with a stiff neck, a rash or sensitivity to light
- facial drooping or weakness, or double vision
- feeling very unwell, with fast breathing or pale, blotchy skin
Get medical advice the same day for:
- redness, swelling or tenderness behind the ear
- an ear that is starting to stick out
- an ear infection that is not improving with treatment, or new symptoms after one
- thick discharge from the ear with a high temperature
- hearing that is getting worse
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your ear: say when the ear infection started and how it was treated, and show the area behind your ear on camera in good light.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s mastoiditis? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call. If you have an emergency sign listed on this page, call 112 instead.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Ear infection can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about mastoiditis
What is mastoiditis?
Mastoiditis is a bacterial infection of the mastoid bone, the part of the skull just behind the ear, usually spreading from a middle ear infection. It causes pain, redness and swelling behind the ear, discharge, a high temperature and worsening hearing.
How serious is mastoiditis?
Mastoiditis is serious and needs hospital treatment, but it is curable when treated in time. Without treatment, it can cause hearing loss, facial paralysis, meningitis, a brain abscess or sepsis.
What is the most common cause of mastoiditis?
Mastoiditis most often follows a middle ear infection that was not treated, or not treated well enough, spreading into the bone behind the ear. Most cases are caused by pneumococcus bacteria.
Can mastoiditis go away on its own?
Mastoiditis should never be left to settle by itself. It needs antibiotics, usually started in hospital through a drip, and sometimes surgery, and waiting risks serious complications.
Is there a home test for mastoiditis?
There is no reliable home test for mastoiditis. Look for redness or swelling behind one ear, an ear that sticks out more than the other, and tenderness over the bone behind it. Any of these with an ear infection needs a doctor to see you in person.
What can I do at home if I think it is mastoiditis?
Nothing at home replaces being seen: suspected mastoiditis needs a doctor in person without delay, because it is treated in hospital. While you arrange that, take paracetamol or ibuprofen for pain and a high temperature, keep drinking fluids, do not put drops or cotton buds in the ear, and keep any discharge wiped away with a clean tissue. Call 112 for confusion, drowsiness, a severe headache with a stiff neck, facial drooping or a seizure.
What is the mastoid?
The mastoid is the bone you can feel just behind your ear. Inside, it has a honeycomb-like structure, and an infection in the middle ear can spread into it.
How is mastoiditis treated?
Mastoiditis is treated in hospital, with antibiotics through a drip, usually for 1 to 2 days before switching to tablets at home. If the infection does not respond or an abscess forms, the middle ear may be drained or part of the bone removed in an operation called a mastoidectomy.
How long does mastoiditis last?
Symptoms usually start to improve a few days after antibiotics begin. Acute mastoiditis usually clears within a month of treatment and does not come back; chronic mastoiditis needs longer treatment.
Can adults get mastoiditis?
Yes. Mastoiditis is most common in young children, but it can affect people of any age. In adults it usually follows a middle ear infection that has not settled.
How can mastoiditis be prevented?
Most mastoiditis follows a middle ear infection that was not treated or did not settle, so the main protection is getting ear infections that are severe, lasting more than 2 or 3 days or affecting a young child assessed, and finishing any antibiotics that are prescribed. Antibiotics for the ear infections that need them have made mastoiditis rare, not smoking around children lowers their rate of ear infections, and any ear that keeps discharging should be checked for a cholesteatoma, a rarer cause.
Can mastoiditis be treated with oral antibiotics?
Mastoiditis treatment usually starts with antibiotics through a drip in hospital, because the infection is inside bone and tablets alone are rarely enough at first. Antibiotic tablets follow once you improve, usually for at least 2 weeks in total, and the doctors check that the swelling and temperature keep settling before you go home.
Can an online doctor diagnose mastoiditis?
No. A doctor by video can look at the area behind your ear, judge whether it could be mastoiditis and how urgently you need care, but the diagnosis needs an examination and usually a CT scan in hospital.
- Mastoiditis, NHS, National Health Service (UK), reviewed 17 August 2026.
- Mastoiditis, Cleveland Clinic (US), reviewed 18 January 2025.
- Mastoiditis, MSD Manual Consumer Version, reviewed June 2026.
- Mastoiditis, MedlinePlus, US National Library of Medicine, reviewed 29 April 2026.
- Ear infections, NHS, National Health Service (UK), reviewed 16 January 2025.
- Cholesteatoma, NHS, National Health Service (UK), reviewed 20 February 2025.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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